Ohioans who tried to obtain health insurance through HealthCare.gov, the online portal for Obamacare’s marketplaces, on its opening day likely ran into a few problems, ranging from delays to problems logging in.
Before logging in, participants typically go through a waiting period that can last up to a few minutes. During this time, a large message pops up that says, “Health Insurance Marketplace: Please wait. We have a lot of visitors on our site right now and we're working to make your experience here better. Please wait here until we send you to the login page. Thanks for your patience!”
Following the waiting period, logging in can become its own challenge. After entering a username and password, the screen often flashes a “Downstream Error,” occasionally joined with the incomprehensible code “E501.”
Even if someone manages to get through the issues and log in,
another error message can pop up that makes browsing insurance plans impossible.
The problems aren’t necessarily unexpected — new software often launches with glitches that are later patched up — and the U.S. Department of Health and Human Services (HHS) is asking participants to be patient.
“We’re building a complicated piece of technology, and hopefully you’ll give us the same slack you give Apple,” HHS Secretary Kathleen Sebelius told reporters at a Sept. 30 briefing.
Federal officials also caution that Oct. 1 is just one day of the six-month enrollment period, which will last through March. And even if someone did manage to sign up on the first day, none of the insurance plans begin coverage until Jan. 1.
Once the marketplaces do work correctly, officials promise that they will allow Cincinnatians to browse, compare and select from 46 different private insurance plans that range from a “bronze” plan that costs and covers the least to a “platinum” plan that costs and covers the most.
The plans’ raw premiums are also 16 percent lower than the federal government previously projected, according to the latest Congressional Budget Office numbers. An Ohio 27-year-old making $25,000 a year will be able to buy a “silver,” or middle-of-the-pack, plan for as low as $145 a month after tax credits, while an Ohio family of four making $50,000 a year will be able to pay $282 a month for a similar plan. Without the tax credits, the individual will pay $212 a month and the family of four will pay $768 a month.
Participants must make between 100 percent and 400 percent of the federal poverty level a year, or $11,490 to $45,960 in annual income for an individual, to be eligible for tax credits. Higher income levels will get smaller subsidies; lower income levels will get larger subsidies.
Anyone interested in the marketplaces can browse options and sign up online at HealthCare.gov, by phone at 800-318-2596 or in person at various locations, including community health centers and the Freestore Foodbank.
Updated: Added more details about tax subsidies in Ohio’s marketplaces.
Limitations imposed by Ohio lawmakers who oppose the Affordable Care Act (“Obamacare”) have forced Cincinnati Children’s Hospital Medical Center to give up a $124,419 federal grant that would have gone toward helping uninsured Ohioans navigate new online marketplaces for health insurance.
Specifically, the state law, which Gov. John Kasich signed on April 30 and went into effect on July 30, excludes any organization that receives payments from a health care payer, such as an insurance company, from being designated as a “navigator.”
The designation is necessary for Cincinnati Children’s Hospital to receive the federal grant, which is part of national outreach efforts to enroll as many Americans, especially young adults, into Obamacare’s online marketplaces when they open for enrollment on Oct. 1.
Without the designation, Cincinnati Children’s Hospital was forced to give up the federal money, Cincinnati Children’s Hospital spokesperson Terry Loftus told CityBeat.
State legislators passed the restrictions to clarify regulations on navigators that avoid potential abuses and conflicts of interest.
But Obamacare’s supporters claim the state law is part of a nationwide effort from state and federal Republicans to make Obamacare more difficult to implement.
The federal government intends to sign up 7 million people into Obamacare’s online marketplaces, but 2.7 million have to be young adults to keep costs low. Otherwise, older, less healthy Americans will fill up the marketplaces, exhaust health services and drive up costs.
Supporters of Obamacare acknowledge that signing up so many young adults will be difficult, so they’ve taken to national and state-by-state education campaigns that tell young adults about the benefits and cost savings made available through the president’s signature health care law. These campaigns are being headed by various organizations that have been dubbed “navigators.”
But opponents, particularly Republicans, are preventing some of the efforts by investigating navigators and passing legislation in state governments that limits what navigators can do and who can be classified as a navigator.
Most recently, Republicans in the U.S. House Energy and Commerce Committee sent a letter to groups participating in the navigator program with a series of accusations and questions.
