COLUMBUS, Ohio — Ohio experienced a steep decline in Affordable Care Act (ACA) marketplace enrollment for the 2026 plan year, federal data show, with preliminary figures indicating roughly 463,000 residents enrolled as of early January — about 120,000 fewer than the previous year.
The 19–20% drop ranks Ohio second nationwide, behind North Carolina, and far exceeds the national decline of roughly 3.5%, according to the Centers for Medicare & Medicaid Services (CMS).
Experts say the primary factor is the expiration of enhanced federal subsidies, which had made premiums more affordable during the pandemic and were extended through 2025. Without the subsidies, many Ohioans faced significantly higher costs, prompting fewer new sign-ups and cancellations of coverage.
Enrollment in Ohio’s ACA marketplace had surged from about 206,000 in 2019 to nearly 583,000 in 2025. Open enrollment for 2026 ended in mid-January, and final effectuated enrollment numbers could change slightly. Analysts warn the state could see up to 140,000 additional uninsured residents in the coming year, with rural areas most affected.
Ohio relies on the federal Healthcare.gov platform for ACA enrollment, and lawmakers debated extending the subsidies, but no agreement was reached before their expiration.