The prevalence of enrollment in employer-sponsored insurance (ESI) decreased from 55.3% to 51.9% between 2010 and 2021. Despite the significant disruption to the labor market during the COVID-19 pandemic, estimated rates of ESI did not decline for adults 19-64 between 2019 and 2021 (51.3% in 2019 vs. 51.9% in 2021). By contrast, the American Community Survey (ACS) found that the estimated rate of ESI for Ohio adults in this age group fell modestly from to 66.8% in 2019 to 65.4% in 2021. The methodologies for OMAS and ACS are not directly comparable because each survey asks respondents about private insurance in different ways, so overall estimated ESI levels may differ, although both surveys are consistent in showing a longer-term decline in ESI rates over the last decade. The The prevalence of enrollment in Medicaid increased from 11% to 25.2% between 2010 and 2021, with an increase of 5.4 percentage points between 2019 and 2021 alone. The prevalence of uninsured Ohioans decreased from 18.9% to 8.1% between 2010 and 2021.

Between 2019 and 2021, the prevalence of children enrolled in Medicaid increased 4.4 percentage points from 42.6% to 47%. As of 2021, Medicaid and employer-sponsored insurance were the most common forms of health insurance coverage for children in Ohio, with 47% of children enrolled in Medicaid and 44.5% in employer-sponsored insurance. The prevalence of uninsured children has been cut nearly in half since 2019, with 4.7% of Ohio children uninsured in 2019, versus 2.4% in 2021.

Most Ohio adults receive routine health care from a doctor’s office or health center; this has increased from 61.3% in 2019 to 72.1% in 2021. The prevalence of those who had no usual source of care increased slightly, from 10.2% in 2019 to 12.6% in 2021. The proportion of Ohio adults reporting their usual source of care at a hospital emergency room was reduced by half, from 9.3% to 4.5% between 2019 and 2021.

Those who are potentially Medicaid-eligible and uninsured are most likely to have no usual source of care and this prevalence has increased by 16.1 percentage points from 2019 to 2021 (from 26.5% to 42.6%). Amongst the potentially Medicaid-eligible population with other insurance, the estimated rate of no usual source of care has nearly doubled, from 8.4% in 2019 to 14.6% in 2021. There has additionally been a modest increase in no usual source of care for those enrolled in Medicaid (from 7.8% in 2019 to 11.2% in 2021).

Across county types, shifts in place of usual source of care mirrored the state overall–a reduction in reliance on hospital emergency rooms and other places (e.g., clinic in a pharmacy or grocery store, urgent care), paired with an increase in use of a doctor’s office or health center. Ohio adults in Appalachian counties have some of the lowest rates of use of doctor’s office or health center for care (69.0% in 2021), while Ohio adults in Rural Non-Appalachian counties have some of the highest rates (77.1% in 2021). Appalachian counties also saw the greatest increase in having no usual source of care (13.8% in 2021, up from 9.4% in 2019).

The primary source of care for children in Ohio remains a doctor’s office or health center, with an estimated 89.6% receiving their usual care at this type of location in 2021. An estimated 1.7% of children do not have a usual source of care, which has remained the same between 2019 and 2021. Reliance on hospital emergency rooms as a usual source of care remains rare, with 2.0% of Ohio’s children using this as a primary location for health care in 2021, versus 3.7% in 2019.

Regardless of insurance status, the most common source of care for Ohio children is a doctor’s office or health center. An estimated 87.9% of children enrolled in Medicaid receive care at this type of location, compared to 84.9% of those who are potentially Medicaid-eligible and have other insurance. The estimated rates of receiving routine care at a doctor’s office or health center has decreased substantially amongst uninsured but potentially Medicaid-eligible children, from 62.5% in 2019 to 48.0% in 2021.

In all county types, around 90% of children’s place of usual source of care was doctor’s offices or health centers. Children in Metropolitan counties have a higher rate of using hospital emergency rooms (2.5% in 2021) than children in Appalacian counties (1.9% in 2021), though the rate in Metropolitan counties has decreased (5.0% in 2019). Children in Appalachian (8.0%) and Rural Non-Appalachian (6.9%) counties have a higher rate than Suburban or Metropolitan county types of using other sources of care such as urgent care centers, or clinics in a pharmacy or grocery store.

Despite the rise of telehealth capabilities during the COVID-19 pandemic, in 2021 only two-thirds of children in Ohio had not had a telehealth visit within the past 12 months. In the same year, an estimated 22.2% of children had 1-2 telehealth visits while 11.2% had at least 3 telehealth visits. Telehealth visits were used slightly more by Medicaid-enrolled children (36.8% had 1 or more telehealth visits) than those with ESI (30.0% had 1 or more visits).

