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.”
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.
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:
To honor National HIV Testing Day — a day meant to raise awareness about the virus — Planned Parenthood Southwest Ohio region is offering free HIV testing at three locations in the Cincinnati area.
Free HIV testing is available today at from 10 a.m.-2 p.m. at Cincinnati's VA Medical Center (3200 Vine St.) and from 1-5 p.m. at the Lower Price Hill Health Center (2136 E. Eighth St.). The test is done quickly using a method called rapid HIV testing, which produces results immediately.
About 1.1 million people in the United States are living with HIV at any given time, and about one in five of those don't even realize they're infected.
That means those one in five could, at any time, be unknowingly transmitting the disease to their partners, or that they're missing out on taking important preventative measures that could keep the infection from developing into AIDS. The HIV virus is most commonly spread through unprotected sexual contact or sharing needles, or can be passed down from mother to child during pregnancy or shortly after birth. For more basic information about HIV, click here.
In 2012, Planned Parenthood Southwest Ohio provided 1,225 HIV tests amongst its eight facilities, among a number of other preventive services. Currently, Planned Parenthood branches across Ohio are being threatened by Ohio conservatives' efforts to defund the organization, which provides myriad health services in addition to abortion, including cancer and STD screenings, birth control, pregnancy testing and health care for both men and women. State and federal funds used by Planned Parenthood aren't used to fund abortions, which are instead funded by private donations.
If successful, the Republican-controlled Ohio legislature could pass a budget this weekend that would put Planned Parenthood at the back of the line for state funds. A separate set of federal funds would also go to crisis pregnancy centers, which have a history of using scare tactics and false information about abortion.
Under Obama's Affordable Care Act, which will go into effect in 2014, insurance providers will be required to cover HIV testing and birth control.
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.
As Ohio debates the Medicaid expansion, a new study from Harvard researchers revealed access to Medicaid in Oregon led to better mental health outcomes and reduced financial strain, but no short-term gains were found in physical health outcomes.
The study, which was released Wednesday by The New England Journal of Medicine, had its most positive findings in mental health outcomes, with Medicaid recipients showing 30 percent lower rates of depression in comparison to people without health coverage. Medicaid recipients had a rate of depression of 21 percent, while those without coverage had a rate of 30 percent.
But the gains did not apply to physical health outcomes. When looking at cholesterol, blood pressure and blood sugar levels, there was no significant difference between Medicaid recipients and people without coverage. The three measures were chosen because they typically reveal better health results within two years and they're easy to obtain.
Still, the study doesn't rule out the possibility of long-term gains. The study found increased rates of diabetes detection and management, which could lead to better physical health outcomes in the future.
Medicaid enrollment also reduced financial strain, allowed patients to use more preventive services and nearly eliminated catastrophic out-of-pocket medical expenses, according to the study.
The study was conducted by looking at Medicaid recipients in Oregon, which enrolled 10,000 people into Medicaid out of nearly 90,000 applicants through a lottery approximately two years ago, giving researchers the first major randomized pool of Medicaid recipients to study.
A previous study from Harvard researchers, including the lead author of the Oregon study, found that Medicaid expansions improved mortality rates, coverage, access to care and self-reported health. That study looked at three states that expanded Medicaid and compared them to neighboring states that did not.
The Oregon study comes at a time when legislators are debating whether Ohio should use federal funds to expand its Medicaid program. Even though Republican Gov. John Kasich supports the expansion, Republican legislators say they're concerned the federal funds will eventually dry up, leaving the state to find a solution for hundreds of thousands of new Medicaid enrollees. Democrats are joining Kasich in supporting the expansion, with Ohio Senate Minority Leader Eric Kearney recently calling it a "no-brainer."
The Health Policy Institute of Ohio found the Medicaid expansion would insure nearly half a million Ohioans and save the state money in the next decade.
The budget bill that recently passed the Republican-controlled Ohio House would forgo the Medicaid expansion while leaving room to consider further Medicaid reforms down the line ("The Chastity Bunch," issue of April 24).