As US News & World Report explains, The Buckeye State has traditionally been “a good microcosm of the country as a whole.” The state’s mixed reception of Obamacare (the ACA) serves as an example. The Republican party dominates the state legislature, and has consistently opposed the ACA. But the state’s uninsured rate is at a record low, and the Ohio exchange has ten participating insurers in 2017, making it much more robust than the exchanges in most other states.
The Ohio House and Senate both rejected Medicaid expansion, but Governor Kasich moved forward with expansion using the state’s Controlling Board. Expanded Medicaid eligibility took effect in January 2014, and by May 2016 there were 702,000 Ohio residents had enrolled in expanded Medicaid (referred to as Group VIII enrollees).
That enrollment, combined with more than 238,000 people who have coverage in the Ohio exchange (most of whom have ACA subsidies) means that Ohio has a lot to lose if the ACA is repealed.
Ohio diverged from the rest of the nation in terms of 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 increased by an average of just 2 percent compared with the national average of 22 percent (average rates across all plans increased by an average of 17 percent, however, compared with 25 percent nationwide). Ohioans 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 2016 edition of America’s Health Rankings, where it placed 40th in the nation, down one spot from 39th in 2015 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 in 2015 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.
The state’s uninsured rate has dropped significantly as a result of the ACA. The Ohio Department of Medicaid reported in early 2017 that the uninsured rate in the state had reached an all-time low of 8.7 percent by mid-2016. That was down from 17.3 percent in 2012.
The bulk of the decrease is due to the expansion of Medicaid, which has been the primary factor in driving the uninsured rate among low-income Ohio residents to 14.1 percent by 2016 — the lowest it had ever been.
2017 health insurance rates and carriers
Ohio’s health insurance exchange saw a few changes in 2017. Exchange carriers InHealth Mutual, Aetna, and All Savers/UnitedHealthcare stopped offering plans at the end of 2016, 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 early 2017, only 5 CO-OPs remained.
The following carriers are offering plans in the Ohio exchange in 2017:
- Buckeye Community Health Plan
- Community Insurance Company (Anthem BCBS)
- Medical Health Insuring Corp. of Ohio (Medical Mutual)
- Premier Health Plan
Carrier and plan availability varies by region, as do rates.
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 would have been immoral to not do so, and he’s vehemently challenged Republicans on this issue. Ohio’s average monthly Medicaid enrollment grew by 643,925 between 2013 and November 2016. That’s a 28 percent increase, which far exceeds Medicaid growth in most states with Republican governors (the national average across all states, including those with Democratic leadership, has been 30 percent).
Kasich has been vocal in his opposition to Congressional Republicans’ proposals to fully repeal the ACA, including Medicaid expansion. Kasich met with President Trump and HHS Secretary Tom Price in February to address his concerns and discuss possible reforms to the current system.
Kasich wants to keep Medicaid expansion in place, but he’s proposed a lower eligibility cut off at 100 percent of the poverty level (as opposed to the current 138 percent). People with income above the poverty level would instead be covered under private plans in the exchange, presumably with subsidies that are similar to what the ACA currently provides for low-income enrollees. Similar proposals have been put forth by several Republican governors over the last few years, but while the Obama Administration gave states some leeway in terms of the details, they did not allow any states to use federal ACA funding to expand Medicaid only to people with income under the poverty level. The Trump Administration might be much more open to proposals like Kasich’s.
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.
Enrollment at the end of open enrollment is always higher than effectuated enrollment later in the spring, since some enrollees don’t pay their initial premiums. 238,843 people enrolled in QHPs through the Ohio exchange during the 2017 open enrollment period, which was 2 percent lower than enrollment in 2016. That decline was expected, given the uncertainty currently surrounding the ACA, and the Trump Administration’s scaled-back advertising for HealthCare.gov in the final week of open enrollment (late January, right after Trump took office). The drop-off was not as sharp as it was in other HealthCare.gov states, though, where enrollment declined by an average of almost 5 percent.
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
By 2016, 34 percent of Medicare beneficiaries in Ohio were enrolled in 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, although they also come with additional network restrictions and out-of-pocket costs (Medicare Advantage has a cap on out-of-pocket, unlike Original Medicare; but Original Medicare can be paired with a supplement that pays all or most of the out-of-pocket exposure). 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: