Congress adjourned for the year without renewing enhanced Affordable Care Act subsidies, a decision expected to significantly affect health coverage across Ohio beginning in 2026. State health policy analysts warn that as many as 140,000 Ohio residents could lose insurance coverage as premiums rise sharply following the expiration of the enhanced premium tax credits at the end of 2025.
The Affordable Care Act has provided premium tax credits since 2014 to help eligible individuals and families offset the cost of health insurance. In 2021, Congress temporarily expanded eligibility, allowing higher-income households to qualify for subsidies and reducing out-of-pocket premium costs for millions nationwide. Those expanded benefits are scheduled to expire, and without congressional action, consumers will face substantially higher insurance costs starting Jan. 1, 2026.
Ohio Senator Jon Husted highlighted the personal impact of the looming changes during a December meeting, describing a case in which a household earning just over $80,000 annually is projected to see its health insurance premiums increase by more than $10,000 in a single year. Similar scenarios are expected across the state as subsidies disappear and insurers implement rate increases.
Ohio participates in the federal ACA marketplace, one of 23 states that rely on the federally operated exchange. According to the Health Policy Institute of Ohio, approximately 600,000 residents obtained health coverage through the marketplace in 2025, with the vast majority relying on premium tax credits to afford their plans. More than 513,000 Ohioans currently depend on the enhanced subsidies that are set to expire.
The anticipated impact is compounded by a roughly 30 percent increase in federal health insurance premium rates. Analysts at the Health Policy Institute estimate that when higher rates are combined with the loss of subsidies, average monthly premium payments in 2026 could more than double compared with 2025 levels, placing coverage out of reach for many households.
Under existing law, premium subsidies are available to U.S. citizens and lawfully present noncitizens who are not incarcerated, lack access to most other subsidized coverage, and earn at least 100 percent of the federal poverty level. The income cap of 400 percent of the poverty level was removed in 2021, allowing higher earners to qualify for assistance. Without renewed legislation, those expanded eligibility standards will end.
The future of the subsidies became a central issue during the recent federal government shutdown, which lasted from early October through mid-November. Negotiations stalled as lawmakers disagreed over extending ACA assistance, and while a temporary funding agreement reopened the government through Jan. 30, no action was taken on healthcare subsidies before Congress recessed.
In mid-December, a bipartisan group of lawmakers in the House used a rarely employed discharge petition to force a vote on a three-year extension of the subsidies. The vote is expected in January, after the initial premium increases take effect. Even if approved by the House, the measure would still require Senate passage and presidential approval.
Ohio Representative Joyce Beatty publicly supported the effort, warning that tens of thousands of residents in her district alone could face steep premium hikes. She cited examples of older couples facing increases of nearly 300 percent, raising concerns that some retirees may be forced back into full-time employment to maintain coverage.
Ohio’s two U.S. senators have proposed alternative approaches rather than a full extension. Competing plans would temporarily extend tax credits while gradually reducing benefits for higher-income households and eliminating zero-premium insurance plans. Without a compromise by the end of January, policymakers and analysts caution that the issue could once again threaten federal funding deadlines and disrupt healthcare coverage for millions nationwide.