Overall, Ohio adults were less likely to go to the doctor’s office in 2021 as compared to 2019. This reduction particularly impacted routine visits, in which adults were an estimated 11.4 percentage points less likely to have a doctor’s visit for a rountine check-up in 2021 than in 2019 (from 78.5% in 2019 to 67.1% in 2021). Ohio adults were 4.8 percentage points less likely to have any type of doctor’s visit in 2021 than in 2019 (from 81.8% in 2019 to 77.0% in 2021). Rates across insurance types are similar over time to the rates for all Ohio adults.

Emergency room (ER) utilization decreased slightly between 2019 and 2021 - while an estimated 70.2% of Ohio adults did not go to the emergency room in the past 12 months in 2019, 74.3% did not in 2021. While this decline in ER utilization was consistent for both ESI and Medicaid-insured persons, Medicaid-enrolled adults remain more likely to visit the ER with 43.8% with at least one visit in 2021 as compared to 17.8% of ESI insured persons.

Emergency room visits were less likely in 2021 as compared to 2019 across all insurance types. This difference is most pronounced amongst those who are potentially Medicaid-eligible, but uninsured, with an 11.7 percentage point decline in emergency room use, from 41.3% to 29.6%, between 2019 and 2021. In all years, Ohio adults enrolled in Medicaid were more likely to have visited the ER in the past 12 months relative to other groups.

Well-child and doctor’s office visits have remained relatively stable since 2017 for children covered with ESI. Medicaid-enrolled children saw a small 3.7 percentage point drop (from 93.9% to 90.2%) in doctor’s visits of any kind and a 4.3 percentage point decline (from 85.2% to 80.8%) in well-child visits from 2019 to 2021.

The prevalence of Ohio adults rating their health as “fair” or “poor” has decreased slightly since 2012, from 20.0% to 16.2% in 2021. Medicaid-enrolled adults are consistently more likely to report “fair” or “poor” health status (31% in 2021) as compared to potentially Medicaid elgible adults with or without insurance and Ohio adults overall.

Mental health impairment (MHI) is defined as self-reporting that stress, depression, and problems with emotions or substance abuse routinely prevent one from engaging in their work or usual activities. Overall, those reporting MHI for significant portions of the month has increased steadily since 2015. In all years, Medicaid-enrolled adults are at least twice as likely to report MHI than Ohio adults overall.

The prevalence of children experiencing ACEs decreased slightly between 2019 and 2021. While an estimated 51.8% experienced 0 ACEs in 2019, this increased to 55.3% in 2021.

The estimated percentage of children with 0 ACEs has increased amongst Metropolitan and Rural Non-Appalachian county types between 2019 and 2021. However, Rural Non-Appalachian counties also saw the greatest increase in having 4-8 ACEs (7.6% in 2019 to 10.6% in 2021).

The percentage of those reporting 0 ACEs between 2019 and 2021 has increased most amongst children enrolled in Medicaid, with an estimated 5.8 percentage point increase from 35.2% to 41% between 2019 and 2021. Those who are potentially eligible for Medicaid but uninsured saw an increase nearly 4 percentage points from 48.4% to 52.1%, while those who are potentially eligible and insured experienced no change (around 58% in both years). In both years, ACEs were reported for more children enrolled in Medicaid than in other groups.

The proportion of Ohio adults in extreme poverty, indicated by income in the 0-75% FPL category, rose from 13.5% in 2019 to 18.9% in 2021. With some exceptions, adults are eligible for Medicaid coverage if they earn 138% FPL or below. This proportion of Ohio adults in this group increased from 26.9% in 2019 to 29.4% in 2021.

The share of Black Ohioans with a household income at 138% FPL or lower increased by 8.8 percentage points between 2019 and 2021. No other race/ethnicity group in the state experienced a comparable change during this time period. There was a 2.1 percentage point increase in the share of White Ohioans with a household income at 138% FPL or lower between 2019 and 2021.

All counties in Ohio experienced an increase in the proportion of residents at or below 138% FPL between 2019 and 2021. The largest increase is amongst the Rural Non-Appalachian counties (22.3% to 26.1%) and Appalachian counties (29.5% to 33.2%).