“This is a blatant and shameful attempt to intimidate groups who will be working to inform Americans about their new health insurance options and help them enroll in coverage, just like Medicare counselors have been doing for years,” Erin Shields Britt, spokesperson for the U.S. Department of Health and Human Services, told The Hill.
For the uninsured, not knowing about the online marketplaces could mean losing out on opportunities to obtain health insurance at lower costs. Recent reports have found that Obamacare’s online marketplaces and tax subsidies will lower costs for Ohioans in the individual health care market.
An Aug. 29 study from the RAND Corporation, a reputable think tank, found health care premiums will rise to an average of $5,312 under Obamacare in 2016. Without the law, premiums would reach an average of $3,973 that year. But when Obamacare’s tax credits are plugged in, the average Ohioan will only pay a premium of $3,131 — $842 less than he or she would pay without the law.
Avik Roy, a conservative health care economist and prominent critic of Obamacare, found even better results for Ohio. His model found premiums will drop by 30 percent in Ohio, although they’ll rise by 24 percent on average for 13 states, including Ohio, and the District of Columbia as a whole. Unlike RAND, Roy’s calculations don’t take subsidies into account, so the final cost for the average Ohioan is likely much lower.
The numbers only apply to Ohioans in the individual health insurance market. Under Obamacare, individuals will be able to enroll for health insurance through an online marketplace. The majority of Americans who get health insurance through their employers or public programs fall under different rules and regulations.
It’s unclear how much Republican opposition will ultimately play into the numbers. But for Cincinnati Children’s Hospital, it means $124,419 less to help its neediest, less knowledgeable patients.
A seven-member legislative board on Monday accepted federal funding to expand Ohio’s Medicaid program to cover more low-income Ohioans for the next two years.
Republican Gov. John Kasich originally attempted to get the Medicaid expansion through the General Assembly, but he ultimately bypassed the legislature after months of unsuccessfully wrangling with members of his own political party to embrace the expansion.
Kasich instead opted to go through the Controlling Board, an obscure panel that typically handles less contentious budget issues that keep with legislative intent.
Most Republican state representatives, including local Reps. Lou Terhar, Louis Blessing and Peter Stautberg, signed a letter in protest of the tactic. The letter invokes legal arguments against the governor’s decision and could be the basis for a lawsuit in the future.
“Our protest is not about the merits or lack of merit in expanding Medicaid,” the letter states. “Our protest goes to the fundamental form of government upon which our country was founded — a Republic of checks and balances and separation of powers.”
Republican legislators say they’re concerned about the government’s involvement in the health care system and whether the federal government can afford to pay for the Medicaid expansion. They argue it would be better to pursue Medicaid reforms instead of expanding the program.
On the other side, Democrats, in a rare alliance with a Republican governor, applauded Kasich for embracing a cornerstone of President Barack Obama’s signature health care law.
Under Obamacare, the federal government asked states to expand their Medicaid programs to cover anyone at or below 138 percent of the federal poverty level, or individuals with an annual income of $15,856.20 or less. If states accept, the federal government pays for the full expansion through fiscal year 2016, and then gradually phases down its payments to an indefinite 90 percent of the expansion’s costs.
In comparison, the Kaiser Family Foundation found the federal government paid for nearly 64 percent of Ohio’s Medicaid program in fiscal year 2013.
The expansion is necessary to fill a so-called “coverage gap” under Obamacare and Ohio law. Without the expansion, parents with incomes between 90 percent and 100 percent of the federal poverty level and childless adults with incomes below 100 percent of the federal poverty level don’t qualify for either Obamacare’s tax credits or Medicaid.
The Health Policy Institute of Ohio previously found the expansion would insure between 300,000 and 400,000 Ohioans through fiscal year 2015. If legislators approve the expansion beyond that, the institute says it would generate $1.8 billion for Ohio and insure nearly half a million Ohioans over the next decade.
The federally funded expansion is set to begin in 2014. It will cost the federal government nearly $2.6 billion, according to the Ohio Department of Medicaid.
Pro-choice groups are criticizing Ohio House Republicans’ budget plan for pulling money from Planned Parenthood and shifting federal dollars to “anti-choice” crisis pregnancy centers.
The Ohio House Republicans’ budget plan would redirect federal funding for family planning services in a way that would strip funding for Planned Parenthood and family planning providers.
During hearings at the Ohio House Finance and Appropriations Committee today, multiple women’s health advocates, ranging from health experts to members of Planned Parenthood, said these services mostly benefit low-income women, particularly in rural areas. On the other side, representatives from anti-abortion groups spoke in support of the Ohio House Republicans’ measures, citing health care options, family values, abstinence and chastity.
Kellie Copeland, executive director of NARAL Pro-Choice Ohio, says the defunding measure has become a recurring trend for Ohio Republicans, who have taken up the Planned Parenthood measure multiple times in the past couple years. But she says the threat could have more weight this time around.
“This feels different,” Copeland says. “They’ve always kind of tried to hide it before. This time they were a lot more upfront about it. It seems like they may be willing to put political capital into this fight this time.”
A separate section of the Ohio House Republicans’ budget plan redirects federal funding to a program that will fund crisis pregnancy centers (CPCs), which provide abstinence-only family planning services.
Some researchers have found abstinence-only programs to be ineffective. A 2007 study published in the Journal of Adolescent Health
found abstinence-only programs have no impact on rates for teenage
pregnancy or vaginal intercourse, while comprehensive programs that
include birth control education reduce rates.
A 2011 study from researchers at the University of Georgia that looked at data from 48 states concurred abstinence-only programs do not reduce the rate of teenage pregnancy. The study indicated states with the lowest teenage pregnancy rates tend to have the most comprehensive sex and HIV education programs.
Still, a 2010 study from a University of Pennsylvania researcher found abstinence-only education programs may delay sexual activity. The study, which tracked black middle school students over two years, found students in an abstinence-only program had lower rates of sexual activity than students in the comprehensive program.
Some supporters say the Ohio House Republicans’ budget measures aren’t specifically about Planned Parenthood, abortion or birth control. Instead, they argue they’re trying to establish more health care options for women.
But the providers that would be able to get more funding already apply for it; they just lose out to Planned Parenthood’s services, which are deemed superior by state officials who distribute the funds during the competitive distribution process.
Copeland says “no thinking person” should fall for the reasoning given by Republicans and supporters who say abortion is not one of their concerns.
“They’re trying to impose their morals on you,” Copeland says. “These are not health care experts. These are not people who are trying to find real solutions for the problems that real people face. These are people who want to impose their personal views, their personal morality on you.”
Some anti-abortion supporters, including Denise Leipold of Right to Life of Northeast Ohio, say abortion and broader cultural issues are absolutely part of the reason they support the Ohio House Republicans’ budget plan.
“Our mission is to support the right to life from conception to natural death,” Leipold says. “Abortion happens to be a big problem right now because in the past 40 years it’s become part of the culture.”
She adds, “Now kids are learning that responsible sex means that you can have sex but just use birth control. That’s not supposed to be the attitude. The attitude is supposed to be that sex is for a committed relationship between a man and a woman in a marital relationship.”
During testimony today, Stephanie Kight, president and CEO of Planned Parenthood of Greater Ohio, asked state legislators to support the organization’s numerous medical services, including women’s health, family planning and sexually transmitted infection (STI) treatment.
Kight also said state and federal funds do not go to abortions. Planned Parenthood’s abortion services are instead funded by private donations.
At the hearings, Republican State Rep. Ron Maag asked Kight why Planned Parenthood doesn’t shut down its three abortion clinics in Ohio if those clinics are potentially threatening the “good work” Planned Parenthood does elsewhere. Kight said Planned Parenthood believes its abortion services are “good work.”
Here they go again. Republicans are renewing their anti-abortion agenda in Ohio. Two of the governor’s October appointments have been criticized by a pro-choice group, and the state legislature is now considering a new version of the heartbeat bill.
Yesterday, Senate President Tom Niehaus told The Cincinnati Enquirer that the Ohio legislature, in cooperation with anti-abortion groups, is giving another look at the heartbeat bill. When the heartbeat bill was first suggested, many on the left labeled it the most radical anti-abortion bill in the country. If it became law, the bill would have banned abortion as soon as a fetal heartbeat is detected, which is typically visible in ultrasounds by the sixth week of pregnancy, with no exceptions for rape, incest or the health of the mother.
