Tracking OH's staggering ACA enrollment decline, rural hospital woes

By Nadia Ramlagan

The rural healthcare landscape in Ohio is worsening, as the state leads the nation in Affordable Care Act enrollment losses.

Recent federal data show more than 32% of Buckeye residents have lost their health coverage. Now, counties are bracing for billions of dollars in lost Medicaid funding over the next decade.

Ashlyn Kelly, deputy communications director for the advocacy group Protect Our Care, said more Ohioans are unable to see a doctor or get the medications they need to stay healthy due to cost.

"The biggest factor is that the Affordable Care Act tax credits expired and Ohioans are seeing what happens when that financial help disappears," Kelly explained.

According to the Center on Budget Policy and Priorities, a family of four in Ohio making $130,000 a year saw their average annual premium costs rise by more than $8,000 this year. Meanwhile, the ACA enrollment decline compared numbers between early 2025 and February of this year. According to federal data, around a dozen rural Ohio hospitals are vulnerable to potential financial distress or service cutbacks due to shifts in Medicaid funding and policy.

Kelly pointed out as coverage falls and access to care disappears, and when fewer people can afford their coverage, hospitals and clinics are left caring for patients who cannot pay their bills. The sites are then forced to increase operating costs.

"They have to raise costs across the board for everyone, not just the people who rely on Medicaid or use their ACA coverage," Kelly noted.

More than 374,000 Ohioans have already lost Medicaid, CHIP or Affordable Care Act coverage, recent estimates showed. Enrollment in the programs dropped by more than 5 million people nationwide as of early 2026, according to data from Protect Our Care.