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The federal government shutdown is now a record, and it's hitting home in Ohio.

We'll have a look at some of the issues involved and the impacts so far.

This weekend, the state of Ohio.

Welcome to the state of Ohio.

I'm Karen, counselor.

More than a half a million Ohioans rely on subsidies to get health insurance through the Affordable Care Act.

And the Republican backed one big, beautiful bill signed this summer made some changes to Medicaid expansion, which covers more than 745,000 Ohioans.

Health care is the epicenter of the dispute between Democrats and Republicans that has led to the federal government shutdown.

Statehouse correspondent Joe Ingles reports.

14 year old Audrey Anderson is.

Hilliard has a rare genetic disorder that results in serious intellectual and physical disabilities.

She needs a lot of specialized care, which she gets from Medicaid expansion.

That means that Audrey gets to live at home instead of an institution which just, you know, maybe four decades ago would be the, what Audrey's life would look like, not just now as a child, but as an adult as well.

But Medicaid waiver keeps children like Audrey in their homes and in their communities where they're loved and valued.

Audrey's mom, Sarah Bloom Anderson, is worried about what's been happening in Washington, D.C.

she and others who rely on Medicaid expansion recently sat down at a health care roundtable with Democratic former U.S.

Senator Sherrod Brown, who's running to regain a seat in that chamber next year.

Stephanie Murray, son, has intractable epilepsy.

He has full blown tonic clonic grand mal seizures.

And, they average about once a week and they're pretty awful.

And, he has a higher chance of what's called sudep, which is sudden, unexpected death in epilepsy.

And the more that he has seizures that kind of raises the percentage, the chances of death, like unexpected death because of the seizures.

Murray, of Dublin, says her son's condition is being helped by a medication that costs $40,000 a year.

Amber Richter's 15 year old daughter is also on Medicaid expansion for a rare genetic syndrome, because the coverage normally provided through a private insurance plan doesn't come close to meeting her needs for therapy, surgery and medications.

Just one drug is $4,500 a month.

Richter, of Columbus says she's worried changes to Medicaid expansion will lead to a loss of coverage, which could leave her financially ruined.

Hate in the system is oftentimes overwhelming.

It is confusing.

It is a heavy lift, and if you are not able to navigate that system or jump through the appropriate hoops, then you are at risk of losing it just because you didn't do the things that needed to be done in a timely fashion.

And like specifically for my family, my daughter has a genetic syndrome.

She's going to have it her entire life.

So the idea that we would need to, prove that or, you know, be to recertify by annually.

I shouldn't have to prove that she's still disabled.

It's it's offensive, quite frankly.

Recipients of Medicaid expansion are not the only ones who are concerned about changes in their health care plan.

530,000 Ohioans rely on subsidies for the Affordable Care Act.

People like Bruce Hoyt of Columbus.

I'm concerned about losing the subsidy that the Affordable Care Act provides because I'm self-employed, and that will double my health insurance costs, adding about $12,000 to my expenses for the year.

Hoyt says he cannot afford to keep that insurance if he can't get the subsidy.

Brown says Hoyt is not alone.

He says he's hearing from a lot of Ohioans who fear they or their families will lose health care because of changes in rules or lack of subsidies.

And he says Congress needs to fix it.

Republicans are in control.

House Senate president.

They can change.

They can fix this immediately.

They can.

They can freeze.

Health care costs, freeze, the benefits, the subsidies, the cost of ACA subsidies has soared over the last decade, from $18 billion in 2014 to an estimated $138 billion this year, according to the Committee for a Responsible Federal Budget.

The Congressional Budget Office estimates that extending those subsidies would cost $350 billion over ten years.

Democrats have said the subsidies need to be restored before they would vote to end the federal government shutdown.

Majority Republicans have said they won't negotiate on those subsidies until Democrats vote to reopen the government.

But some in the GOP, including those who have criticized Obamacare, have said they want to see those subsidies extended.

Brown will be running against Republican U.S.

Senator John Hughes dead next year.

Houston's office said he couldn't do an interview, but they sent over some statements.

When it comes to Medicaid changes, Hughes stead said through the budget law, we're saving Medicaid for the people.

It was designed to serve poor children, the elderly, those with disabilities and people truly in need to do this able bodied, healthy Americans without children can and should work, attend classes or give back to their communities in some way in exchange for their benefits.

As far as ACA subsidies, Hughes dad said he'd be happy to talk about those.

But putting money into the system is a Band-Aid on the problem.

And he called for Democrats to vote for a clean, continuing resolution to reopen the government.

Meanwhile, doctors throughout Ohio are urging lawmakers on both sides of the aisle to fix the issues with Medicaid expansion and the Affordable Care Act, including Central Ohio emergency Room doctor Laurel Barr after the ACA.