Legislators and anti-abortion groups aren’t offering specifics on the new bill. Ohio Right to Life opposed the heartbeat bill when it was first suggested because the group believed it was too likely to fail in front of the U.S. Supreme Court, which upheld abortion rights in Roe v. Wade in 1973. The new version of the heartbeat bill will likely be retooled to sustain any court challenges.
Kellie Copeland, executive director of NARAL Pro-Choice Ohio, says Republicans haven’t taken the right lessons from the Nov. 6 election: “It’s clear that they didn’t get the memo. Pro-choice Ohioans overwhelmingly voted to re-elect President Obama and reject this war on women. Here we are, we haven’t even made it to the weekend, and our senate president is resuming attacks on women’s reproductive health care.” She added, “I think they didn’t care what Ohio women thought before the election, and it’s clear they don’t care now either.”
In response to questions about whether the governor will support a new heartbeat bill, Rob Nichols, spokesperson for Republican Gov. John Kasich, said in an email, “We are watching the Senate’s activity closely.”
A few appointments from Kasich have also come under scrutiny. On Oct. 12, Kasich appointed Marshall Pitchford, a board member at Ohio Right to Life, to a committee in charge of filling a vacancy in the Ohio Supreme Court. On Oct. 29, Kasich appointed Mike Gonidakis, Ohio Right to Life president, to serve a five-year term on the State Medical Board of Ohio, which is in charge of the state’s medical regulations.
In a statement, Copeland criticized the appointment to the Supreme Court committee: “Because legislation promoted by Ohio Right to Life is likely to come before the Ohio Supreme Court, it is inappropriate for Pitchford to be placed in a position where he can cherry-pick a justice to serve on that court.”
She also criticized the appointment of Gonidakis to the State Medical Board. Copeland says she’s “concerned” that he’s on the board to regulate and restrict access to abortions. “No group in the state of Ohio has done more to interfere with the private medical decisions of Ohio women,” she says. “For their leader to now be on the State Medical Board is completely inappropriate and disturbing.”
She added that the two appointments show Kasich is “playing a more active role in the war on women than Ohioans realize.”
According to Gonidakis’ biography on the Ohio Right to Life website, Gonidakis went to school for law at the University of Akron. No professional medical experience is noted.
Nichols said in an email the appointments should come as no surprise: “The governor believes strongly in the sanctity of human life, so it's a surprise that someone would be surprised that he practices what he preaches.”
If Tuesday's election was supposed to be a strong message from social progressives, women and younger voters, Ohio Republicans are not getting it. Instead, they are continuing their pursuit of the heartbeat bill. That’s what Ohio Senate President Tom Niehaus told The Cincinnati Enquirer yesterday. At the time the heartbeat bill was originally suggested, it was called the most radical anti-abortion bill in the country. Yet Republicans, in cooperation with anti-abortion organizations, are pushing a version of the bill once again. Ohio Republicans have also shown interest in continuing their crusade against Planned Parenthood, according to Kellie Copeland, executive director of NARAL Pro-Choice Ohio.
Cincinnati’s budget proposal is coming later this month. Specifically, Vice Mayor Roxanne Qualls says it will arrive Nov. 26. City Manager Milton Dohoney Jr. and his budget team are currently working on a budget to close a $40 million general fund deficit. One idea that was suggested recently in a memo was privatizing parking services, but it faces skepticism from Councilman P.G. Sittenfeld. The budget will first go through Dohoney, then the mayor and then City Council. However, this calendar year’s budget will only cover six months, and then the city will transition into filing budgets based on fiscal years on July 1.
To match some of Obamacare’s requirements, Ohio officials are considering a hybrid approach to health care exchanges. The exchanges are federally regulated insurance markets. As part of Obamacare, states have the option of creating their own exchange programs, which have to be approved by the federal government; setting up a hybrid approach, which is what Ohio is looking into doing; or putting the responsibility on the federal government.
During the lame duck session, the Ohio legislature will take up legislation to regulate puppy mills and election reform. Regulations on puppy mills were previously covered by CityBeat when a group tried to get dog auctions banned in the state. Election reform could mean a lot of things. The current Republican-controlled legislature previously tried to restrict and limit in-person early voting before repealing its own rules. Ohio Secretary of State Jon Husted has also suggested “more strict” voter ID laws.
