ACA Enrollment Declines Following Tax Credit Expiration

Data released 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. This decline comes following the expiration of enhanced premium tax credits at the end of 2025, which caused out of pocket costs for Marketplace insurance to skyrocket.

A brief compiled by the Health Policy Institute of Ohio (HPIO) highlights these federal figures, which indicate that Ohio experienced roughly a 20% drop in ACA exchange enrollment for the 2026 plan year, ranking it among the states with the largest declines in the nation, exceeded only by a few states including North Carolina, Georgia, and Florida. The total drop in enrollment nationwide was 5%; making Ohio’s reduction four-times larger than the national average.

These trends are important for providers to consider as you evaluate payer mix, budget planning, and uncompensated care needs. A shrinking insured population typically translates into a higher proportion of uninsured patients and greater financial pressure on safety-net providers. Providers and ADAMH boards may want to factor these enrollment shifts into their forecasting and resource allocation strategies for 2026 and beyond.