100K fewer Ohioans enrolled in ACA plans

FINDLAY — Around 100,000 fewer Ohioans appear to be enrolled in Affordable Care Act health plans this year. The majority are likely uninsured, which is expected to create ripple effects for not only those individuals but the healthcare system, said Brian O'Rourke, health care policy analyst at the Health Policy Institute of Ohio. The expiration of enhanced tax credits at the end of 2025, combined with premium increases of around 26%, have led many Americans to opt out of re-enrolling on ACA plans. The cutoff to sign up for ACA insurance for 2026 was Jan. 15. O'Rourke said Tuesday that the final figures hadn't yet been released, but data is available indicating how many people had enrolled by Jan. 3. Comparing the 2026 figures for that date to the 2025 figures, it looks like 100,000 fewer people are enrolled in plans — a 19% drop from last year. These preliminary figures seem to indicate Ohio has the second-largest enrollment decline of the 50 states. "There is a lot of variation between states," and some states have even seen enrollment increases, he said. Insurance premiums have increased more in the states, like Ohio, that use the federal health insurance marketplace than those which have their own, O'Rourke said. However, more than 30 states use the federal marketplace, so this alone doesn't explain why so many people in Ohio have dropped their coverage. He noted that individuals and families have had to weigh health insurance costs against other cost-of-living pressures. It could be that a large number of Ohioans had a hard time when balancing these costs against the cost of housing and food. O'Rourke added that it also remains to be seen how many people who did re-enroll in ACA plans may cancel them within the next few months. Some plans may have auto-renewed, and when people realize their premiums have skyrocketed from last year and they can't pay them, they may go without coverage, he said. "It can lead to really difficult decisions down the road," he said. The drop in enrollment in ACA plans has "substantial implications for our uninsured rate and our healthcare safety net," O'Rourke said. He said many of the people going uninsured may be younger and healthier. "The gamble's, essentially, if you can just avoid using health services … That can work for younger, healthier people sometimes," he said. But regardless of age, it is a gamble, as younger adults do develop serious illnesses, or become injured in car accidents. A hospitalization or even an ER visit could lead to "substantial medical debt," he said. And even if they go a year without seeking health care, it's possible that the following year they will need more extensive care, since conditions that could have been treated earlier on weren't spotted until they had gotten more severe. If 100,000 fewer Ohioans have health insurance, that also has implications for health care in Ohio overall, O'Rourke said. The majority of those insured through ACA plans last year chose these plans because they did not have access to insurance through their employer, and they earned too much to qualify for Medicaid, he said. "In most cases these are people who do not have access to another form of insurance," he said. That doesn't mean they will not get sick or injured — but they may seek care differently when they do. Before the ACA became law, when the uninsured rate was a lot higher, people who didn't have insurance would access health care not in a regular doctor's office but a free clinic or an emergency room, he said. If you receive care in an emergency room and you are uninsured, you will receive a bill for these services, he said. But it could be $100,000. Most people, "frankly, are never going to pay that," at least not in full, he said. If they don't pay their bill, that becomes uncompensated care for the hospitals and healthcare providers, he said. In rural areas, in particular, this is going to put financial strain on already financially vulnerable organizations, he said. O'Rourke added that other federal health policy changes are coming from H.R. 1, the "One Big Beautiful Bill Act." Over the next few years, these will involve multiple changes to Medicaid, as well as changes to Supplemental Nutrition Assistance Program (SNAP) benefits. "It's important to acknowledge that they all compound each other," he said. Each of these may create more cost-of-living concerns, so, in combination, they are likely to put more strain on the system, he said.