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The Health Policy Institute of Ohio has released a new policy explainer on changes to the federal health insurance marketplace.

The Affordable Care Act health insurance marketplaces are at the center of the federal government shutdown, particularly the upcoming expiration of enhanced premium tax credits that reduce the cost of these insurance plans for consumers. The debate over extending the enhanced credits comes at the same time as broader conversations on the difficulties that Ohio families are facing with the cost of living and increased cost of health insurance.

Nearly 600,000 Ohioans got health insurance through the marketplace in 2025. With enhanced tax credits expiring next year and large increases in the cost of premiums, more than 100,000 Ohioans are expected to no longer purchase insurance coverage in 2026.

The policy explainer is the latest in a series of publications that HPIO has developed to explore the healthcare access and affordability impacts of recent policy changes, such as HR 1 and the state’s biennial budget bill.

Two federal judges ruled today (Oct. 31) that the Trump administration is required to use emergency funds to continue paying for Supplemental Nutrition Assistance Program (SNAP) benefits (source: “Judges order the Trump administration to use contingency funds for SNAP payments during the shutdown,” Associated Press, Oct. 31).

The rulings — one in a case brought in Massachusetts by 25 states and D.C., the other in a case brought in Rhode Island by a national coalition of municipalities (including Columbus) and non-profits — came after weeks of uncertainty about the future of SNAP payments amid the federal government shutdown.

The Trump administration had previously announced that those enrolled in SNAP would not receive payments starting tomorrow (Nov. 1) because of the ongoing federal government shutdown. The program has never been disrupted during any previous government shutdowns.

Because of the timing of the rulings, just hours before benefits were set to be halted for some enrollees, it is not immediately clear how quickly the electronic benefits transfer cards that beneficiaries use to buy groceries can be reloaded. That process often takes one to two weeks.

More than 1.4 million Ohioans, or 12% of the population, are enrolled in SNAP, including 723,870 households, as illustrated above. According to a recent fact sheet from the Ohio Association of Foodbanks, the average Ohio SNAP participant receives $5.64 a day. That is substantially less than the average cost of groceries calculated by the United States Department of Agriculture. To qualify for SNAP, Ohioans must have a net income at or below federal poverty guidelines — $32,150 a year for a family of four.

Ohio’s monthly allotment of federal SNAP funding for September 2025 was more than $252 million.

On Thursday (Oct. 30), Gov. Mike DeWine announced that he, Ohio Senate President Rob McColley and Ohio House Speaker Matt Huffman agreed to a plan to provide $25 million for emergency food assistance. According to a news release from the Governor’s office, $7 million will be given to Ohio food banks and up to $18 million will be given as emergency benefits to Ohioans who earn below 50% of the federal poverty level ($16,075 for a family of four). It is uncertain whether this aid will be distributed now that the federal government is required to continue benefits.

The current uncertainty of SNAP benefits comes as states are preparing for significant federal cuts to the program as part of HR 1, the federal reconciliation bill sometimes called the One Big Beautiful Bill Act. That legislation includes $186 billion in cuts to SNAP over the next decade, with significant changes to eligibility and increased costs to states. The Ohio Association of Foodbanks fact sheet includes a timeline of scheduled changes to the program.

HR 1, the federal reconciliation bill (sometimes referred to as the “One Big Beautiful Bill Act”) that passed Congress over the summer, includes a requirement that states impose cost sharing of up to $35 per service for some Medicaid expansion enrollees.

As illustrated above, Ohioans who are enrolled in Medicaid are more likely to report difficulty paying household costs, such as food, housing and medical expenses, than those with other forms of insurance or those who are uninsured.

The new cost-sharing requirement is set to go in effect on Oct. 1, 2028, and includes co-pays, co-insurance and deductibles. The requirement will apply to all Medicaid enrollees earning between 100% and 138% of the federal poverty level ($32,150 to $42,759.50 for a family of fourin 2025).

