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More Ohioans expected to be without health insurance in 2023 as Medicaid waiver ends

More Ohioans expected to be without health insurance in 2023 as Medicaid waiver ends

Mark Ferenchik

Columbus Dispatch

Recently released census numbers show a higher percentage of Ohioans were covered by private or public health insurance in 2022 than the year before.

But officials say those numbers are dropping this year after COVID-19 pandemic waivers for Medicaid enrollment ended.

According to recently released American Community Survey numbers, the percentage of Ohioans without any health insurance dropped from 6.5% in 2021 to 5.9% in 2022.

The percentage of Ohioans with private health insurance coverage increased from 67.6% in 2021 to 68.1% in 2022, according to the survey. And the percentage of those covered by public insurance such as Medicaid and Medicare ticked up from 38.6% to 38.8%.

Lisa Lawless, chief communications officer for the Ohio Department of Medicaid, said the reason the private and public percentages total more than 100% is that during the course of the year, some move from private to public insurance, which includes the Affordable Care Act, or vice versa.

In 2022, the number of Ohioans enrolled in Medicaid topped out at 3,665,421, according to figures from the state of Ohio. That was up 11% from the 3,308,090 enrolled in 2020.

But at the end of August 2023, the number was 3,384,042, almost back to 2020 levels.

When the COVID-19 pandemic began in early 2020, the federal government prohibited states from booting people off Medicaid even if they were no longer eligible.

But that ended in December 2022.

“We started doing determinations on the April renewal date,” Lawless said. Now the numbers of those enrolled in Medicaid, which includes children, are falling.

Peggy Lawson, of Amherst, in Lorain County, west of Cleveland, said she told she was going to be kicked off Medicaid this year because she and her husband earned $40 a week too much to be eligible.

Lawson, 59, is a home health aide and has been diagnosed with lung cancer. Her husband is on disability. She was told she’d be dropped on Aug. 31.

Lawson said she reduced her hours, and has now taken a leave of absence. She reapplied for Medicaid, and after an arduous process is covered again. She starts chemotherapy on Oct. 10.

“I was rushing around trying to get my health care needs met,” Lawson said.

Lawless said that while some parents may not be eligible for Medicaid coverage, their children still may be. “We’re spending time trying to educate them on that as well,” she said.

Also, Lawless said there are times when individuals are not eligible for Medicaid when they do seasonal work. They then come back and reapply after three to six months of working, she said.

Cathi Steele, executive director of the Mid-Ohio Workers Association, which advocates for low-income workers, said one of the problems is the difficulty people have with re-enrolling, with some waiting for hours to talk to representatives at the state.

People apply online to re-enroll but then call because there’s no way to follow-up online with the state, Steele said.

“We know someone who works there, they’ve been overwhelmed with people reapplying for Medicaid,” she said.

Steele said that a member of her organization works and applied for Medicaid eight months ago. The person almost was fired for waiting on the phone too long to check on the status of her application, which the state representative said couldn’t be found.

“From what we’ve seen with the rising cost of everything, people are working two, three jobs to survive. To apply for benefits is a burden,” she said.

In a statement, Kelly O’Reilly, CEO of the Ohio Association of Health Plans, said the number of uninsured in 2023 could return closer to pre-pandemic levels, mentioning the Ohio Department of Medicaid temporarily suspending eligibility determinations during the pandemic.

“In the meantime, Ohio’s health plans are working with employers and brokers to control costs and find ways to provide more options for health care coverage,” he said.

Charlotte Rudolph, the interim executive director of the Universal Health Care Action Network Ohio, a nonprofit working to influence health policy issues, said that without health coverage, some may not seek care. It’s important to enroll them in the federal health insurance marketplace, she said.

“They’re racking up medical bills they can’t afford to pay,” she said.

Rudolph said others may have lost Medicaid coverage because they’ve moved.

She said that people who don’t have coverage and are in the middle of cancer treatments or treatment for substance-use disorders puts their lives at risk.

“You have people who churn on and off. That’s unhealthy,” Rudolph said.

Michael Wilkos, senior vice president of community impact for the United Way of Central Ohio, studies demographic trends. In an email, he said that more people covered with health insurance provides many community benefits such as lower death rates, better health outcomes and improved productivity for workers and businesses.

“As central Ohio continues to grow and diversify keeping more people covered with insurance will help the region prosper,” WIlkos said.