In other election news, an upset federal judge demanded Husted’s attorneys explain a last-minute directive that changed rules on provisional ballots. U.S. District Court Judge Algenon Marbley told the lawyers, “You have a lot of explaining to do.” The directive, which Husted sent out Nov. 2, shifted the burden of providing identification for provisional ballots from poll workers to voters. Voter advocates argued the directive was against Ohio law and would lead to more provisional ballots, which are ballots filed when a voter’s eligibility to vote is uncertain, being wrongly rejected. Husted and Republicans were heavily criticized for alleged attempts at voter suppression in the run-up to the election.
City Council approved a $750,000 tax break for the E.W. Scripps Company. As part of the deal, Scripps will hire for 125 new local jobs and retain 184 current employees.
The Wall Street Journal covered
Cincinnati’s “pie war” between Frisch’s and Busken Bakery.
CincyTech, a nonprofit venture organization, has invested $14.3 million since it began five years ago. Its investments, which focus on information technology and life sciences, have helped create more than 360 jobs, according to company officials.
As part of a national movement, Cincinnati-based Kroger will be making an effort to hire more military veterans.Republican Gov. John Kasich is focused on his re-election bid for 2014. When asked about whether he will run for president in 2016, Kasich said he has not made any announcements. The news came shortly after the Ohio Democratic Party began printing signs that say “Kasich... you’re next” on one side and “2014 can’t come soon enough” on the other.
Ohio Treasurer Josh Mandel won’t be leaving state politics any time soon. He says he’ll be running for re-election in 2014. Mandel is the Republican who led a failed bid for U.S. Senate against Democratic incumbent Sherrod Brown. His campaign was notorious for its dishonesty.
U.S. Sen. Rob Portman, an Ohio Republican, may take up running the National Republican Senatorial Committee in 2014. That would put him in charge of managing the Republican Party’s senate campaigns for the year. Republicans are expected to make gains in the U.S. Senate in 2014 because 20 Democratic seats will be up for grabs, in comparison to 13 Republican seats, and 12 of the Democratic seats are in swing or red states.
Democrats in the U.S. House of Representatives won the popular vote, but they ultimately lost the House. The culprit for the discrepancy seems to be politicized redistricting. In Ohio, the Republican-led committee redrew congressional district boundaries to give Republicans an advantage. The First Congressional District, which includes Cincinnati, was redrawn to include Republican-leaning Warren County, which slanted the district in favor of Republicans and diluted the say of Cincinnati’s Democratic-leaning urbanites. On this year’s ballot, Issue 2 attempted to tackle the redistricting issue, but Ohio voters overwhelmingly voted it down.
Some scientists are really excited by the discovery of “Super Earth.”
What doomed the Mayans? Climate change.
A new poll from the Health Foundation of Greater Cincinnati found a clear majority of Ohioans supports the Medicaid expansion.
The poll asked a random sample of 866 Ohioans, "Generally speaking, do you favor or oppose expanding Medicaid to provide health insurance to more low-income uninsured adults?" About 63 percent of respondents said they favor an expansion, with a margin of error of 3.3 percent.
The poll found a partisan divide on the issue: About 82 percent of Democrats support the expansion, while 55 percent of Republicans oppose it.
The question was part of the Ohio Health Issues Poll conducted between May 19 and June 2. The University of Cincinnati's Institute for Policy Research has conducted the poll for the Health Foundation each year since 2005.
"The Health Foundation supports the expansion of Medicaid in Ohio because we believe that it will have a positive impact on the health of uninsured Ohioans who will be newly covered by Medicaid," said Health Foundation CEO Jim Schwab in a statement. "We also believe that expansion of Medicaid will have a positive impact on Ohio’s economy. This positive impact was validated in an economic impact study that the Foundation helped underwrite earlier this year. The OHIP findings show that the majority of Ohioans also support the expansion."
Under the Affordable Care Act ("Obamacare"), states are asked to expand their Medicaid programs to 138 percent of the federal poverty level, or an annual income of about $15,856 for a single-person household and $32,499 for a family of four.
For the first three years, the federal government would pay for the entire expansion. Following that, the federal government would phase down its support for the expansion to 90 percent of the costs, where it would indefinitely remain.
