The record-breaking 43-day government shutdown finally ended on Nov. 12. The Ohio Department of Job and Family Services (ODJFS) announced Thursday that all eligible households will be issued their full November Supplemental Nutrition Assistance Program (SNAP) benefits “promptly.” While uncertainty is finally lifting for those approximately 1.4 million SNAP recipients, a new concern is on the horizon for another population of Ohioans.
A legislative package that ended the government shutdown leaves out any clear decision on the expiring Affordable Care Act (ACA) tax credits, also known as enhanced premium tax credits or subsidies, that make private health insurance more affordable for nearly 20 million Americans and 530,000 Ohioans.
With open enrollment for 2026 coverage well underway, subscribers may wait until December when the U.S. Senate votes on the future of the subsidies. Even if a bill makes it to the House, Speaker Mike Johnson, R-La., has not committed to holding a vote as many House Republicans want the subsidies to expire. Then President Donald Trump would have to sign off — Dems do not have great odds.
“We submitted 12 amendments to this budget to address healthcare, food assistance, tariffs. Every single one was rejected,” said Rep. Greg Landsman (OH-1). “I can’t let down the 32,000 people in my district now facing skyrocketing healthcare costs.”
What could happen to healthcare in Ohio?
Health care research nonprofit KFF estimates the monthly cost of health insurance could more than double for most people who rely on the subsidies in the Health Insurance Marketplace, also known as healthcare.gov. Just like how an employer pays for part of their employees’ monthly health insurance cost, the subsidy is a monthly discount paid by the government for insurance plans purchased through the marketplace.
“That’s what’s being discussed right now is taking away that contribution,” said Kate Schroder, president and CEO of Interact for Health, a regional nonprofit that seeks to advance health equity. Schroder explained to CityBeat that broad swaths of Ohioans get their health insurance on the marketplace, and 90% of Ohio’s enrollees get a subsidy. People making between 100% and 400% of federal poverty guidelines are eligible for the subsidy — a family of three making between $26,650 and $106,600 a year would qualify.
“The folks that are using the marketplace and currently receiving the subsidies tend to be small business owners, entrepreneurs, farmers. They’re individuals that aren’t receiving health care through an employer,” Schroder said. “It cuts across all demographics — rural, urban, suburban — and it does exclude those that are part of Medicare and Medicaid. It does tend to be a lot of individuals who are working in smaller or entrepreneurial places.”
One of those local entrepreneurs is Jennifer Lynn, a licensed mental health counselor with her own private practice in Cincinnati. She’s been using the Health Insurance Marketplace since 2024 while she works part time to take care of her toddler. Making less than $40,000 a year, she was able to sign up for a plan that, with the discounts for her dependent, cost her $0 a month in premiums. But that doesn’t mean her healthcare is totally free.
“The coverage is not, like, fantastic by any means,” Lynn told CityBeat. “I still paid $600 bucks out of pocket this summer for a biopsy on a mole.”
Without the subsidy, Lynn’s monthly cost for premiums will go from $0 to $244, in addition to her high out-of-pocket care. She said she knows self-employed therapists whose monthly premiums could reach $1,600. For Lynn, giving up an additional $244 a month will not be easy.
“We’re kind of in this gray area of, like, everything’s fine right now, but,” she said. “We’re working class, under $100,000 with a three person household.”
Ripple effects
Because so many of those who use the Health Insurance Marketplace don’t have the option of employer-provided healthcare, Schroder said the loss of subsidies could mean the loss of their healthcare entirely.
“In the absence of subsidies, it’s likely that a large number of folks would not be able to afford insurance on the marketplace, and we would have an increase in the uninsured rate, and that has a burden on all of us,” she said. “It increases our health care costs. And what it does for families is it often means there’s no preventative care.”
Since 2010, plans under the ACA have been required to offer access to no-cost preventive care, including immunizations, well-baby and child visits, cancer screenings, depression screenings, fall prevention for seniors, and much more. The ACA’s preventative care guarantee almost vanished this year when The Supreme Court heard a case challenging the requirement. Dozens of patient organizations and professional medical societies filed a joint amicus brief in the case, pointing to studies that show access to no-cost preventive care greatly increases the likelihood that patients will seek routine preventative care.
“When you’re not able to do the preventative care that you could do with insurance, you wait until an issue gets really bad,” Schroder said. “Then you’re seeking care and it costs more and it’s more damaging.”
Without health insurance — or with less money in your pocket for co-pays — Schroder said care for ongoing health issues like asthma or diabetes also goes down.
“It is especially, especially hard for individuals and families that have chronic conditions where that ongoing care and access — whether it’s insulin or blood pressure medication — who need consistent access to manage their chronic condition,” she said. “In the absence of insurance, you are unable to take the medication at the regular times, conditions worsen and it gets more expensive. You also see this in something like cancer.”
Then there’s the interpersonal impacts. Schroder points out how the stress from losing healthcare can reverberate through families and cause more harm.
“It’s a huge stress on families, and so it leads to other factors,” she said. “Whether it’s increased substance use or smoking, we often see that associated when there are rises in stress within families and communities. The downstream effect that that has on the children in the family. Like, we live in community, we live in houses with multiple members, and so when parents lose health insurance, it creates a cascade.”
As a mental health care professional, Lynn sees that cascade, not just in the communities she serves, but in the industry she represents.
“The fact that health care workers themselves, therapists, can barely afford health care is just pretty hard to wrap our heads around,” Lynn said. “I feel like a lot of people are starting to see that our entire health insurance landscape is really just paying towards avoiding medical bankruptcy. I think it’s an uphill battle, but we are so far from it that any movement to push the needle towards making it more affordable, accessible, consistent across the board is just, it really is life or death at this point for so many people.”
The Senate is expected to vote on the ACA subsidies sometime in mid-December.
Follow CityBeat’s staff news writer Madeline Fening on Instagram. Got a news tip? Email mfening@citybeat.com.