“Like many regions across the country, there is more than a 20-year gap in life expectancy between wealthy areas and those with concentrated poverty,” he said. “The increase in health coverage, driven by in increase in those typically uninsured, helps to mitigate this disparity and many others.”

He also said that as housing costs grow relative to wages, any way a family can increase its income to pay for housing is a great thing.

“Having more people covered by health insurance can free up more income to stay stable in housing,” he said. “When workers are more productive and families are stable in their housing, we all win.”

mferench@dispatch.com

@MarkFerenchik

Millions of people could lose their insurance if ARPA premium subsidy expires

Millions of people could lose their insurance if ARPA premium subsidy expires

A surprise deal between Sen. Joe Manchin and Senate Majority Leader Charles Schumer is being worked out that includes major changes to the Affordable Care Act, the nation’s biggest-ever climate bill and the largest tax hike on corporations in decades.

Among the provisions if the deal passes are an extension of an American Rescue Plan Act premium subsidy. The premium tax credit has meant that millions of Americans with health insurance on the ACA Marketplace have affordable coverage. The ARPA subsidies let to a record increase in Marketplace enrollment, but if they expire more than 3 million Americans may lose their health insurance and premiums will go up.

Joining Cincinnati Edition to discuss what’s at stake are Universal Health Care Action Network of Ohio Executive Director Steve Wagner; Urban Institute Health Policy Center Senior Fellow Matthew Buettgens; and Patrick LaPrade who previously bought his insurance through the ACA Marketplace.

Ohio health care advocates want Congress to extend health insurance purchasing subsidies

WASHINGTON, D. C. – Health care advocates in Ohio want Congress to extend temporary federal health insurance premium subsidies that expire at the end of the current plan year. They warn that failing to extend the subsidies would jeopardize health insurance coverage for thousands of Ohioans who would otherwise have difficulty paying their premiums.

The American Rescue Plan pandemic relief measure adopted last year reduced premium costs for many who signed up for Affordable Care Act health insurance plans by extending subsidies that were previously offered to only lower-income purchasers. If the subsidies expire, people with incomes over four times the federal poverty level would have to pay full price for coverage.

According to a report from the Kaiser Family Foundation (KFF), a typical 40-year-old with an income just over four times the poverty level ($51,520 per year for individuals buying coverage in 2022), would see their premium payments increase from 8.5% of their income to about 10% of their income if the subsidies expire. It estimated that continuing the enhanced subsidies or making them permanent would cost the federal government around $22 billion each year.

Northeast Ohio Black Health Coalition Executive Director Yvonka Hall called continuing the credits a “life or death issue.” If the credits expire, she said marketplace enrollees would have to spend hundreds of dollars more on premiums per person per year. She said individuals who make $12,880 yearly and families of four with incomes starting at $26,500 would experience the largest coverage losses if the tax credit that subsidizes the premiums expires.

“For many, it will mean coverage at the expense of food, utility payments and medicine,” Hall told reporters on Thursday.

Molly Nagin, an Affordable Health Care Navigator at UHCAN Ohio said the subsidies have made coverage more affordable for low and middle income individuals across Ohio. She said loss of the tax credits would particularly affect older adults and small business owners.

U.S. Rep. Shontel Brown, a Warrensville Heights Democrat, said the subsidies have helped more than 200,000 Ohioans afford health insurance. Last month, she joined several dozen Democrats in a letter that asked congressional leaders to include language to continue the subsidies in an upcoming budget bill.

“Insurance premiums are being set as we write, and we fully anticipate that our constituents will see a dramatic rise in their premiums this October, on our watch,” the letter said. “We need action now to address costs, especially when Americans are struggling with broad price increases.”

She said the tax credit in the American Rescue Plan saves an Akron family of four with a household income of $75,000 almost $250 a month in premiums, and saves more than $100 a month for a single adult in Shaker Heights who earns $30,000.

“When many Ohioans go to the polls to vote in November, families will start seeing a drastic uptick in premiums during the enrollment period,” Brown said.” Once the tax credits expire, thousands of families in our state will be significantly impacted.”

She said she’d do everything she can as a member of Congress “to get this across the finish line.”

Affordable health insurance: ‘It’s not a financial option’

Affordable health insurance: ‘It’s not a financial option’

Cincinnati Enquirer

Dan Horn
10:00pm ET March 23, 2022 | Updated 11:13 am ET March 24, 2022

Ryan Luckie and his team at Cincinnati’s Freestore Foodbank try to help the uninsured get coverage before things get so dire.