Earlier this year, the Health Policy Institute of Ohio released an analysis that found the Medicaid expansion would insure nearly half a million Ohioans and save the state about $1.8 billion in the next decade.
Although Gov. John Kasich supports the expansion, his Republican colleagues, who control the Ohio House and Senate, have so far passed on the expansion in budget plans and legislation.
In an April interview with CityBeat, Michael Dittoe, spokesperson for Ohio House Republicans, said the proposed federal commitment to the Medicaid expansion is unprecedented, which, according to Dittoe, makes Republican legislators skeptical that the federal government can live up to such obligations in the long term.
Bipartisan legislation introduced this week in the Ohio House and Senate would reform the Medicaid program — supposedly in a way that lowers costs without cutting services. But the legislation wouldn't take up the Medicaid expansion.
A poll analysis released today suggests more than 1.25 million Ohioans between the ages of 18 and 65 are uninsured, representing about 17 percent of the state’s working-age population.
The poll also found that working-age Ohioans are obtaining health insurance less through employers and more through public insurance programs like Medicare, Medicaid and veteran benefits.
About two in 10 working-age Ohioans use public programs in 2013, up from 12 percent in 2006. At the same time, 52 percent now get insurance through an employer, down from 64 percent in 2006.
The numbers are relatively unchanged from 2012, according to the analysis from the Health Foundation of Greater Cincinnati.
Nearly one in 10 of those who did have insurance also reported losing it in the past 12 months.
“Certain groups are more likely to experience insurance instability,” said Jennifer Chubinski, director of community research at the Health Foundation, in a statement. “Almost half of adults living below 100 percent of the federal poverty level, African-Americans and adults with less than a high school education were uninsured currently or at some point in the past year.”
The analysis also concluded that Ohioans with health insurance are generally healthier than those without it.
The results came from the 2013 Ohio Health Issues Poll, which between May 19 and June 2 interviewed 868 Ohio adults by phone. The poll had a margin of error of 3.3 percent. It was conducted by the University of Cincinnati’s Institute for Policy Research for the Health Foundation.
The poll’s findings could spur efforts to widen Medicaid eligibility in Ohio, which has become a contentious political issue fueled by mostly Republican opposition and Democratic support.
Under the Affordable Care Act (“Obamacare”), states are asked to expand the public insurance program to include everyone at or below 138 percent of the federal poverty level, or roughly $15,856 for a single-person household. If a state agrees, the federal government will pay for the entire expansion for the first three years then phase its support down to 90 percent, where it would indefinitely remain.
The offer presents a great deal for the state, according to the Health Policy Institute of Ohio. The think tank’s analysis found the expansion would insure roughly half a million Ohioans and generate about $1.8 billion in revenue for the state in the next decade.
But the Republican-controlled General Assembly rejected the expansion in the state budget, despite Republican Gov. John Kasich’s pleas to embrace the Obamacare initiative.
Legislators say they’re concerned the federal government won’t be able to uphold its commitment to Medicaid in the future. That, they argue, would leave Ohioans stranded if the state is forced to pare back benefits.
The federal government and states have jointly funded Medicaid programs around the nation since 1965. About 57 percent of the cost is carried by the federal government.
Still, the legislature will in the fall consider a standalone bill that would take up the expansion. But that bill will likely face continued opposition from tea party groups that are historically opposed to increased government spending at any level.
Whatever the case, legislative approval may be politically prudent: Earlier-reported results from the Ohio Health Issues Poll found 63 percent of Ohioans favor the Medicaid expansion.
The Centers for Medicare and Medicaid Services (CMS) unveiled price data today for more than 3,000 U.S. hospitals, revealing large price variations between hospitals around the nation, including in Cincinnati.
For treating chest pain, charges from three Cincinnati hospitals varied by thousands of dollars: Bethesda North charged on average $17,696, Christ Hospital charged $12,000 and University Hospital charged $10,130.
But the initial charge seems to have little relation to what Medicare ultimately paid out. In the three cases for chest pain, Medicare on average paid $3,242 to Bethesda North, $3,657 to Christ Hospital and $5,463 to University Hospital.
In other words, University Hospital charged about 57 percent of what Bethesda North charged, but University Hospital was ultimately paid 68 percent more.