Rarely do I encounter patients who lack coverage due to preexisting conditions, but I commonly see patients who make hard choices about their health every day because they cannot access or afford the medications and health care interventions that will keep them healthy and alive.

Simply choosing not to fund the existing system without offering any alternative is just not just irresponsible.

It's deadly.

This week, the federal shutdown centered on health care coverage became the longest in U.S.

history.

Joe Ingles, Statehouse News Bureau.

Premiums for those who buy health insurance on the marketplace created by the Affordable Care Act are up by an average of 26% because of increased cost of medications, hospital and doctor visits, and tariffs on equipment and supplies.

But they're soaring, too, because of the expiration of enhanced tax credits that decrease subsidies that 92% of marketplace enrollees get to buy their insurance.

And that's hitting even as the federal shutdown is halting supplemental Nutrition Assistance Program or Snap benefits for food.

I talked about all that with Tara Britton, the director of public policy at the center for Community Solutions, which does research on policies related to health and poverty.

so I want to start with the subsidies for those who get their health insurance through the Affordable Care Act and the marketplace, which we just heard about from my statehouse news bureau colleague Joe Ingles.

The average increase is expected to be around 26% for 2026, but that means half of those increases are more than that.

What is the impact on the more than half a million Ohioans who rely on these subsidies to get health insurance?

Yeah.

So we're seeing increases to premiums, regardless of any of the conversation happening around what the tax credits and the expiration that really the government shut down is kind of focused in on.

We'll see those premiums increase.

And then when tax credits the enhanced version of them that we got through the American Rescue Plan and the Inflation Reduction Act, those are set to expire at the end of 2025.

And so premium increases plus the expiration of the tax credits.

We're looking at more than doubling some folks premiums.

And that means that we're going to see fewer people make that decision to enroll in health insurance.

And these were people who were going to the marketplace because they don't have an option to go to their employer or they don't have their self-employed there.

There are a lot of different reasons, but this is their option essentially.

Yeah.

And the Affordable Care Act, you know, when it was passed in 2010 and went into effect, we saw that there was this big swath of the population who had no access to health insurance.

They were working not enough hours.

They had a small business.

There were, you know, no other options.

And the Affordable Care Act gave them this option through the marketplace.

And then these tax credits made it affordable.

We all know that health insurance is one of the biggest expenses, even for those of us who have employer sponsored insurance.

You you know, you see those amounts have been going up over the last few years.

But right there, there weren't other options.

And these folks really won't have an affordable place to turn if these tax credits fully expire.

What is the ripple effect here?

I mean, obviously people can't get health insurance.

There is an effect on them and their family, but there's a wider effect here potentially as well.

Right?

Yeah.

And to not get too far into the wonky health policy conversation this, this change, the expiration of the tax credits with fewer folks there will mean that costs are going to go up for the rest of us.

The rest of the health care system, when you have, you know, a significant portion of the population uninsured, that doesn't mean they're not going to need health care at some point.

And so they will show up to emergency rooms, have to look at paying, you know, full freight for their care.

And that essentially ripples out into the rest of the health care system and increases premiums for others.

It means that the folks who are going to enroll in the marketplace are likely older and sicker, because they're making that decision.

Hey, I really do still need this coverage even.

It's going to cost me more.

But that means there are, you know, fewer dollars available in their budget for other things, too.

So, you know, health care is such a critical engine within the economy that it does not just impact the folks who have to go without coverage, make the case here for why the Affordable Care Act has been a good thing, that we've had critics still exist who say Obamacare didn't work as planned, that there are other methods, that other ideas that could be done.

Why is the Affordable Care Act something that Democrats have been standing behind and that advocates have been standing behind?

So the Affordable Care Act was designed to work as a three legged stool.

So it means that the law tells insurers they cannot discriminate against people with preexisting conditions.

That's one leg.

The other leg is the are the tax credits.

And so even we're talking about this sort of enhancement of them right now.

But those tax credits have been in place since the beginning of the Affordable Care Act.

That makes coverage more affordable for sort of those low to middle income folks.

And then the other piece of it is the mandate for coverage.

And that is something that has been long controversial in the conversation about the Affordable Care Act.

But the mandate says that everyone has to have some form of health insurance and brings everyone into the insurance pool.

Thinking of it like other types of insurance, you know, homeowner's insurance or car insurance, you have to have everyone in the pool to make it work.

Because if you only have people in the pool that are using health care all the time, it makes everything really expensive.

The first Trump administration, they didn't eliminate the mandate, but they eliminated the penalty for not having coverage.

So in essence, they eliminated the mandate without having that other leg of the stool.

The other pieces become a whole lot more, more weight is placed on them.

And so it has really worked to bring people into health insurance and make sure they have access, but we have to have more people in the pool.

