The Affordable Care Act (ACA) marketplace plan selections in Cuyahoga and Summit counties have seen a significant decline, with a 20.4% to 25% drop from 2025 to 2026, according to an analysis of federal enrollment data. This trend is not isolated to these two counties; Ashtabula, Trumbull, Mahoning, and Columbiana counties have also experienced a similar decline. However, what makes this situation particularly intriguing is the contrast between the premium increases and the overall decline in plan selections. While Clark County recorded the largest increase in average marketplace premium, rising 161% from 2025 to 2026, the statewide decline in Ohioans with paid marketplace coverage was even more striking, with 161,385 people losing their coverage. This raises a deeper question: Are the premium increases a result of the enhanced subsidies expiring, or is there another factor at play? In my opinion, the loss of enhanced subsidies is a significant contributor to the premium increases, but it's not the only factor. The movement towards bronze plans, which have lower monthly premiums but higher deductibles and out-of-pocket costs, could also be a factor. What makes this situation even more fascinating is the contrast between the premium increases and the decline in plan selections. While the average monthly premium paid after subsidies rose from $126 in 2025 to $233 in 2026, the number of Ohioans enrolled in marketplace plans and current on their premiums dropped from 497,443 in February 2025 to 336,058 in February 2026. This suggests that the higher premiums may not be affordable for many families, leading them to drop their coverage. One thing that immediately stands out is the shift towards bronze plans, which have seen a significant increase in popularity. The share of bronze plans rose from 43% in 2025 to 60% in 2026, while silver plan selections fell from 52% to 36%. This raises a question: Are families choosing bronze plans because they are more affordable, or are they being pushed towards them due to the higher premiums? From my perspective, the shift towards bronze plans is a concerning trend. While bronze plans may be more affordable in the short term, they expose families to higher costs when they need care. This could lead to a situation where families are unable to afford their healthcare needs, even if they have coverage. The data also do not show how many people who left marketplace coverage became uninsured. Some could have obtained insurance through an employer, Medicaid, Medicare, or another source. However, it's likely that many of these individuals may have fallen behind on their premiums and lost their coverage. This raises a deeper question: Are the premium increases leading to a situation where families are unable to afford their healthcare needs, even if they have coverage? In my opinion, the situation in Cuyahoga and Summit counties is a wake-up call for policymakers. The loss of enhanced subsidies and the shift towards bronze plans are contributing to a situation where families are unable to afford their healthcare needs. Congress has considered restoring the expired subsidies, and the U.S. House has passed legislation that would extend the enhanced premium tax credits through 2028. However, the Senate has not yet acted on the bill. If the enhanced subsidies are not restored, the situation in Cuyahoga and Summit counties could become even more dire. Families may be forced to choose between their health and their financial stability, and the consequences could be devastating. In conclusion, the decline in ACA plan selections in Cuyahoga and Summit counties is a complex issue with multiple contributing factors. The loss of enhanced subsidies, the shift towards bronze plans, and the higher premiums are all contributing to a situation where families are unable to afford their healthcare needs. Policymakers must take action to address this issue and restore the enhanced subsidies to ensure that families can afford their healthcare needs.
