Graphic of the week: ACA enrollment in Ohio declines

Data released this week by the Centers for Medicare and Medicaid Services shows that 469,616 Ohioans enrolled in Affordable Care Act (ACA) marketplace coverage in the open enrollment period that ended Jan. 15, a decrease of nearly 114,000 from last year (20%), as illustrated above.
 
Ohio saw the second-largest percentage drop in enrollment of any state in the country following the expiration of enhanced premium tax credits.
 
The national drop in enrollment was 5%, with states running their own exchanges retaining more enrollment than those, like Ohio, that use the federally operated exchange. According to KFF analysis, the drop in enrollment is likely to be even steeper in coming months because “people who have selected a plan or been automatically renewed may not ultimately choose to pay for their plan, thus ‘effectuating’ their coverage.”
 
Marketplace enrollment in Ohio had more than doubled between 2021 and 2025, when COVID-era enhanced subsidies decreased monthly premiums by 41%. The tax credits were at the center of the federal government shutdown last year, with Congress ultimately failing to reach an agreement on extending them.
 
While data on average premium payments in 2026 have not been released, the expiration of the tax credits was expected to increase premiums, on average, by 114% in 2026.
 
In November, HPIO released a policy explainer that provides background about the ACA marketplaces and details how recent changes to the marketplace could impact Ohioans in 2026.