And so, you know, I think having that conversation again about making sure all three legs are there to make the system work is, you know, what we've been talking about for a long time, let's talk a little bit about Snap.

The Supplemental Nutrition Assistance Program, 1.4 million Ohioans receive Snap benefits, and as of November 1st, stopped getting them.

Though it's kind of a staggered schedule, some still had benefits.

Remaining.

I want to ask you about the impact first on those recipients.

I mean, we keep hearing that it's Supplemental Nutrition Assistance, that nobody should be relying on it for food.

But these are people who are in that low income category where they're struggling with costs at the grocery store and having issues.

Absolutely.

So the way that snap works is it is meant to be supplemental.

But so the formula, I guess, is folks contribute about 30% are expected to contribute 30% of their net income toward groceries.

And so that's after, you know, deductions and things that everyone has health care costs, housing, things like that.

Then the the snap payment, the monthly payment makes up that difference.

And what is happening with folks not receiving their Snap benefits this month is they're still expected to contribute their 30%.

But you, you know, I think kind of move through that pretty quickly.

At the beginning of the month when you're paying for increasing cost of groceries and, to not have I think payments would have started on November 2nd.

So we're now at, you know, a couple days into the month, the folks who received their benefits, normally those first few days of the month are feeling that they've gone a month or more than a month without their snap.

as I just asked you before about, Affordable Care Act and the subsidies and the ripple effect here, there is potentially a ripple effect here as well, because you have not only people who are having trouble getting food, but then there's an economic factor involved in that as well.

Definitely.

And snap is really designed to, the origin of snap is for it to function in the, you know, competitive marketplace.

And so folks are getting their Snap benefits that they are spending in their communities.

You know, there are, certainly areas in the state of Ohio where there are not a lot of grocers or places to spend those Snap dollars.

And, when those are the anchors of small towns and villages across the state of Ohio, and that's many hundreds and thousands of dollars over of these few days that have not gone into the economy.

That definitely makes a difference.

You folks at the center for Community Solutions produce fact sheets about all of Ohio's 15 congressional districts.

And so statewide, 12.4% of Ohioans receive Snap benefits.

76.6% of those households have at least one adult who's working.

Absolutely.

And the range goes from 6.6% of the population in district seven, which is represented by Republican Congressman Max Miller, to 22.3%, which is in the Cleveland area, represented by a Democratic congresswoman, Shantel Brown.

So it really is the whole state, though it's affecting different parts of the state in different ways.

It does.

Yeah.

And I mean, and I think it's partially based on population centers and things like that where, where folks are living.

But poverty spans both, you know, rural, urban, increasingly I think suburban areas across Ohio.

So this is being felt everywhere.

There were already cuts expected with snap from the measure that was known as the One Big beautiful Bill.

Are you concerned that snap is never going to come back to what it was, especially since those cuts were kind of in the background throughout this whole conversation?

I think there is a lot of confusion about the changes happening in Snap right now.

So we're dealing with the impact of the shutdown in the Snap program and a few others that have been, you know, sort of acutely felt these first few days of November.

But the changes to snap that were in air 1 or 1 day, beautiful Bill were set to go into effect November 1st.

And so there's an expansion of work requirements for more individuals who are enrolled in Snap.

There are categories of immigrants, legal immigrants who are no longer going to be eligible for Snap.

And so that's all happening in the midst of this.

And the counties who determine eligibility and field all of the calls and inquiries about these programs are really trying to navigate how best to communicate to, the constituents in their, their counties.

We're working really closely with Cuyahoga County to help develop, what we're calling a toolkit right now to sort of communicate about these changes.

But I can tell you, like, the number of changes we've had to make to these documents based on things constantly being in flux, constantly getting new, guidance from the federal government.

And, the state is doing their best to kind of field that information and communicate it out.

And so it has really, I think, just confusion abounds as it relates to snap right now.

And when costs have been going up and folks are facing, you know, I think a time when, you know, people are gathering for holidays and things, it's a lot harder to navigate not having clarity on what it means to be someone enrolled in Snap.

Are you concerned that all of these obstacles and especially this, that you have, you know, three quarters of people who are getting Snap benefits?

There's one person in the family who's working so that time is limited.

There's all these obstacles to try to get these benefits that some people will just say it's, I can't handle it.

It's too much.

I'm not going to I'm not going to bother with it.

I think there will be people who do actively make that decision, and I think there will also be folks who fall through the cracks.

So they are busy.

They're parents.

They're older adults who might be caring for people in their home.

They might be a caregiver in the sandwiched generation of both an older adult and a younger child.

And they missed the phone call.

They missed the letter.

The counties are doing a whole lot more with less over these last few years.