Across the Ohio population overall, the prevalence of working adults declined slightly, from 71.5% to 69.4%, between 2019 and 2021. The prevalence declined most sharply amongst those who are potentially eligible for Medicaid, but uninsured, from 65.0% in 2019 to 54.6% in 2021. The prevalence of working adults among those who are potentially Medicaid-eligible and insured increased from 63.5% in 2019 to 66.4% in 2021.

Compared to the overall population of working-age adults in Ohio, those who were enrolled in Medicaid, as well as those who were potentially eligible, but uninsured reported higher rates of losing a job since March 2020. An estimated 18.3% of Ohio adults lost a job since the start of the pandemic, compared to 32.6% of those enrolled in Medicaid, and 43.4% of those who were potentially eligible, but uninsured.

Across all groups, it has become harder to pay rent or mortgage, relative to 2019. Overall, an estimated 27% of Ohio adults had greater difficulty paying for housing in the last 12 months in 2021, compared to 16.4% in 2019. The increase between 2019 and 2021 was greatest for adults enrolled in Medicaid and adults who are potentially eligible for Medicaid, but uninsured. In 2021, an estimated 42.1% of adults enrolled in Medicaid and 45.5% of those who are potentially eligible for Medicaid but uninsured found it harder to pay for housing in the last 12 months.

23% of Ohio adults had problems paying medical bills in 2021. The prevalence of having difficulty paying for medical bills has generally declined since 2017, with the sharpest decrease amongst those who are potentially Medicaid-eligible, but uninsured (from 58.3% in 2019 to 41.9% in 2021). Potentially Medicaid-eligible adults who were uninsured consistently reported the highest rates of difficulty paying for medical bills.

Cigarette use amongst adults has steadily declined since 2012, both amongst the Ohio population overall and those who are enrolled in Medicaid, excluding an increase from 42.4% to 46.1% among those enrolled in Medicaid from 2015 to 2017. This decline continued between 2019 and 2021 and was the largest estimated decrease observed between survey years. There was a 6.4 percentage point reduction in cigarette use amongst the overall population of Ohio (from 25.6% to 19.2%), approximately a 12 percentage point reduction amongst the potentially Medicaid-eligible, both insured (from 26.8% to 15.2%) and uninsured (from 40.9% to 29.3%) persons, and an 8 percentage point reduction amongst those enrolled in Medicaid (from 45.3% to 37.1%).

E-cigarette use was slightly more prevalent amongst Ohio adults in 2021 as compared to 2019, with an estimated increase of 0.8 percentage points from 6.1% to 6.9%. There was a 2.6 percentage point increase amongst those enrolled in Medicaid from 7.9% to 10.5% between 2019 and 2021.

The prevalence of those who report consuming alcohol in the past 30 days has generally increased since 2012. However, rates have leveled amongst the general Ohio population between 2019 and 2021, decreasing by an estimated 2.8 percentage points, from 45.4% to 42.6%, amongst those enrolled In Medicaid during that time and 7.3 percentage points, from 51.3% to 44%, amongst those potentially Medicaid-eligible without insurance. Medicaid-enrolled adults consistently reported lower rates of alcohol consumption in the past 30 days when compared to the general Ohio adult population (42.6% vs. 59.5% in 2021).

Despite the slightly lower rates of alcohol use overall in Ohio, binge drinking increased slightly between 2019 and 2021, both amongst the Ohio population overall with an estimated 1.9 percentage point increase from 25.5% to 27.4%, and those who are enrolled in Medicaid with a 0.8 percentage point increase from 19.9% to 20.7%. Rates of binge drinking among Medicaid-enrolled adults has been consistently lower than the general Ohio population since 2012 (20.7% vs. 27.4% in 2021).

The prevalence of cannabis use amongst Ohio adults, as well as Medicaid-enrolled adults, remained largely unchanged between 2019 and 2021 with higher prevalence of cannabis use among Medicaid-enrolled adults in both . Potentially Medicaid-eligible individuals saw greater reductions in cannabis usage, with an estimated 3.6 percentage point reduction (from 16.6% to 13.0%) for those with insurance and an estimated decline of 8.5 percentage points (from 29.2% to 20.7%) among those without insurance.

Loneliness - feeling isolated, left out, or lacking companionship - increased between 2019 and 2021. Loneliness increased from an estimated 20.3% in 2019 to 26.3% in 2021 across Ohio adults overall, with sharp increases amongst those who are Medicaid-enrolled (36.0% in 2019 vs. 42.4% in 2021) and those who are potentially eligible for Medicaid but uninsured (34.8% in 2019 vs. 41.9% in 2021).