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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.