The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
The federal government remains closed for business as Democrats and Republicans battle over health programs for low and middle-income Americans.
If Republicans get their way on one of those programs, insurance premiums for 427,000 Ohioans could double on average. Insurers in the state are already asking for big increases in premiums.
The government shut down at midnight Wednesday as Democrats and Republicans failed to agree to a spending plan. Democrats are demanding that the GOP roll back nearly $1 trillion in cuts they made to Medicaid earlier this year as part of President Donald Trump’s One Big Beautiful Bill Act.
That bill also gave giant tax cuts to the richest 1% of Americans, largely by extending tax breaks passed in 2017 during the first Trump administration. Even though congressional Republicans were eager to extend those tax breaks, they’re digging in over demands to extend health subsidies for average and low-income Americans.
Known as the “enhanced premium tax credit,” it was created during the COVID-19 pandemic to subsidize premiums for insurance on the exchanges created under the 2010 Affordable Care Act. The average subsidy they provided was $705 a year in 2024.
Since they were introduced in 2021, the number of people using the exchanges more than doubled, from 11 million to 24 million, KFF, a health-care analysis nonprofit, reported this week. The subsidies have been credited with helping to push the rate of uninsured Americans to an all-time low.
In the same report, KFF said that premiums for insurance purchased on the exchanges “will more than double” if the subsidies are allowed to expire at the end of the year. As with the cost of health care, the size of the subsidies has grown annually, so their expiration means bigger losses for recipients going forward, the KFF report said.
“Based on the earlier federal data and other more recent publicly available information, KFF now estimates that, if Congress extends enhanced premium tax credits, subsidized enrollees would save $1,016 in premium payments over the year in 2026 on average,” it said. “In other words, expiration of the enhanced premium tax credits is estimated to more than double what subsidized enrollees currently pay annually for premiums — a 114% increase from an average of $888 in 2025 to $1,904 in 2026.”
Individual impacts will vary based on age and income.
For example, a 45-year-old making $35,000 a year would see an annual increase of almost $1,600. Meanwhile, a 60-year-old couple making $85,000 would see an $18,000 premium increase, the KFF report said.
With the credits in jeopardy, insurers who offer plans on the Ohio exchanges are proposing big increases. Open enrollment for 2026 begins on Nov. 1, so insurers and state regulators have to plan without knowing what the fate of the subsidies will be.
In Ohio, eight companies are offering 17 plans for 2026. All are proposing premium increases ranging from 2.5% to 42%. While increases at the top end of the spectrum are big, it’s not clear they’ll keep pace if the subsidies are allowed to expire.
Centene, owner of Buckeye Community Health Plan, insures the largest number of Ohioans using the ACA exchanges — 75,ooo in 2023. In an email, a spokesman cited several reasons for proposed increases of 25% to 28% for its 2026 plans.
“Over the past several months we have been working closely with Ohio regulators and their third-party actuaries to balance rising healthcare costs with the needs of Ohio citizens,” the spokesman said. “Our rate adjustments reflect higher-than-expected care needs than in previous years, including increased hospitalizations, emergency room utilization and behavioral health services.”
The company is “committed to ensuring affordability of health care coverage” and is urging Congress to extend the enhanced premium tax credits.
“These tax credits, which are set to expire at the end of the year, are essential to keeping coverage affordable for Ohioans and working people throughout the country,” the spokesman said.
Dayton-based CareSource was the state’s second-biggest provider as of 2023. For 2026, it’s proposing to hike premiums by about 17%.
Asked why the increase was needed, spokesman Joseph Kelley didn’t specifically mention the looming expiration of the subsidies.
“The ACA Marketplace is facing significant challenges nationwide, driven by a more competitive landscape, rising health care costs and anticipated regulatory shifts,” he said. “These factors led us to adjust our rates to maintain sustainability while continuing to provide quality care.”
Regulators have until Oct. 15 to finalize next year’s rates.
America’s Health Insurance Plans, an industry group, goes further than KFF did in its report. It said that millions of American families will face a 75% increase in health premiums if the enhanced subsidies are allowed to expire.
In a Sept. 22 blog post, the group’s president and CEO cited polls saying that more than 70% of Americans want the insurance subsidies to be renewed.
“Public opinion is clear, with polls from leading Democratic, Republican, and independent researchers showing overwhelming support for continuing these tax credits,” said CEO Mike Tuffin. “The issue is poised to play a significant role in how millions of Americans vote in the 2026 elections.”
