A record 477,793 Ohioans enrolled in the Affordable Care Act’s Health Insurance Marketplace Plan in 2024, according to data compiled by the The Centers for Medicare & Medicaid Services. This is an increase from last year’s report, which recorded only 294,644 Ohioans participating in the program, and more so from 2022, when 259,999 enrolled. 

Ohio’s increased enrollment is one example of a larger national trend. On Jan. 24, the Centers for Medicare and Medicaid Services announced that 21.3 million people nationwide selected a Marketplace plan during the open enrollment period. Of those, 16 million renewed their coverage, while 5 million were new users. 

“Once again, a record-breaking number of Americans have signed up for affordable health care coverage through the Affordable Care Act’s Marketplace, and now they and their families have the peace of mind that comes with coverage, “Health and Human Services(HHS) Secretary Xavier Becerra said. “The ACA continues to be a successful, popular, and important federal program to millions of people and their families. As we celebrate the success of this most recent enrollment effort, HHS will double down on the Biden-Harris Administration’s efforts to increase access to quality care and lower costs.”

What is the Affordable Care Act?

Passed in 2010, the Affordable Care Act — also known as Obamacare — seeks to make health care more affordable for Americans who need it. Subsidies are provided for households with an average income below the Federal Poverty Level, while Medicaid is expanded to include all adults with income 138% below the poverty level. Under the ACA, states that refused to expand Medicaid would see their Medicaid funding cut at the federal level. The act also includes protections for health care customers, stopping insurance companies from refusing or overcharging customers if they have “preexisting conditions,” aka a health problem which existed before someone’s health care coverage started. 

What is the Marketplace? 

Created by the Affordable Care Act in 2010, Marketplace is shorthand for “Health Insurance Marketplace,” an enrollment service for medical insurance. Through websites, call centers and self-help, the Marketplace allows customers, oftentimes uninsured, to shop for affordable health plans. Based on income and household information, applicants for Marketplace may qualify for tax credits for more affordable health insurance, or coverage through programs like Medicaid and CHIP. 

How did the States React? 

In 2012, the U.S Supreme Court ruled  in a 5-4 vote that the Affordable Care Act was constitutional. “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” wrote Chief Justice John Roberts in the court’s majority opinion. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” 

However, the Supreme Court also ruled, in a 7-2 vote, that the ACA was coercive, and that if states chose not to expand Medicaid coverage, the federal government couldn’t withdraw Medicaid funding. 

“The threatened loss of over 10 percent of a state’s overall budget is economic dragooning that leaves the states with no real option but to acquiesce in the Medicaid expansion,” Justice Roberts also wrote.  

Since this ruling, only ten states have chosen to not expand Medicaid coverage, with North Carolina — once a holdout — expanding coverage in December of last year. Of the states that refuse to expand Medicaid, all have either Republican governors, or Republican majorities in their state legislature. 

How has the Affordable Care Act Impacted Ohio? 

Republican Governor John Kasich pushed through Medicaid expansion in 2013, with the policy taking effect a year later, despite protests from Republican lawmakers about Kasich’s decision. 54,000 Ohioans enrolled in the program in 2014, and 234,507 enrolling or renewing their membership a year later. 

According to research conducted by the Center for Budget and Policy Priorities and published in 2019, the Affordable Care Act’s Medicaid expansion saved an estimated 19,200 lives for adults aged 55-64 from 2014-2017, including 1,452 Ohioans. 

“The lifesaving impacts of Medicaid expansion are large: an estimated 39 to 64 percent reduction in annual mortality rates for older adults gaining coverage,” wrote the study’s authors. 

Meanwhile, an analysis from Policy Matters Ohio released in 2018 stated that around 54,000 jobs in Ohio were directly supported by the state’s Medicaid expansion, and boosted disposable income by $2.7 billion for Ohio’s citizens. 

“Ohio’s expansion of Medicaid allows 691,803 more working-age people access to health care. A recent evaluation of the program confirmed that access to medical care resulted in improved health, including earlier diagnosis and timely treatment of chronic conditions,” wrote Policy Matter Ohio researchers Wendy Patton and Amanda Woodrum. 

However, last year, 609,517 Ohioans lost their Medicaid coverage after COVID-19 protections ended in April, with 73% of individuals being disenrolled because of procedural reasons. Another 86,000 Ohio children lost Medicaid coverage last year, causing HHS Secretary Becerra to send a letter to Gov. Mike DeWine saying, “Your state is among the nine states with the largest number or highest percentage of children who have lost Medicaid or CHIP coverage since full eligibility renewals for these programs restarted this spring.”

How Have Ohio Politicians Reacted? 

All three candidates in the Republican primary for Senate have expressed opposition to the Affordable Care Act. “Affordable Care Act had zero to do with affordability,” wrote Bernie Moreno in a Twitter post from July 27, 2022. 

Frank LaRose Tweeted on June 28, 2012 that he was “disappointed,” in the Supreme Court’s ACA ruling, writing it “may amt to billions in Medicaid cost for OH & huge tax spike on mdl class.” 

On Matt Dolan’s campaign website it states that Obamacare “was conceived wrongly, implemented poorly and has become a tool of partisan grift.”

Ohio Democratic U.S. Sen. Sherrod Brown voted for the Affordable Care Act and has consistently voted against efforts to repeal it.

Republican Party frontrunner for the 2024 nomination for president Donald Trump unsuccessfully tried to get the Affordable Care Act repealed during his first administration, and has vowed to repeal it if he wins in 2024.