Ohio ACA enrollment falls off a cliff

Ohio has seen the second-largest drop in Obamacare enrollment of any state as the system absorbs a premium spike tied to the expiration of federal subsidies, initial data released by the federal government show.

As of earlier this month, 463,086 Ohioans had signed up for Affordable Care Act marketplace plans, according to a report from the Centers for Medicare and Medicaid Services. That’s compared to the 568,904 enrollees in last year’s report – a nearly 19% drop. On a percentage basis, Ohio’s drop was multiple times larger than the national average and second only to North Carolina.

The numbers are incomplete, health care experts said. One reason: Last year’s report came out following the conclusion of open enrollment for the ACA marketplaces, while this year’s came out 12 days before it ended. 

But Brian O’Rourke, an analyst for the Health Policy Institute of Ohio, said that, even after controlling for the different report release dates, CMS still showed a similar drop. 

Experts have been widely expecting a drop in ACA enrollment after federal subsidies for plan holders expired in January. The change will cause average ACA premiums to more than double, according to the HPIO, which projects 140,000 more Ohioans will become uninsured as a result. The change will disproportionately affect people in rural areas, where jobs with health coverage are less common.

“The expectation is that a lot of people are going to see those big rate increases of thousands of dollars in some cases, and they’re going to decide that they just cannot afford it with their budgets and all the other cost of living constraints that many Ohioans are currently facing,” O’Rourke said in an interview.

O’Rourke said he isn’t sure why Ohio saw such a disproportionately large enrollment drop. His best guess: Ohio declined to set up its own state marketplace and instead chose to piggyback on the federal ACA program. States such as Pennsylvania and Georgia with their own marketplaces have more flexibility and are insulated from federal changes and have seen more stable enrollment as a result, he said. 

Another factor is the large increase Ohio saw in ACA enrollees – exploding from 206,500 in 2019 to 583,000 last year – after congressional Democrats first approved the enhanced subsidies in 2021, making the plans much more affordable. 

“It’s not super surprising to me that once those enhanced subsidies were wiped out, and there were other premium increases, that a lot of Ohioans potentially decided to drop their coverage,” O’Rourke said.

We expect the ACA subsidy issue to be one factor that will make health care affordability – and the rising cost of living in general – a major theme in this year’s election, unless Congress acts to resolve it.

Congressional Democrats last approved a three-year extension of the ACA subsidies in 2022, during former President Joe Biden’s administration. Republicans now control Congress and so far have failed to reach a deal to renew them, although negotiations are ongoing, with Republican Sen. Bernie Moreno, of Ohio, playing a central role in talks. 

The enrollment numbers might paint an incomplete picture for another big reason: they include people who were re-enlisted in ACA plans by default. More people could end up dropping coverage in the coming months after their higher premium bills arrive, O’Rourke said.

John Palmer, a spokesperson for the Ohio Hospital Association, in an interview on Wednesday called the enrollment drop “concerning.”

He said hospitals likely won’t notice any resulting increase in uninsured patients until spring. 

“It certainly will have an impact. Insurance is everything when it comes to accessing healthcare,” Palmer said. 

ICE could be on the OH-9 ballot

A new candidate for Ohio’s 9th Congressional District has shaken up the race – and provided a rare opportunity for a hot-button political issue to appear directly on the ballot. 

Madison Sheahan announced last week that she had resigned as the No. 2 ranking administrator at U.S. Immigration and Customs Enforcement, the agency commonly referred to as ICE, so she could run for the 9th District seat currently held by longtime Democratic Rep. Marcy Kaptur.

The district presents a top pickup opportunity for Republicans. After Republicans redrew Ohio’s congressional maps last October, it’s now the most Trump-friendly of any Democratic-held district in the country. 

Sheahan’s résumé and her ties to President Donald Trump’s immigration apparatus instantly drew national attention to her campaign in a race where other candidates have failed to gain clear traction. 

Sheahan, 28, grew up in the Toledo area but moved to attend Ohio State University and has never run for office before. That means district voters likely will form their opinions knowing exactly one thing about her: that she used to help run ICE in President Donald Trump’s administration.

Sheahan also enters the race with something that matters more than pretty much anything else for a Republican politician trying to win a primary election these days – an obvious path to getting Trump’s endorsement.

This goes beyond just her work at ICE. Her campaign team also includes a couple of accomplished GOP operatives linked to Trump World: Bob Paduchik, who worked for the Trump campaign in high-level roles in 2016 and 2020, and Clayton Henson, an Ohio political operative with close ties to the White House. 

Sheahan’s choreographed campaign launch last week leaned into the Trump angle. Her first interview with national media was on Lara Trump’s show on Fox News. And a biographical campaign video references the “call” she got to help Trump “clean up the dangerous immigration mess” while splicing in a few pictures of the president, too. Using Trump’s image in that way can be a calculated risk, since he’s been sensitive in the past about candidates prematurely insinuating that he’s endorsed them. Or maybe it’s a sign of confidence that an endorsement might land soon. 