Health care navigators, as they’re known, guide people through their options, from employer-based coverage, which many low-wage workers don’t have, to Medicaid or Obamacare’s public insurance exchanges.

The first hurdle, Luckie said, is convincing people it’s worth their time and money to invest in health insurance. Even low-cost plans, which, depending on eligibility, can sometimes be purchased for about $50 a month, can be too expensive or provide inadequate coverage, or both.

“In their mind, it’s not a financial option,” said Luckie, the Freestore’s director of public benefit services. “It is a significant line item in most people’s budget.”

He said many of the people who come to him wait until they have a health crisis to sign up, which means they’ve already incurred substantial medical bills. He said it’s a little like waiting to get car insurance until right after an accident.

“It always takes something catastrophic,” Luckie said. “That is the catalyst for most people.”

Elizabeth Thuranira, a navigator for UHCAN in southwest Ohio, said she’s found many clients also struggle with the complexity of the online exchanges, enrollment deadlines and the need for basic documents related to income and eligibility.

Even the language on the websites can be difficult to understand, especially for non-English speakers but also for anyone unfamiliar with medical and insurance jargon.

But Thuranira said cost remains the greatest obstacle. Several times, she said, she’s sat down with clients for hours, searching for affordable plans and plugging their family and financial information into the system, only to find the available plans were too expensive.

“It’s just a letdown,” she said. “Because you’re thinking you’ll finally have coverage to cover your health-related needs and, suddenly, you’re hit with another barrier.”

Bender knows those barriers well. Though she’s been insured since her miscarriage 10 years ago and now lives in Cheviot, her experience without insurance is an asset in her new job as a community health care worker in Cincinnati.

She now spends her days helping poor and uninsured people get the coverage they need.

“I love helping people,” she said.

Most of those people aren’t so different from her. She knows what it’s like to put groceries ahead of insurance premiums in the family budget, and she knows how it feels to live with illnesses she can’t afford to treat.

She also knows, maybe better than some of her clients, that going without insurance carries personal and financial costs that can linger for years.

Because even though she has insurance now, the old bills keep coming.

Ohio survey details views on racial bias in healthcare settings; hospitals aim to address how unequal treatment can affect care

Ohio survey details views on racial bias in healthcare settings; hospitals aim to address how unequal treatment can affect care

Published: Feb. 10, 2022, 8:00 a.m.

CLEVELAND, Ohio — Yvonka Hall hoped a nutritionist could provide answers about her unexplained weight gain despite her healthy eating habits.

But the nutritionist was more focused on his computer than her. He didn’t ask questions; just gave his opinion. Stop drinking Pepsi, and you’ll lose weight.

“I’m sitting there thinking, is he talking to me?” recalled Hall, who doesn’t drink soda, or eat pork or beef, but does have thyroid disease. “I said, ‘Is there something in my chart that says I have an addiction to soda?’

Hall’s experience was far from unique, according to a new statewide survey on bias in health care commissioned by a group of organizations promoting antiracism. People of color — especially women — said they often felt disrespected. Nearly 60% of Black women and 52% of white women reported their symptoms had been dismissed, as compared to 41% of Black males and 20% of white males. Many respondents said they skipped follow-up doctor appointments because of perceived unfair treatment.

The informal survey, conducted by four Ohio health equity nonprofits, was shared through newsletters, email and social media with whoever might be interested. Surveys were also collected at community festivals in Toledo.

“Now we had the validation of what we knew,” said Hall, executive director of the Northeast Ohio Black Health Coalition, a social justice organization. “People were saying — particularly African-American women — that I feel discriminated against when I go into medical settings.”

National studies reinforce the findings of the Ohio survey. Blacks reported being discriminated against or unfairly judged by health care providers almost three times more often than whites, and twice as often as Hispanics, according to a 2021 analysis by the Robert Wood Johnson Foundation.

Hall and other leaders of Ohio health equity organizations recently met with representatives from University Hospitals, the Cleveland Clinic, MetroHealth System and Southwest General Health Center.

The health systems were asked to support the goal of eliminating bias in healthcare settings, Hall said.
Local healthcare systems said they are trying to do better, by implementing diversity, equity and inclusion training and taking steps to diversity their workforce. The meeting participants agreed to future talks.

But a recently published Cleveland Clinic study suggested there were no significant differences in rates of mortality or length of ICU stay between racial or ethnic groups hospitalized for COVID-19 at Clinic facilities.