Primary care, mental health and substance use disorder services will be excluded from the cost-sharing requirement, as will services provided by federally qualified health centers, behavioral health clinics and rural health centers.

HPIO has developed a series of publications to explore the healthcare access and affordability impacts of recent policy changes, such as HR 1 and the state’s biennial budget bill.

The percent of Ohioans with a credit report that includes medical debt dropped by nearly 40% from 2011 to 2022, although the percent remains higher than the U.S. overall, as illustrated above.

The decline in medical debt coincides with a drop in Ohio’s uninsured rate, which has been halved following the passage of the Affordable Care Act in 2010 and Ohio’s decision to expand Medicaid eligibility beginning in 2014.

A bipartisan bill under committee review in the Ohio House aims to curb aggressive medical debt collection practices.

House Bill 257 would end the ability of hospitals to garnish wages and would reduce (from 8% to 3%) the legal interest rate that runs on collection judgments. The legislation also would prohibit healthcare providers from reporting unpaid medical debts to credit reporting agencies. Bad credit scores can limit access to loans and raise costs for borrowers. The nation’s three largest credit bureaus voluntarily stopped reporting medical debt of less than $500 in 2023.

In recent media interviews, the sponsors – Rep. Jean Schmidt, a Cincinnati-area Republican, and Rep. Michele Grim, a Toledo Democrat – said medical debt isn’t like a car loan or credit card debt. Injuries and illnesses are usually unplanned, and patients have little ability to price shop or weigh pros and cons before executing what are oftenexpensive costs for health needs.

Maine, Colorado, Oregon, Vermont and others have recently passed legislation to prohibit providers from reporting medical debt to the credit agencies.

A recently released HPIO data snapshot provides a series of data graphics that illustrate the challenges Ohio immigrants face in accessing health care,

The publication gives an overview of the demographics of immigrants in Ohio, factors that hinder healthcare access, Medicaid eligibility, uninsured rates (as illustrated above) and potential impacts of recent federal policy change.

"These challenges limit access to preventive care, treatment and insurance coverage," according to the snapshot. "Recent federal and state policy changes are likely to further reduce healthcare access for Ohioans who are immigrants."

The data brief is the third in a series of HPIO publications that includes data and analysis about the current challenges facing working Ohioans, and examines how recent federal and state policy changes will impact access to care and affordability in Ohio.

The Health Policy Institute of Ohio has released a new quick, high-level policy explainer of potential Medicaid work requirements in Ohio.

The publication details Medicaid work requirements recently established by federal law through HR 1, the federal reconciliation bill that is sometimes referred to as the “One Big Beautiful Bill Act,” and the work requirements proposed by Ohio policymakers through an 1115 waiver proposal submitted in February 2025.

The publication describes the potential impacts of Medicaid work requirements, key points in the implementation timeline and upcoming decisions for state policymakers.

The implementation of work requirements will occur over the next few years, as illustrated above, and will be impacted by upcoming regulatory decisions from the federal Centers for Medicare and Medicaid Services. Additionally, Ohio policymakers will need to make important decisions related to work requirements in the state, including potentially reconciling the submitted 1115 waiver with the requirements in HR 1. [BO1] [NW2]

The data brief is the latest in a series of HPIO publications that includes data and analysis about the current challenges facing working Ohioans and examines how recent federal and state policy changes will impact access to care and affordability in Ohio.

HPIO’s 2025 Health Policy Summit, which will take place on Thursday, Oct. 9, will feature a plenary session focused on the health policy impacts of HR1. The session will feature:

• Jennifer Tolbert, MPH, MSW, Director of State Health Policy and Data and Deputy Director Program on Medicaid & Uninsured, KFF
• Adam Searing, JD, MPH, Associate Professor, Georgetown University McCourt School of Public Policy, Center for Children and Families

Click here for more information about the Summit and to register (the deadline for registering is Thursday, Oct. 3).