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Far fewer Ohioans enrolled in insurance marketplaces after Republican-controlled U.S. Congress allowed subsidies to expire at the beginning of the year. That likely means many more uninsured people.

The U.S. Centers for Medicare and Medicaid Services on Jan. 12 reported that 463,000 Ohioans had purchased insurance on HealthCare.gov since the start of open enrollment on Nov. 1.

Nearly 600,000 in the Buckeye State purchased insurance on the exchanges in 2025, the Health Policy Institute of Ohio reports. That’s at least a 21% drop in enrollment if the current numbers hold.

The New York Times last week reported that nationally, enrollment has dropped by 1.4 million, roughly a 6% drop.

KFF analysisThe subsidies were created during the coronavirus pandemic in 2021, and are used by the vast majority of people participating in the marketplaces. Most of them have moderate incomes.

About 70% of the people using the ACA exchanges make 250% or less of federal poverty guidelines. For a family of four, that’s $80,375 a year.

KFF, a health-analysis nonprofit, last year predicted that the average consumer would see the cost of her or his coverage more than double if the subsidies were allowed to expire. But after a 43-day government shutdown in a fight over extending the subsidies, Republicans in Congress voted to allow them to die.

They did so after voting last summer to extend President Donald Trump’s 2017 tax cuts — $1 trillion of which will benefit the richest 1% of Americans over the next 10 years and add $4.1 trillion to the national debt. At the same time, the bill cuts more than $1 trillion from Medicaid and federal food assistance over the same period.

The Urban Institute and the Robert Wood Johnson Foundation estimate that nationally, 4.8 million Americans will lose insurance coverage altogether in the absence of ACA subsidies. In Ohio, that would eventually add thousands of newly uninsured people in a state that already saw 600,000 lose Medicaid coverage between 2023 and 2025.

People who don’t have insurance tend to get sicker, be deeper in debt, and die earlier, according to a 2012 report by Families USA.

Other reports describe a downward spiral in which the stress of medical debt can cause health to deteriorate further, creating more debt and sometimes even premature death.

And emergency departments are required by law to treat people regardless of their ability to pay.

Emergency physicians warn that growing the population of uninsured Ohioans will put additional financial stress on hospitals — especially in rural areas and low-income neighborhoods.

That will result in longer wait times, reduced service and, in some cases, hospital closures, they said.

Meanwhile, an October KFF health tracking poll found that 78% of adults thought the subsidies should be extended, compared to just 22% who said they shouldn’t.

With their expiration and plummeting ACA enrollment, some Republicans are supporting renewal.

On Jan. 8, 17 House Republicans joined Democrats in voting for a three-year extension. They included Ohio U.S. Reps. David Joyce, Max Miller, and Mike Carey.

Despite the subsidies’ popularity, however, there is widespread skepticism that a three-year extension will pass the Republican-controlled Senate.

A bipartisan group is said to be working on a compromise, but thus far it hasn’t produced anything.