Navigator cuts leave Americans with less help finding Obamacare plans

CINCINNATI – For four years, Kimberly Dudley has worked as a navigator on the front lines of the Affordable Care Act, helping Ohioans solve the puzzle of purchasing private insurance on the federal marketplace HealthCare.gov.

But the task is now more complex, the answers more concise. In one of its first acts, the second Trump administration cut annual funding for seafarers by 90%, from $100 million to $10 million, saying the program was wasteful. Under the ACA, better known as Obamacare, navigators help educate and enroll people — especially those living in hard-to-reach communities. They were paid via a usage fee on monthly premiums.

In January 2025, 50 navigators served Ohio’s 88 counties, using their laptops to meet Ohioans in rural libraries and suburban food courts to help them find a health insurance plan in the market. But when open enrollment began Nov. 1, the busiest time of the year, only five Navigators remained. Dudley from Cincinnati is one of them.

Married with one child, she was hired at the Freestore Foodbank in Cincinnati in 2022 and found “such joy in helping people, even though things have been difficult this year.” The hotline, for example, is now in Dudley’s hands. The other navigators who made calls were fired.

The government did not respond to requests last week to discuss cuts to the Navigator program. But when we announced the cuts last year, says a government statement: “Navigators do not recruit nearly enough people to justify the significant amount of federal money previously spent on the program. This reduction will ensure that funding is directed more efficiently and effectively toward achieving the program’s statutory goals.”

Dudley’s task became even more complex behind schedule last year when the Trump administration and Congress allowed certain pandemic-era subsidies to expire Insurance premiums rose sharplyoften more than many Ohioans can pay.

She hears the stories every day on her own phone, which doubles as Ohio’s ACA hotline. People call when they don’t qualify for Medicaid, usually because their income is too high. In early March, Dudley heard from Tonya Horn, 59, of Cleveland Heights, who needed help.

Throughout her career, Horn said, she was fortunate to have employer-paid health insurance benefits until her most recent job, when she worked remotely for Empower, a financial services company in Colorado, as a manager of talent acquisition and diversity programs. But last year, her job at Empower felt less secure. Her pink panties arrived in January.

While helping Horn, Dudley discovered a plan on HealthCare.gov that would cost $450 a month with no deductible with an income-based subsidy. But then Dudley learns that Horn’s doctor doesn’t accept this insurance plan.

“I don’t know if this will work for you,” Dudley said, “but getting insurance might require a change of doctor.”

Horn sighed. “Can we keep looking?”

Withdrawal from enrollment

This year, enrollment in the HealthCare.gov marketplace in Ohio fell 20%, the second-largest decline among the 50 states. The whole national enrollment slipped by 5%.

Experts in Ohio said a few factors were depressing enrollment. Some people have moved on to Medicare. Others found jobs with health benefits. A key factor, however, was the expiration of pandemic-era subsidies for most market plans on December 31.

The ACA provides premium subsidies based on income, but the federal government began offering additional help in 2021 as short-lived pandemic relief. The “enhanced” subsidies will reduce many people’s monthly premiums by hundreds of dollars.

They also helped augment the number of people buying health insurance on insurance markets from 11.4 million people in 2020 to 24.3 million last year.

Americans who had the increased subsidies were warned by their insurers that they would expire on December 31st. As of March 26, the number of Americans with market coverage has fallen by about 1.2 million compared to 2025, according to the Centers for Medicare and Medicaid Services.

Last week, a spokesman for U.S. Sen. Jon Husted, an Ohio Republican, said Husted had proposed extending the subsidies for two more years, with up-to-date restrictions to prevent fraud in market plans. Democrats rejected the idea, said Joshua Eck, Husted’s deputy chief of staff. “But if they had supported the bill or been willing to discuss it, this issue probably would have been resolved in December.”

In Ohio, the Columbus-based nonprofit research group Health Policy Institute of Ohio found that of the more than 580,000 Ohioans with HealthCare.gov plans for 2025 Almost 90% took advantage of the short-lived grants.

California and at least nine other states who operate their own health insurance marketplaces State money to help residents absorb the expiring price shock, although only New Mexico fully fills this gap. Ohio could not intervene in its budget in this way because it uses the federal marketplace.

In January the Ohio Health Policy Institute It is estimated that premiums for marketplace plans in Ohio would augment by an average of 114% in 2026. Brian O’Rourke, an analyst at the institute, said: “It is reasonable to expect that (the enrollment decline) is due to the phasing out of subsidies.”

On the nationwide ACA hotline call with Horn, Kimberly Dudley said her own mother received a notice from her insurance company that her monthly premium would augment from $40 to $400. “I was able to help her come up with a plan, but her premium still went up a little,” Dudley said. “We will find a way forward for you.”

“I hope so,” Horn said.

Ohio expands the ACA

Ohio’s industrial base collapsed in the 1990s and hundreds of thousands of workers lost their employer-paid coverage. Young people left Ohio to work, and the insurance pool shrank as people aged. Numerous studies have found that Ohio’s health is deteriorating, in enormous part because nearly 1.5 million Ohioans, more than 10% of the population, lacked health insurance.

The ACA also allowed states to expand Medicaid to adults with incomes up to 138% of the poverty level, although some Republican-led states have rejected the expansion. In Ohio, Republican Gov. John Kasich pushed the Republican-led state legislature to approve the expansion in 2013; 40 states and the District of Columbia have expanded their programs. Ohio’s participation in the federal market grew through 2025, when enrollment reached a record high.

The pace of withdrawal of the ACA in Ohio had rapid consequences. The Columbus nonprofit group UHCAN Ohio “has been helping people since the law was introduced,” said Executive Director Charlotte Rudolph. Then last fall: “If we saw five people, maybe one would be enrolled. They make the hard decision to say, ‘I hope I don’t get sick.'”

“We’re now looking through our archives and asking ourselves: How did we help people back when they didn’t have insurance?”

The Trump administration’s cuts to Medicaid are further complicating Ohio’s health care horizon. More than 3 million Ohioans employ the health care program for low-income residents. But under the sweeping tax and spending measure President Donald Trump signed last summer, that number is as high as one in 10 of those Ohioans could be found to be ineligible through up-to-date work requirements and other hurdles.

Horn said in the hotline call that her $624 weekly unemployment benefit exceeded the Medicaid limit. Dudley nodded as she typed on her keyboard. “I hear that a lot,” she said.

What the future brings

While the immediate problems are straining the system, experts say they are concerned about the future of health care in Ohio.

Uninsured people often employ emergency rooms for primary care, straining hospitals still under pressure from the pandemic and understaffed. Many Ohioans who receive Medicaid live in rural areas where the safety net has long been frayed. The trade group Ohio Hospital Association told the state legislature last year that more than 70% of the state’s rural hospitals have been in the red for years.

“My fear,” said Grace Wagner of the Ohio Association of Foodbanks, “is that policymakers are not aware of these changes and are not prepared to respond to them.”

Dudley and Horn spent another 30 minutes on the ACA hotline, but none of the HealthCare.gov options clicked. Finally, Horn said she would call back.

“Sure, there’s a lot to think about,” Dudley said, ending the conversation. Then she sat there looking at her laptop screen full of HealthCare.gov. She doesn’t like to leave a mystery unsolved for someone who has asked her for help.

“I love what I do. It’s amazing to be able to do this work, even in the midst of all this,” she said. “But there are times when I feel a little overwhelmed.”