In an interview, Paduchik said the video was meant to introduce Sheahan to Northwest Ohio voters.

“It’s no surprise that we would talk about her successful record as deputy director of ICE in highlighting her career in that introduction,” Paduchik said. 

But Sheahan’s late entry in the race has perturbed some local Republican insiders. The Lucas County Republican Party quickly amended its rules so it could only issue endorsements to those with a recent history of living in the district, according to Josh Culling, a local Republican operative who supports another Republican candidate, state Rep. Josh Williams. Chris Enoch, the Republican Ottawa County clerk of courts, also posted a lengthy thread on X questioning how much Sheahan could know about a community she hasn’t lived in recently.

“Let Northwest Ohio never become a résumé stop, a D.C. export market, or a proving ground for federal ambition,” wrote Enoch, who also endorsed Williams.

Kaptur’s team isn’t saying much about the race at this point. Kaptur told the Toledo Blade when asked about Sheahan on Monday: “It’s not my party.” 

But Lucas County Democratic Party Chair Schuyler Beckwith said Sheahan’s entry suggests to her that Trump and other Republicans were displeased with the existing candidates. 

Beckwith also said she thinks district voters will reject the tactics of ICE.

The county party recently issued a press release condemning an ICE agent’s killing of Renee Good, an unarmed driver in Minneapolis. Trump administration officials have said the incident was justified.

The question for voters in a general election could end up being whether they think Sheahan is the face of necessary, tough immigration enforcement or heavy-handed, dangerous tactics. 

“What we’re seeing across the country, with the attacks on residents by this false law enforcement agency, is horrifying,” Beckwith said. “And I don’t think we need someone showing up to claim they’re a leader in our community who’s affiliated with an organization like ICE.”

A lump of coal for Acton

A small but storied labor union has come off the sidelines to issue a rare endorsement in an Ohio’s governor’s race.

Dr. Amy Acton’s campaign announced this week it had been endorsed by the United Mine Workers of America, which represents a few thousand active and retired coal miners in Ohio, according to Dave Dilley, a union official. 

The Mine Workers union, previously a major power player in Appalachian politics, has been more active here in federal races lately, endorsing a mix of state Democrats and Republicans. But the last time it endorsed in the Ohio’s governor’s race was in 2010 when it endorsed then-Gov. Ted Strickland, a Southeast Ohio Democrat.

In an interview, Dilley cited Acton’s experience as Gov. Mike DeWine’s health director and her campaign’s focus on public health. In contrast, he said the likely Republican nominee, billionaire entrepreneur Vivek Ramaswamy, had an anti-union record during his brief tenure in the Trump administration and is out of step with average working Ohioans.

“If he is elected, I hope he will do some good for labor,” Dilley said. “But we don’t see that as happening. The guy came out of DOGE with Elon Musk. They dismantled a whole lot of unions in the federal part of it. So he’s not been a good voice for us.”

Ramaswamy has gotten some labor union support, including from building trades and other unions involved in the construction industry and from the Ohio Conference of Teamsters, the trucking union. Some unions, including the Midwest Council of Carpenters, have split endorsements between Ramaswamy and Sherrod Brown, the Democratic former senator who’s challenging Republican Sen. Jon Husted this November. 

Fracking more parkland

You might remember Jake Zuckerman’s story last week about the state opening 6,600 acres of preserved wildlife areas for fracking. That included 4,360 acres of the Egypt Valley Wildlife Area. 

In the week or so since then, developers have submitted formal requests for state officials to open another 6,638 acres of the park for oil and gas development. It’s the latest request as part of a new legal process for the gas industry to tap into the riches beneath Ohio’s publicly owned state parks and preserved, pristine spaces.

Mark the calendar

Today: Vice President JD Vance visited Toledo to tout the Trump administration’s economic agenda.

Monday, Jan. 26: The criminal trial for two former top FirstEnergy executives, Chuck Jones and Mike Dowling, is set to begin in Akron on Monday. The company fired both men in 2020 for their roles in the House Bill 6 scandal, and state Attorney General Dave Yost charged them with corruption-related offenses last year.

In the news

Higher education in prisons: The Ohio Senate could soon take up a proposal to end college and technical career education in higher security state prisons and cut off inmates’ access to electronic tablets. Read the story from Jake Zuckerman. 

From our partners in D.C.: Democratic lawmakers and state officials are warning that the changes to the Supplemental Nutrition Assistance Program enacted through last year’s reconciliation package are unrealistic for states and counties, which are expected to do more to run the program. Read more from NOTUS.

Worth another look

Deadly house parties: Dozens of shootings have broken out at crowded house parties hosted at Airbnbs, Vrbos and other short-term rentals since 2019. Cities want to impose new restrictions on these kinds of businesses, while a proposed state law would block cities from doing so.  Read more from Jake.