The price variation wasn’t exclusive to chest pain, either. For major joint replacement or reattachment of a lower extremity without major complications, Bethesda North charged $61,947 and was paid $12,712 on average, Jewish Hospital charged $38,465 and was paid $14,069 on average and University Hospital charged $46,463 and was paid $20,116 on average.
In fact, all of the 100 metrics tracked by CMS had at least some degree of variation in charges and payments. Whether it was chest pain, joint replacement, diabetes or cardiovascular complications, prices always varied between hospitals — sometimes greatly, other times by a little.
The data from fiscal year 2011 shows how much hospitals initially charged Medicare for the 100 most frequently billed discharges and how much Medicare ultimately paid out. The difference between charges and payments is usually large because Medicare negotiates prices down.
CMS says the price discrepancy is happening at hospitals all around the nation: “As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.”
Still, some health care advocacy groups say Ohio is doing worse than other states. A study from Catalyst for Payment Reform and the Health Care Incentives Improvement Institute gave Ohio and six other states a “D” for health care price transparency, based on the states’ laws and regulations. That was actually better than 29 other states, which flat-out flunked with an “F.” Only New Hampshire and Massachusetts received an “A,” the highest grade possible.
Even then, the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute cautioned in the study that their grades were given on a curve, which means all states would likely fare worse if the organizations measured them based on ideals instead of comparatively.
Many health care experts and advocacy groups claim the price variation is caused by a lack of transparency in the health care system, which gives hospitals free reign to charge without typical market checks (“Healthy Discussion,” issue of April 10).
A "phone-a-thon" is seeking to address one of the main issues public officials have faced when trying to provide health coverage to low-income Americans: awareness. The event could help reach some of the estimated 15,000 children in southwest Ohio who are uninsured but qualify for Medicaid.
The event, which is being hosted by WCPO and the Legal Aid Society of Greater Cincinnati on May 29, will reach out to families with uninsured children who qualify for Medicaid. It's part of the Centers for Medicare and Medicaid Services (CMS) Connecting Kids to Coverage National Campaign, a nationwide effort to enroll more children into free and low-cost health insurance programs.
"Medicaid provides eligible children the coverage they need to address asthma and allergies, as well other benefits to keep children healthy," the event's release said. "Children in a family of four earning up to $47,100 a year may qualify for free or low-cost health insurance. Medicaid not only covers allergy and asthma treatment, but also regular check-ups, immunizations, doctor and dentist visits, hospital care, mental health services, prescriptions and more."
For public officials, raising awareness has been one of the biggest hurdles to ensuring widespread health coverage. As the Affordable Care Act ("Obamacare") kicks in, the problem is becoming even more pronounced as state and federal governments attempt to inform Americans of new insurance options, including health exchanges and expanded Medicaid programs.
"There's a segment of the population that hasn't interacted with these programs in the past," says Trey Daly, senior attorney at the Legal Aid Society of Greater Cincinnati. "Those folks don't typically know they're eligible."
Daly says there's also a segment of the population that has used Medicaid services but stopped after "bad experiences." For those situations, the Legal Aid Society of Greater Cincinnati explains the benefits of Medicaid coverage, but it also files forms and applications for participants to help them avoid the bureaucracy and paperwork required for enrolling into Medicaid.
The Legal Aid Society of Greater Cincinnati's efforts are funded by a federal grant. Since the program began in 2009, the seven counties in southwest Ohio covered by the Legal Aid Society of Greater Cincinnati — Hamilton, Butler, Warren, Clermont, Clinton, Brown and Highland — have increased their Medicaid enrollment of children by 12 percent. The rest of the state has increased enrollment by 4 percent.
At the legislative level, there is currently a bill in the Ohio House that would expand the state's Medicaid program with federal funds provided through Obamacare. Republican Gov. John Kasich originally proposed the expansion in his budget plan, but Republican legislators opposed the measure and took it out of their own budget bill.
Still, Kasich has continued pushing the expansion, along with Democratic support. A March report from the Health Policy Institute of Ohio found the expansion would save the state money and insure half a million Ohioans in the next decade.
To participate in the "phone-a-thon," call 513-749-9400. The event will be on Wednesday, May 29, between 11 a.m. and 8 p.m.