Roughly 161,000 people in Ohio lost or dropped insurance coverage under the Affordable Care Act between February 2025 and February 2026. That included more than 10,000 people in Hamilton County and almost 13,000 in Franklin County.
It’s the largest percentage drop in any state.
Health policy experts attribute the decline largely to the expiration of enhanced federal subsidies that drove premiums sharply higher. The losses were concentrated in rural and lower-income communities, and experts warn the effects could extend well beyond the people who lost coverage.
To see the percentage loss in your county, keep scrolling.
“These things are all going to come together in Ohio and produce some really significant issues for Ohioans,” said Brian O’Rourke, a health care policy analyst for the Health Policy Institute of Ohio.
Affordable Care Act premiums rocket after subsidies expire
In 2021, more than a decade after President Barack Obama signed the Affordable Care Act, the U.S. Congress passed enhanced subsidies to cover more of an enrollee’s monthly Obamacare premium. After intense debate and a prolonged government shutdown, those subsidies expired Dec. 31, 2025, leaving parts of the U.S. with soaring monthly premiums.
Ohio recorded the nation’s largest percentage decline in Marketplace enrollment between February 2025 and February 2026, according to the Centers for Medicare & Medicaid Services. There are a couple of possible reasons for this, O’Rourke said.
Rising household costs have made health insurance harder for some Ohioans to afford.
“Trying to keep up with your health insurance premiums each month versus putting food on the table, paying for gas, other transportation costs, housing − all of these other pressures that Ohioans are feeling really strongly,” O’Rourke said.
But the most compelling reason for the plunging enrollment is the higher, less subsidized cost of premiums, O’Rourke added. Ohio’s average monthly cost increased by 85% − roughly $107 − from 2025 to 2026, according to the Health Policy Institute of Ohio. Rising premiums meant even fewer people could keep up with monthly payments, O’Rourke said.
Ohioans with income between 138% to 400% of the federal poverty level qualify for Obamacare Marketplace coverage and subsidies on monthly premiums. For individuals, that’s an annual income roughly between $21,000 to $62,000. For a family of four, the range for annual income is about $45,000 to $132,000.
If you make more than that but have no other way to be insured, you can still qualify for Obamacare. But with the passage of the One Big Beautiful Bill, you will no longer qualify for any subsidies on monthly premiums starting on Jan. 1, 2026, according to the American Medical Society.
Of the roughly 161,000 Ohioans who lost Obamacare coverage since February 2025, about 62% dropped within three months after subsidies expired.
While this significant decrease happened in many parts of the country, some states fared better than others.
Ohio, along with many other Republican-controlled states, uses the federal Marketplace exchange − healthcare.gov. This gives the state less control to add in financial support and help offset the loss of enhanced subsidies, O’Rourke said, which means it couldn’t “bridge the gap” when the enhanced subsidies expired.
Meanwhile, places like New York, California and Illinois have their own Marketplace exchanges. Illinois, for example, transitioned from healthcare.gov in 2025 to Get Covered Illinois. The average monthly premium for Obamacare enrollees in Illinois increased by $40, according to a brief from the Health Policy Institute of Ohio. Illinois lost 0.4% of its enrollees, according to data first compiled by AP News.
Some people are bearing the brunt of these rising costs.
Rural counties, low-income communities see largest loss in enrollment
While the Cincinnati metropolitan area − including Hamilton, Butler, Warren, Clermont and Brown counties − saw a combined loss in Obamacare enrollment of over 16,000 people, rural counties experienced the largest rate of disenrollment across the state.
People who tend to qualify for Obamacare are often self-employed, farmers or workers in the gig economy who do independently contracted work, often through a digital platform like Uber or TaskRabbit, O’Rourke said.
Vinton County, home to about 12,000 residents with a median household income of roughly $55,000, saw the sharpest drop in enrollment. Nearly 43% of Vinton County residents lost coverage between 2025 and 2026. The county’s neighbors, including Gallia, Jackson, Meigs and Lawrence, also posted steep enrollment declines.
This is not a surprise, O’Rourke said. Vinton County’s average Obamacare premiums rose by 155% from 2025 to 2026, according to a brief from the Health Policy Institute of Ohio.
“It’s our lower income families that tend to be really grappling with these decisions of putting food on the table and paying for gas versus keeping up with your health insurance premiums,” O’Rourke said.
Rise in uninsured Ohioans puts pressure on all
The Urban Institute originally predicted a 29% increase in Ohio’s uninsured population if 140,000 people lost Obamacare coverage after the subsidies expired. While researchers do not yet know how 161,000 people losing insurance may change these numbers, there’s no doubt that the impact is immediate, O’Rourke said.
Insurance coverage is a strong predictor of who receives preventive care − like vaccines or health screenings − and who can manage chronic diseases, said Dr. Grant Mussman, the Cincinnati Health Department’s health commissioner. Those without insurance are more likely to delay seeking care, according to KFF.
“What I think is really important to recognize is the role that chronic disease plays in the health of our communities,” Mussman said.
Uninsured people with chronic conditions like heart disease or cancer − the two leading causes of death in Hamilton County from 2018 to 2022 − are three to four times more likely than people with insurance to delay or forgo seeking care, according to KFF. Certain neighborhoods that already experience these conditions more often than others will pay a steeper price, Mussman said.
But the price is steep for everyone, not just those who lost Obamacare coverage.
“We rely heavily on our safety net providers to provide care for folks who don’t have insurance,” Mussman said. “When that uninsured rate goes up, that is a huge strain on their ability to sustainably provide care.”
The city of Cincinnati’s health center serves roughly 45,000 people a year, and about a third of those patients lack health insurance, Mussman said.
“If that rate goes up, that’s more and more of a strain on us and what our expenses are,” Mussman said.
This is an issue that those at city clinics or emergency departments will both experience.
When someone comes into the emergency room without insurance, they’re facing a medical bill that will most likely never be paid, O’Rourke said. This places financial pressure on the provider. The response is to raise prices for the insured population to make up for the uncompensated care.
“The worry is that this trend is just gonna continue − more people dropping coverage, the insurance pool getting sicker and thicker, which means premiums just rise more and more, and that kind of cycle happens,” O’Rourke said.
In the next two years, changes in the eligibility requirements and income verification process under the Affordable Care Act Marketplace are expected to lead to more drops in enrollment.
Marketplace insurers are also proposing a medium premium price increase of about 14% for 2027, according to KFF.
“It was expected because when people drop coverage, the insurance market becomes less stable,” O’Rourke said.
The combination of Marketplace and Medicaid changes could further increase the number of uninsured Ohioans, adding pressure to hospitals, clinics and other safety-net providers. The result has serious implications for Ohio’s public health, O’Rourke said.
This article originally appeared on Cincinnati Enquirer: Ohio loses a third of Obamacare enrollees, highest in U.S. Here’s why.
Reporting by Esther Launstein, Cincinnati Enquirer / Cincinnati Enquirer
USA TODAY Network via Reuters Connect
By Esther Launstein, Cincinnati Enquirer | USA TODAY Network
