Ohio tops the nation in ACA enrollment drop
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Ohio has seen the nation's largest percentage decline in residents covered by Affordable Care Act plans as a result of federal subsidies allowed to expire this year, per federal data.
Why it matters: Expiration of the subsidies has resulted in tens of thousands of Ohioans losing health care access in a state that already struggles with health.
Zoom in: Ohio lost 32.4% of its enrollment between February 2025 and 2026, representing over 160,000 residents.
- That number is even higher than the 114,000 projected in February by health care advocacy group Protect Our Care.
State of play: The coverage losses are hitting deep-red states as well as blue ones after the Republican-led Congress let the subsidies expire.
- The topic was a main point of contention in the longest government shutdown in history.
- Six months later, a federal report from the Department of Health and Human Services shows that nationwide ACA enrollment fell 13% — about 3 million people — since last year.
The latest: The state-by-state breakdown shows enrollment decreased in every state but New Mexico.
- Enrollment dropped by at least 20% in 14 states.
The big picture: The pandemic-era enhanced subsidies that Democrats passed in 2021 have overwhelmingly benefited red states, especially those that haven't expanded Medicaid, according to analysts.
What we're watching: More could lose coverage over the next few years.
- A March report from the Urban Institute suggests the "big, beautiful bill" could result in more than 350,000 Ohioans losing Medicaid coverage.