Changes to the federal health insurance marketplace

This policy explainer provides background about the Affordable Care Act (ACA) health insurance marketplaces and details how recent changes to the marketplace could impact Ohioans in 2026.

Almost 600,000 Ohioans got health insurance through the ACA marketplace this year. It is an important source of insurance for individuals who are not eligible for programs like Medicaid and do not have access to affordable health insurance through their employer. For example, over a quarter of farmers and ranchers receive insurance through the marketplace. Self-employed individuals and gig workers also frequently use the marketplace for insurance.

Marketplace plans have always offered subsidies for families with lower incomes to offset the cost of insurance. In 2021, Congress enacted enhanced subsidies, referred to as enhanced premium tax credits, which significantly reduced premiums for a broader population of enrollees. This year, about 9 in 10 people with marketplace plans received subsidies to reduce their premiums, making insurance more affordable.

These enhanced subsidies are set to expire at the end of the year. This means that many Ohioans will see significant premium increases next year on the marketplace, which may lead some to drop coverage entirely.

About HPIO's Healthcare access and affordability in Ohio series

This series of HPIO publications 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. Support for this project was provided by HPIO’s core funders.