State Policy · OH
Ohio ACA Enrollment Drops 32% After Federal Subsidies Expire
Ohio has experienced the nation's steepest decline in Affordable Care Act marketplace enrollment since enhanced federal subsidies expired in January 2026, with enrollment falling more than 32%. Rural Ohioans are disproportionately affected by the loss of premium assistance. The decline comes as the Trump administration proposes Medicaid spending cuts of $900 billion over 10 years, which could push millions off the program. Ohio Attorney General and federal officials have increased public messaging around Medicaid fraud cases, which policy analysts characterize as an effort to build support for program cuts.
Why it mattersThe subsidy expiration and proposed federal Medicaid cuts will increase uninsurance rates and shift coverage costs to state Medicaid programs and safety-net providers, particularly affecting rural and low-income populations who may churn between marketplace and Medicaid coverage.