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.
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.”
Two bills discussed today at a hearing of the Ohio House of Representatives' Judiciary Committee would, if passed, offer greater protections to victims of domestic violence and extend them more legal rights to protect their employment, housing and financial livelihood.
Those bills will join H.B. 243 and H.B. 160, which are still awaiting hearings before the judiciary committee and would, respectively, require individuals served with temporary protection orders to surrender their firearms and offer legal protection to the pets of domestic violence victims — often cited as a reason victims have difficulty leaving a violent situation.
Most significant are the changes that would be implemented by H.B. 297, first introduced to the Ohio House in October by Reps. Ann Gonzales (R-Westerville) and Denise Driehaus (D-Cincinnati). The bill outlines new legal protections for domestic violence victims who need to terminate a rental agreement or take unpaid leave at work in order to deal with domestic violence incidences.
Under the bill, victims of domestic violence would be legally protected against termination at work and have the ability to dissolve a rental lease if the tenant has been a victim of domestic violence. The bill would also prohibit landlords from kicking out tenants because they've been victims of domestic violence at the residence and requires them to comply with requests to change locks when a tenant has been a victim of stalking or menacing.
H.B. 309, also introduced in October, by Reps. Dorothy Pelanda (R-Marysville) and Nickie Antonio (D-Lakewood), would dissolve any charges related to modifications made to a domestic violence, anti-stalking or other type of protection order or consent agreement
In August, CityBeat spoke with domestic violence victim Andrea Metil, who talked about her personal experiences with legal trip-ups that made protecting herself from her attacker difficult. Metil called for stronger legislation to protect victims of domestic violence.
This is the first hearing for both of the bills.
According to the Cincinnati Health Department, 36 babies died from unsafe sleeping conditions between 2010-2011. The campaign addresses simple "ABCs" of safe baby sleep to stop infant mortality deaths that otherwise could have been prevented. The most important things to remember, according to the campaign, are that infants should always sleep alone, in a crib and on his or her back. The health department provides other helpful tips here.
It's another step forward in addressing a concern that plagues neighborhoods across the city. Some Cincinnati zip codes in the past have held higher infant mortality rates than those of third-world countries.
The campaign is also donating 1,000 onesies to area birth hospitals that read "This Side Up" on the stomach — a friendly safety reminder to new parents. Kroger is also partnering with the campaign by helping to spread the tenets of the campaign in diaper and baby food aisles at local stores.
According to a Cincinnati.com editorial by Noble Maseru, Cincinnati’s health commissioner, the recent efforts have been working. He says the city’s 2013 infant mortality rates are projected at 6.4 deaths per 1,000 live births, a 52 percent reduction in fatalities that brings the city drastically closer to the national average.
Previously, the infant mortality rate in Cincinnati was more than double the national average: 13.3 babies out of 1,000, compared with 6.1 deaths per 1,000 nationally.
In June, the city of Cincinnati announced the community partnership spearheaded by Hamilton County Commissioner Todd Portune to lower infant mortality rates, uniting health experts, political leaders and some nonprofits to share ideas and best practices to better overlap city efforts.
University of Cincinnati Health president and CEO Jim
Kingsbury agreed to offer the new collaboration initial funding from the
county’s sale of Drake Hospital.
Mayor Mark Mallory also entered the city into a contest in February to earn a grant to expand the city's Infant Vitality Surveillance Network, which monitored the pregnancies of new mothers in high-risk areas across the city with an updated database. The city's entry was a finalist, but ultimately didn't win a grant.
Today, the Infant Mortality Surveillance Network still works with both University Hospital and Christ Hospital to collect data on new mothers from zip codes with the worst infant mortality rates and provides them with information, education, depression screening and home care help, if needed.
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).
Food deserts are a big problem for many of Hamilton County’s impoverished families, but ongoing research suggests officials may be overlooking mobility when attempting to pinpoint neighborhoods that lack access to healthy foods.
University of Cincinnati professor Michael Widener is heading research that looks into how mobility can alter perceptions about food deserts. So far, his findings have suggested that some people may have access to healthy foods throughout their daily commute despite being classified as living in a food desert.
Widener explains the research is necessary to make identifying food deserts more accurate. “In previous work and when I was doing my dissertation, I was noticing how a lot of food desert research failed to take into account the dynamics of everyday urban life,” he says. The observation led Widener to incorporate those dynamics, particularly people’s movements throughout the day, to see how they impact people’s access to food.
Still, Widener cautions that his findings don’t dismiss the problems caused by food deserts: “Of course, there are a lot of assumptions being made, like are (these commuters) totally drained after work? The biggest (assumption) is of course that (someone has) a car.”
Widener says his findings could impact how public officials approach food desert policies. He points to potential stopgap measures, such as better access to public transportation, that could alleviate the pains of living in a food desert while a more permanent solution is put in place. Widener argues these policies could make financial sense: Considering how many potential costs a food desert can bring on a community, it might be cheaper for a city to build a bus route and encourage better ways to load groceries into buses. Widener knows these aren’t perfect solutions, but he thinks they could provide some aid in a bogged-down political climate that often results in sluggish policy changes.
There is a caveat: Widener acknowledges research has so far been inconsistent as to whether access to healthier food actually leads to healthier results. Eventually, he wants to research what actually causes healthier results and whether broader economic factors, such as poverty, play a more important role. That could give officials a clearer picture on which policies work and which don’t.
The first part of Widener’s research came out in a January paper that looked at auto commuters’ access to food, and the next part will look at public transportation’s impact. The research project is using local transportation data from The Ohio-Kentucky-Indiana Regional Council of Governments.
Food deserts are neighborhoods that lack access to fresh, healthy foods. In Hamilton County, many of the identified food deserts are in neighborhoods on the city’s west side, including Price Hill and Queensgate. Cincinnati’s food deserts are just one problem being addressed by Plan Cincinnati, the city’s first master plan in more than 20 years (“Core Future,” issue of Sept. 5).
Part of the parking plan proposed by City Manager Milton Dohoney Jr. on Feb. 19 (“City Manager Proposes Parking, Economic Development Plan,” issue of Feb. 20) would also build a modern grocery store with access to fresh fruits and vegetables in Downtown.
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.
Mallory puts the issue in perspective on the proposal's page on The Huffington Post: "In Cincinnati, we have had more infant deaths in recent years than victims of homicide. Our community, justifiably, invests millions of dollars, immense political capital, and large amounts of media attention in reducing our homicide rate. It's time to start doing the same for our infant mortality rate."
Mallory's proposal would create an Infant Vitality Surveillance Network, which, according to a press release sent out by Mallory's office, has already been launched via a pilot version with significant success. Here's how it works: When a woman finds out she's pregnant, she's enrolled in First Steps, a care program that maintains a secure database of new mothers and monitors pregnancies.
The competition garnered applications from 305 cities, and Cincinnati was one of 20 finalists selected. If recognized, Cincinnati could win a $5 million prize or one of four $1 million prizes to help implement and sustain the Infant Mortality Network.
"City after city deals with this issue, but in Cincinnati, we are dealing with an infant mortality rate that is twice the national average. And half of those deaths occur in just five zip codes. So we know exactly where the problem is, we know exactly what community is having the issue. ... We're really trying to create a program in Cincinnati that can be replicated all across the country. So that in city after city, they can see the same type of success that we are seeing — continuing to drive that infant mortality rate down so that we are saving babies' lives," Mallory says in the Mayors Challenge finalist video below.
According to data from 2007-09 from the Cincinnati Health Department, the five zip codes experiencing the highest infant mortality rates are: 45219 (30.4), 45202 (24.2), 45246 (20.7), 45203 (20.1) and 45214 (19.2). For more detailed information from the Cincinnati Health Department, click here.
Watch the full finalist video: