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Ohio health insurance

Buckeye State’s CO-OP escapes closure, will sell 2016 plans

A wide range of issues play a role in the overall health of a state’s residents. If you live in Ohio, there are numerous factors that could impact your own health outcomes and that might be of interest to you in terms of the state’s approach to healthcare and healthcare reform, as well as where you can acquire health insurance coverage for yourself and your family. Here’s a summary:

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 details on how the ratings are calculated.

But the state didn’t fare as well in the 2014 edition of America’s Health Rankings, which placed Ohio 40th in the nation. Ohio’s rating is helped by the fact that the state had a lower-than-average uninsured rate, easily accessible primary care, low rates of infectious disease and small disparities in health status among people of different education levels. But the state grapples with low immunization coverage among children, a high rate of preventable hospitalizations and high infant mortality.

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 2015 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. You can see Ohio health data on a county level with this interactive map created by the Robert Wood Johnson Foundation.

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 Brown is still in the Senate, but Voinovich has since been replaced by Rob Portman, a vocal opponent of the ACA.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 enrolled nearly 157,000 people in Medicaid as of mid-April, far more than most states with Republican governors.

How did Obamacare help Ohio Residents?

In 2013, about 13.9 percent of Ohio residents were uninsured. By mid-2014, six months after the bulk of the ACA was implemented, that number had fallen to 11.5 percent. The Ohio exchange enrolled nearly equal numbers of people in private plans and in Medicaid during the 2014 open enrollment period, so exchange subsidies and Medicaid expansion both played a key role in the reduction of the number of people without health insurance.

The 2015 open enrollment period resulted in a significant decrease in Ohio’s uninsured population. By the end of June 2015, the uninsured rate had dropped to 6.1 percent – more than half since 2013, before Obamacare’s first open enrollment period. Because the state has expanded Medicaid and people can enroll in Medicaid year-round, that number is expected to keep changing.

Ohio enrollment in qualified health plans


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. In late 2013, the Kaiser Family Foundation estimated the potential exchange market in Ohio to be 812,000 residents, and that 544,000 of them would probably be eligible for premium subsidies.

Ohio saw substantial gains in enrollment for 2015 coverage. By the end of the 2015 open enrollment period, 234,241 individuals had selected private health plans. However, some of these enrollees failed to make their initial premium payments or dropped coverage. As of June 30, effectuated enrollment was 188,223. About 84 percent were in plans with advanced premium tax credits, and 43 percent were receiving cost-sharing subsidies.

For the 2016 coverage period, 14 total carriers will offer QHPs on Ohio’s exchange. It has been estimated that Ohio’s exchange plans will see a weighted average rate increase of anywhere from 7.2 to 11.5 percent – rates will be finalized in time for Nov. 1, when open enrollment begins.

One of Ohio’s exchange carriers is Coordinated Health Mutual, 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, and Coordinated Health Mutual was formed. Even though many CO-OPs have announced closure, Ohio’s will continue in 2016.

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 20 states have not yet moved forward with any type of Medicaid expansion.

In early 2014, the Kaiser Family Foundation estimated that about half of the uninsured population in Ohio 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, 156,899 people had enrolled in Medicaid through the Ohio exchange.

By 2015, average monthly Medicaid enrollment in Ohio had increased by 660,800 enrollees since 2013 – a 28 percent change. 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 2.14 million in 2015. About 42 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 81 percent of Medicare recipients qualify based on age, while 19 percent qualify due to disability. Medicare spends about $10,299 per Ohio enrollee each year and ranks 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: