Rural Ohioans more likely to lose ACA coverage following subsidy expiration, analysis finds

Rural residents in states that participate in the Affordable Care Act (ACA) Marketplace, including Ohio, are losing health insurance coverage at higher rates than their urban and suburban counterparts, according to new analysis (Source: “As Affordable Care Act enrollment declines, rural Ohioans are being hit hard,” Daily Yonder via WOSU Public Media, Aug. 3).
 
Data included in HPIO’s recently released data snapshot of updated Ohio enrollment in the federal ACA marketplace shows that since enhanced federal subsidies for ACA plans expired in January, Ohio has seen the nation's steepest decline in Marketplace enrollment. The state’s ACA enrollment fell more than 32% between February 2025 and February 2026.
 
A national rural news organization analyzed data from the Centers for Medicare and Medicaid Services and found that in nonmetropolitan counties, the number of people signed up during the open enrollment period dropped by approximately 12%, representing 29,000 consumers. Small metropolitan counties saw a drop of 11%, representing about 154,000 consumers, the next largest decrease in enrollment among all of the county types.