And so the capacity to reach people, you know, I think they're doing the best that they can.

But it has it will be some folks saying, well, these this especially this month with the partial benefits expected if they come in the next few weeks, you know, that folks might make the decision, but we're certainly encouraging people to keep applying, keep keep up with, all of the documentation that is required.

But I, I could understand how someone is in those tough spots.

It can also be said that, hey, there's food banks for people who need assistance.

But even governor Mike DeWine has said that that's not a substitute for snap.

It's not a substitute for I mean, the state put in some money toward food banks and other benefits, but that's not a substitute for what's missing here in the food banks themselves will tell you that there is no way they can fill the gap that is created by snap.

So it's, you know, they're they're a vital safety net in our communities.

And I know how much we appreciate their role on an ongoing basis and the support that they've been given by the state and local communities around Ohio.

But they can't fill the gap.

Our community is going to have to step in and do more and find other ways to try to help this population.

I think it's certainly, kind of twofold the the piece around making sure that communities have what they need in terms of clear, consistent information.

And then the other part is money.

Certainly, as much as, you know, local communities can support food banks and things, but making it, really, accessible and tangible for folks I know, you know, we've received communication from local school districts about how they're trying to step in and help and make, connections with families.

And it is really tough to navigate all of that.

But I do think local communities are doing the best they can right now.

One of the other things that's been happening throughout the shutdown and as a reporter, I've seen this when I go to websites to try to get data and information.

There are a lot of government websites that are just not updating because the government shut down.

Right?

You rely on some of that data to produce the reports and the things that you do.

This is this is a real impact for people who look at that data and use it to make policy decisions.

Yes.

And we certainly encourage every, everyone to reach out to agencies and, and folks who supply that data to make sure that it's going to continue to be updated.

But we've seen since the shutdown, and I think even before that, with this sort of move toward looking at helping government become more efficient, which I think is a worthy goal, we've sort of just said, well, we're not going to do this anymore before we understand what it's doing, what it's telling us.

We know that there are some sources of data around food insecurity that are just not going to be tracked anymore.

And so that is a vital piece of information that tells us something about our neighbors and friends and family in our community and their access to healthy food.

We know that, you know, some of the data around the economy and things aren't being reported as consistently.

So I think it's it's sort of a twofold, the government shutdown is certainly impacting the availability of that more real time, routinely updated data.

And then there's this other piece of were sort of constantly, I feel like finding new pages that have a, you know, website not answering go over here sort of response.

And, and that is, challenging to navigate as a researcher, people who do research, are you concerned about the quality of data that is available?

Because it seems like there's a partizan bent that's coming through in some of the data.

Now, some people would argue there and always has been.

But I mean, numbers are numbers.

And are you concerned that certain numbers are just not going to be there anymore, or that the numbers are not being reported the way that they have been in the past?

I think we're still trying to gauge that.

There are lots of conversations and things we hear announced or, posted on social media that I don't know that those always come to fruition.

But as we are navigating those different sources and checking to see if you know how they compare to past years and things like that, where we're navigating all of that.

Some final shutdown notes to Ohio headstart.

Classrooms in Sierra and Highland counties have closed for lack of federal funding to more programs in Sierra and Allen counties are likely to shut their doors in the next week, meaning more than a thousand kids and their families will not have access to the educational services headstart provides for low income Ohioans, and while the estimated 83,000 federal employees in Ohio are feeling the shutdown impact, as many as 9000 state employees across six agencies could face furloughs if federal funding is halted, The Department of Administrative Services said in a statement.

Those agencies are the adjutant general, the Ohio Environmental Protection Agency.

Opportunities for Ohioans with disabilities, the Ohio Department of Health, the Ohio Department of Job and Family Services, and the Ohio Department of Public Safety.

But Das stressed its announcement about the potential for furloughs was informational only.

Contracts between agencies and unions require notification of funding interruptions 14 days in advance, and affected workers would be notified individually.

So for now, those employees are at work and getting paid.

And that is it for this week.

For my colleagues at the Statehouse News Bureau of Ohio Public Media.

Thanks for watching.

Please check out our website at State news.org or find us online by searching the State of Ohio Show.

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And please join us again next time for the state of Ohio.

Support for the Statehouse News Bureau comes from Medical Mutual, dedicated to the health and well-being of Ohioans, offering health insurance plans, as well as dental, vision and wellness programs to help people achieve their goals and remain healthy.

More at Med mutual.com.

The law offices of Porter, right, Morris and Arthur LLP.

Porter, right, is dedicated to bringing inspired legal outcomes to the Ohio business community.

More at Porter.

Right.

Com Porter Wright inspired every day.

You know, Ohio Education Association representing 120,000 educators who are united in their mission to create the excellent public schools.

Every child deserves more at o h e talk.