As a Black woman Dr. Tosin Goje, a Clinic OB/GYN, said she empathizes with patients who feel disrespected. But, sometimes patients might not appreciate the excellent care they received because of how they were treated, she said.

Goje and other Clinic employees recently took part in unconscious bias training. During one activity, participants were shown a photo of a Black woman wearing shorts and a T-shirt, and a white man with tattoos. Participants were asked for their first thoughts about these images.

Later, it was revealed that the Black woman was an entrepreneur, and the tattooed man was a NASA scientist. Some participants admitted that they jumped to negative conclusions about the people in the images because of implicit bias.

“Sometimes you need to learn that you don’t just allow your brain to make a decision for you, based on how somebody looks,” Goje said. “Instead, listen to that person, not just what your brain flashes.”

‘Now we had validation’

The start of the COVID-19 pandemic prompted several Ohio organizations to talk about inequities in health care, and their causes.

MetroHealth System earlier declared racism as a public health crisis. And last year, Black infants died at a higher rate than white infants, according to preliminary 2021 Cuyahoga County numbers.

The informal survey was conducted by the Cleveland-based Northeast Ohio Black Health Coalition, and three Columbus-based organizations — UHCAN Ohio, the Ohio Unity Coalition and the Multiethnic Advocates for Cultural Competence.

The informal online and paper survey collected responses from about 1,000 people starting in June. About 600 responses came from people contacted by the Northeast Ohio Black Health Coalition, Hall said. A report based on survey findings was released Jan. 13.

Here are additional findings:

* About 42% of Black respondents said they were denied care or received inferior care.

* Black females (61%) and Black males (59%) reported race as the most common perceived reason for discrimination, while white females (7%) and white males (10%) rarely reported race.

* About 20% of Black males reported, “People act as if they are afraid of you” in medical settings.”
Enlightened Solutions co-founder Chinenye Nkemere was struck by how closely the health equity organization’s findings mirrored the bias found in her nonprofit’s report. “Project Noir: Cleveland is Failing Black Women” collected stories from 450 Black women in Northeast Ohio about harassment, discrimination and abuse in health care, education and the workplace.

“It is good to have studies that really explore the serious, urgent healthcare problems that specifically our region is experiencing, and that black women in general are experiencing,” Nkemere said about the health equity organization’s survey.

Nkemere understands why people who feel disrespected choose to not to return for follow-up care.
“If you get poor service at a restaurant, you absolutely will not go back to that restaurant,” she said. “Why would we think that somebody that has chronic healthcare problems would want to go back to the same exact doctor, the same exact health care system, to receive the same exact terrible, dismissive and racist care?”

Ohioans on Medicaid encouraged to prepare for end of COVID emergency

Ohioans on Medicaid encouraged to prepare for end of COVID emergency

By Mary Schermann Kuhlman Public News Service

Apr 14, 2022

No news is good news for Ohioans who enrolled in Medicaid coverage during the COVID-19 public health emergency.

State Medicaid agencies are prohibited from dis-enrolling beneficiaries until the end of the month in which the emergency expires. Saturday is set to be the termination date, but because the feds have not yet notified states, advocates expect that deadline to be pushed to mid-July.

Elizabeth Thuranira, an organizer for UHCAN Ohio, said it’s crucial that enrollees respond to any renewal forms sent by Medicaid so they don’t lose coverage.

“The emphasis currently is on updating your contact info, whether that’s their mailing address, their phone number or even email,” she said. “Just getting people to update those is imperative at this time, so that they do not end up losing coverage.”

When the public health emergency ends, more than 14 million Medicaid enrollees could lose coverage nationally. In the meantime, Thuranira said, they should continue making use of the preventive health services available as part of their coverage. In Ohio, Medicaid enrollment increased nearly 20% between March 2020 and last January.

If Medicaid beneficiaries are found to be ineligible in the redetermination process, Thuranira said the marketplace is a good option that often has discounted premiums for individuals and families. She explained that health insurance navigators are available throughout Ohio to assist with enrollment.

“They are the navigators who have been tabling at local events, at churches, at social services centers and even on campuses and just getting the word out that Ohioans do have options when it comes to coverage,” she said.

The Centers for Medicare and Medicaid Services has a special enrollment period, open until the end of the year to help people earning up to 150% of the federal poverty level receive free health insurance coverage. For a family of four, that’s $39,750.

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