Ohio tends to be the most important swing state in any presidential election, and 2016 is no different. The reason being, as US News & World Report explains, is that The Buckeye State has traditionally been “a good microcosm of the country as a whole.” The state’s mixed reception of Obamacare serves as an example.
Elected officials strongly opposed it, yet Gov. Kasich expanded Medicaid. Under the ACA, the state’s uninsured rates have dropped significantly. However, a 2016 Ohio Health Issues Poll sponsored by Interact for Health reports that 1 in 10 Ohio adults age 18-64 is without health insurance (about 800,000) – an increase from about 500,ooo in 2015. The largest increase in uninsured was among young adults ages 18 to 29, which reflects what the country as a whole has been facing.
The Obama administration has made public its plans to improve outreach to young adults during 2017 open enrollment and claims that “more than 9 in 10 Marketplace-eligible young adults without health insurance have incomes that could qualify for tax credits to make plans affordable.” Enrollment of young, healthy adults is critical to balancing and strengthening the risk pool.
Ohio diverges from the rest of the nation when it comes to 2017 health insurance rates and carrier options. Benchmark plans (i.e., the second-lowest-cost silver plan available) offered through the state’s federally facilitated health insurance exchange will increase an average of 2 percent compared with the national average of 25 percent. Ohioans will also have far more carrier options than many others.
Ohio health ratings
The Commonwealth Fund’s 2015 Scorecard on State Health System Performance rated Ohio 33rd out of the 50 states and District of Columbia – showing a little slippage from its 31st ranking in 2014. Ohio’s scorecard includes extensive details on how the ratings are calculated. The Buckeye State ranked highest in the Prevention & Treatment categories, placing in the second quintile for both. Twelve percent of Ohio adults and 5 percent of children were uninsured compared with 5 percent and 2 percent, respectively, in the best-ranking state. If nearly half a million Ohioans (483,986) gained health insurance, Ohio would perform at the same level.
Ohio didn’t fare as well in the 2015 edition of America’s Health Rankings where it placed 39th in the nation. Again, a high percentage of insured residents proved one of its strongest measures along with its number of primary care physicians. However, relatively low public health funding and preventable hospitalizations pulled the ranking down.
Trust for America’s health has also compiled data on the prevalence of specific illnesses and health indicators in Ohio. The details are available in the 2016 listing of Key Health Data About Ohio.
But even within the state, there are differences in health factors and outcomes from one county to another. In general, the northwest part of Ohio fares better in most of these areas than the southeast. Uninsured rates ranged from 7 percent in Delaware County to 24 percent in Holmes County. Delaware County also had the best primary care physician to patient ratio (770:1). View more county-specific Ohio health data using this interactive map created by the Robert Wood Johnson Foundation.
How has Obamacare helped the Buckeye State?
Under the ACA, Ohio’s federally facilitated exchange and expanded Medicaid program have both helped residents gain health coverage. During the first open enrollment period, equal numbers of people enrolled in private plans and Medicaid.
In 2013, before the first ACA enrollment, about 13.9 percent of Ohio residents were uninsured. By late 2015, that number had dropped 6.3 percentage points to 7.6.
2017 health insurance rates and carriers
Ohio’s health insurance exchange will see a few changes in 2017. Exchange carriers InHealth Mutual, Aetna, and All Savers/UnitedHealthcare will cease to offer plans, and Medical Mutual purchased HealthSpan.
InHealthMutual was, a Consumer Oriented and Operated Plan (CO-OP) created under the ACA with a federal grant of $129 million. The federal government awarded $2 billion in grants to 23 CO-OPs – initially, there were 24, but Vermont’s never got off the ground. Ohio was one of the states that chose to participate in the program; however, in May 2016, the Ohio Department of Insurance announced that InHealth would be liquidated and those who were insured by it participated in a special enrollment period to select new plans. As of August 3, 2016, only 7 CO-OPs remained.
Ohio residents who shop the state’s federally facilitated marketplace during 2017 open enrollment will be able to choose from the following carriers’ plans:
- Buckeye Community Health Plan
- Community Insurance Company (Anthem BCBS)
- Medical Health Insuring Corp. of Ohio (Medical Mutual)
- Premier Health Plan
Carrier and plan availability will vary by region, as will rates. On August 24, the Ohio Department of Insurance said that they had approved final 2017 rates averaging about 13 percent.
Ohio and the Affordable Care Act
In 2010, Ohio’s U.S. Senators were split on healthcare reform. Sherrod Brown, a Democrat, voted yes on the ACA, while Republican George Voinovich voted no. In the U.S. House, 10 Ohio Democrats voted yes, while eight Republicans voted no. Brown is still in the Senate, but Voinovich has since been replaced by Rob Portman, a vocal opponent of the ACA. In the House, Ohio’s delegates now include 12 Republicans and just four Democrats.
Ohio’s state legislature has a strong Republican majority, and Republican Governor John Kasich is not a fan of the ACA in general. (He doesn’t see it as being effective in reducing healthcare costs and says it’s “messing up the economy.”) So it’s no surprise that Ohio opted for a federally facilitated exchange rather than running its own exchange.
But Kasich broke ranks with most of his fellow Republican governors – and with his state’s legislature – in opting to expand Medicaid in Ohio. His reasoning is that it’s immoral to not do so, and he’s vehemently challenged Republicans on this issue. Ohio’s average monthly Medicaid enrollment grew by 611,735 between 2013 and June 2016, far more than most states with Republican governors.
Ohio enrollment in qualified health plans
In late 2013, the Kaiser Family Foundation estimated Ohio’s potential exchange market to be 812,000 residents and projected that 544,000 of them would probably be eligible for premium subsidies. By mid-April when the 2014 open enrollment period ended, 154,668 people had finalized their qualified health plan (QHP) enrollments through Ohio’s health insurance exchange.
Ohio Medicaid/CHIP enrollment
Ohio’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in the state’s success with Obamacare. The ACA called for Medicaid expansion in all states, but the Supreme Court ruled in 2012 that states could opt out, and 19 states have not yet moved forward with any type of Medicaid expansion.
In early 2014, the Kaiser Family Foundation estimated that about half of Ohio’s population would be eligible for expanded Medicaid or CHIP, in large part because of the more generous eligibility guidelines under the ACA. As of mid-April 2014, 156,899 people had enrolled in Ohio Medicaid through the exchange.
Ohio’s average monthly Medicaid enrollment has increased 26 percent since the expansion went into effect. Enrollment in Medicaid is year-round, so that number continues to increase, making an ever-growing dent in the state’s uninsured rate.
Medicare enrollment in the state of Ohio
Ohio Medicare enrollment totaled 2.15 million in 2015. About 38 percent of those enrollees had selected a Medicare Advantage plan instead of Original Medicare. Medicare Advantage plans offer an alternative for beneficiaries who want additional benefits beyond what traditional Medicare offers. About 48 percent Ohio’s Medicare enrollees are enrolled in stand-alone prescription drug benefits through a Medicare Part D plan.
In the state of Ohio, about 83 percent of Medicare recipients qualify based on age, while 17 percent qualify due to disability. Medicare spends about $9,463 per Ohio enrollee each year – higher than the national average of $8,970. In 2009, the most recent data available, the state ranked 6th in overall spending with $19.3 billion per year.
State-based health reform legislation
Here’s a summary of recent Ohio bills related to health reform: