Navigation cuts mean Americans have less help finding Obamacare plans

CINCINNATI — For four years, Kimberly Dudley worked on the front lines of the Affordable Care Act as a navigator, helping Ohioans solve the puzzle of purchasing private insurance on the federal HealthCare.gov marketplace.

But now the work is harder and the answers are rarer. In one of its first acts, the second Trump administration cut annual funding for navigators by 90%, from $100 million to $10 million, arguing that the program was wasteful. Under the ACA, better known as Obamacare, navigators help educate and enroll people, especially those living in hard-to-reach communities. These were paid for through a user fee in the form of monthly premiums.

In January 2025, 50 navigators served 88 Ohio counties, bringing laptops to meet with Ohioans in rural libraries and suburban food courts to help them search the marketplace for a health care plan. However, only five navigators remain until open enrollment begins on November 1, the busiest time of the year. Dudley from Cincinnati is one of them.

She is married and has a child. In 2022, she was hired at the Freestore Foodbank in Cincinnati and found “great joy in helping people, even though it has been difficult this year.” For example, the hotline is now in Dudley’s hands. The remaining navigators who worked on the connections were fired.

Last week, the administration did not respond to requests to discuss the cut to the Navigator program. But when we announced the cuts last year, – says the administration’s statement“

Dudley’s task became even more challenging tardy last year when the Trump administration and Congress allowed some pandemic-era grants to expire, and policy premiums have skyrocketedoften for more than many Ohioans are willing to pay.

He hears these stories every day on his phone, which also serves as Ohio’s ACA hotline. People call when they are deemed ineligible for Medicaid, usually because their income is too high. In early March, Dudley received a message from Tonya Horn, 59, of Cleveland Heights, who needed help.

Throughout her professional life, Horn said, she felt fortunate to have employer-paid health benefits until her most recent job, when she worked remotely for Empower, a financial services company in Colorado, as a diversity program manager for talent acquisition. But last year, her job at Empower felt less secure. Her pink slip arrived in January.

While helping Horn, Dudley spotted a plan on HealthCare.gov that, with income-based subsidies, would cost $450 a month without a deductible. But then Dudley discovered that Horn’s doctor did not accept this insurance plan.

“I don’t know if this will work for you,” Dudley said, “but getting insurance may mean changing doctors.”

Horn sighed. “Can we keep looking?”

Sign in

Ohio’s enrollment in the HealthCare.gov marketplace is down 20% this year, the second-largest decline among the 50 states. Generally national registration decreased by 5%.

Ohio experts said several factors negatively impact recruiting levels. Some people of Medicare age. Others found jobs with health benefits. One strength, however, was the December 31 expiration of pandemic-era subsidies for most market-based plans.

The ACA provides income-based premium subsidies, but the federal government began offering additional help in 2021 as part of momentary pandemic relief. “Enhanced” subsidies have reduced many people’s monthly premiums by hundreds of dollars.

They also helped boost the number of people purchasing health insurance on insurance markets from 11.4 million people in 2020 to 24.3 million last year.

Americans who had increased subsidies received warnings from their insurers that their eligibility would expire by December 31. As of March 26, the number of Americans covered by the marketplace had declined by approximately 1.2 million compared to 2025. Centers for Medicare and Medicaid Services.

Last week, a spokesman for U.S. Sen. Jon Husted, an Ohio Republican, said Husted had proposed extending the subsidy for another two years with fresh restrictions aimed at preventing fraud in marketplace plans. Democrats rejected the idea, said Joshua Eck, Husted’s deputy chief of staff. “But if they had supported the bill or been willing to discuss it, the problem would likely have been resolved in December.”

In Ohio, the nonprofit research group Columbus Health Policy Institute of Ohio found that of the more than 580,000 Ohioans with HealthCare.gov plans through 2025: nearly 90% used momentary subsidies.

California i at least nine other states running their own health insurance markets state money to help residents cushion the end-of-term price shock, although only New Mexico completely fills the gap. Ohio couldn’t tap into its budget this way because it uses the federal market.

In January Ohio Health Policy Institute it was estimated that premiums for marketplace plans in Ohio would boost by an average of 114% in 2026. Institute analyst Brian O’Rourke said: “It’s reasonable to expect that (the decline in enrollment is) due to the subsidy expiration.”

During Horn’s statewide ACA hotline, Kimberly Dudley said her mother received notice from her insurance company that her $40 monthly premium would boost to $400. “I helped her come up with a plan, but her premium still went up,” Dudley said. “We are going to find a solution for you.”

“I hope so,” Horn said.

Ohio Expands ACA

Ohio’s industrial base collapsed in the 1990s, and hundreds of thousands of workers lost their employer-based insurance. Young people left Ohio for work, and insurance pools shrunk as people aged rapidly. Multiple studies have shown that health in Ohio is degenerating, in gigantic part because nearly 1.5 million Ohioans, or more than 10% of the population, had no health insurance at all.

The ACA also allowed states to expand Medicaid to adults with incomes up to 138% of the poverty level, although some Republican-led states declined to expand. In Ohio, GOP Gov. John Kasich pressured the Republican-led state legislature to approve expansion in 2013; 40 states and the District of Columbia have expanded their programs. Ohio’s share of the federal market continued to grow until 2025, when enrollment reached record highs.

The speed of the ACA’s retreat in Ohio has brought swift consequences. Columbus nonprofit UHCAN Ohio “has been helping people since this bill was introduced,” said Executive Director Charlotte Rudolph. Then last fall: “If we saw five people, maybe one would sign up. They make that hard decision to say, ‘I hope I don’t get sick.'”

“We’re now looking through our archives and asking ourselves, how did we help people at a time when they didn’t have coverage?”

Ohio’s health care horizon is further complicated by Trump administration cuts to Medicaid. More than 3 million Ohioans benefit from the low-income health care program. But under the sweeping tax and spending legislation signed by President Donald Trump last summer, as many as 1 in 10 Ohioans could be deemed ineligible due to fresh work requirements and other obstacles.

During a hotline call, Horn said her $624 weekly unemployment benefit put her over the Medicaid threshold. Dudley nodded as she typed on the keyboard. “I hear that a lot,” she said.

What the future holds

While immediate problems are straining the system, experts say they are concerned about what’s next for health care in Ohio.

Uninsured people often employ emergency departments for primary care, putting a strain on hospitals that are still reeling from the pandemic and understaffed. Many Ohioans on Medicaid live in rural areas where the safety net has long been broken. Last year, the Ohio Hospital Association, an industry group, told state officials that more than 70% of rural hospitals in the state had been losing money for years.

“I am concerned,” said Grace Wagner of the Ohio Association of Food Banks, “that as these changes come, policymakers will be unaware or unprepared to respond.”

Dudley and Horn spent another 30 minutes on the ACA hotline, but none of the options available on HealthCare.gov were used. Finally, Horn said she would call back.

“Sure, something to think about,” Dudley said and ended the call. Then she sat down and stared at her laptop screen full of HealthCare.gov. She doesn’t like leaving a mystery unsolved for someone who came to her for help.

“I love what I do. To be able to do this job is fantastic, even in the midst of everything that’s going on,” she said. “But there are times when I feel a little overwhelmed.”