We were surprised to learn this week that the Ohio Department of Insurance (ODI) secretly approved the merger between Aetna and Humana health insurance companies back on May 10, 2016. Today, we issued a press release criticizing ODI for the lack of transparency in this decision.  

We know that affordability of health coverage is a top concern for Ohio consumers. That’s why we sent a letter to the Ohio Department of Insurance back in February with our concerns about the proposed merger between Aetna and Humana health insurance companies. In the letter, we expressed our concerns, including that the merger would:

• reduce competition and therefore raise health insurance costs;
• reduce reasonable access to a sufficient number of in-network doctors, known as network adequacy; and
• make it more difficult for new insurance companies to join the Health Insurance Marketplace.

ODI, in its 1 ½ page decision paper, buried deep on its website, did not respond to any of the concerns we raised.

In contrast, when Missouri Department of Insurance was faced with a similar decision, they held public hearings and issued a well thought-out decision, ruling against the merger. Missouri ruled against the merger because it would result in fewer companies serving more people (sometimes referred to as “market concentration”). Ohio’s market concentration is similar to Missouri, yet ODI provided no response on the harm to competition.

Ohio’s Insurance Commissioner could have examined different protections that could have been imposed on the merging insurers to protect Ohio consumers. These protections weren’t considered either.

At UHCAN Ohio, we believe that Ohioans deserve transparency on a decision of this magnitude that will affect so many lives. If you or someone you know has Humana or Aetna insurance through the Marketplace or through a Medicare Advantage plan, please let us know if this merger affects you. 

UHCAN Ohio joined other consumer groups who submitted comments on February 10, 2016 to Insurance (ODI) Commissioner Mary Taylor requesting that the Ohio Department of Insurance hold hearings on two proposed mergers of health insurance companies: Cigna with Anthem Blue Cross and Blue Shield; and Aetna with Humana. The other groups signing on to the comments are Consumer Action, Consumer Federation of America, Consumers Union, DC Local 37 AFSCME AFL-CIO, Consumer Watchdog, and U.S. Public Interest Research Group. 

We noted in the comments that Ohio has a “concentrated” market—meaning that a few insurance companies control a great deal of market share. Three health insurance companies control 84% of the individual, small group, and large group markets. As noted in the article we published in our newsletter of October 12, 2015, mergers tend to result in premium increases. Ohio already faces some of the highest health insurance premiums in the country. One of the major culprits of Ohio’s high premiums is the lack of competition among insurers, and these mergers will only make matters worse. 

We are also concerned about the Medicare Advantage Market. This is the market that serves Medicare beneficiaries who choose not to stay with “traditional” Medicare but to secure lower premiums in exchange for networks of doctors that are narrower than traditional Medicare. Aetna, Anthem, and Humana are players in the Ohio Medicare Advantage Market. The combined Aetna-Humana would have a 50 percent market in Medicare Advantage throughout Ohio, according to the Kaiser Family Foundation, with Anthem also controlling 23 percent of the market. Along with having a dominant market share in the state, the Aetna-Humana transaction would substantially lessen choices for Medicare Advantage consumers in the following counties: Clark, Clermont, Delaware, Franklin, Hamilton, and Lorain. 

The day of the filing, ODI told the Columbus Dispatch that the Department does not have to hold a hearing, and that they accept written comments. However, this would significantly undermine ODI’s ability to impose a remedy on the insurance companies, which the statute says may be imposed after a hearing. The Department of Insurance has broad powers to look out for the best interests of the insured. And securing all necessary evidence and being fair to all involved clearly requires a hearing that is public and transparent. 

UHCAN Ohio recognizes that dental hygienists are a critical part of the dental team. They provide services that keep people healthy and prevent tooth decay and other diseases. Because of the time they spend with patients, dental hygienists are leaders in providing preventive care and education that are essential to improve our dental access crisis. Because of their role in the dentist-led team, dental hygienists have a unique perspective on the value of allowing dental therapists to join the team in Ohio.

Don’t take it from us. Here’s what Barb Ranck, current President of the Ohio Dental Hygiene Association (ODHA), had to say about why ODHA supports our campaign to allow dental therapists to practice in Ohio: “If we allowed dental therapists and dental hygiene therapists to be utilized in this state, we could help so many more Ohioans and better serve those who can’t afford the necessary treatments they need! It’s really sad to look in a child’s mouth and see so many decayed teeth when I know it can be prevented.” She added that the dental therapist and dental hygienist therapist “would be able to go to the areas where people live that are unable to get to the bigger cities or even to a dentist due to transportation issues. They can provide the needed education that will help families to understand the importance of good oral care.”

Barb continued to explain, “I currently work in a pediatric office. We see many children who live in the Appalachian areas of our state. The amount of decay we see in patients under the age of three is huge. When I speak of decay, I’m referring to 3 or more affected teeth per patient. A lot of the parents are unable to afford the necessary treatment…needed to help all of our patients.” Often she says these are not patients who are enrolled in the Medicaid program, they are just poor Appalachian working people.

She talked about the impacts she sees every day, saying, “The lack of dental care creates a child [with] low self-esteem, improper development of the jaws, the inability to concentrate while in the class room, and someone that other children will make fun of (bully). I can say this because I teach once a month in a Baby Basics class sponsored by our local hospital, and one of the parents in the class shared that with the class. He is a teacher, and he commented that he had had a student in this exact situation.”

 She continued, “There is a huge need that needs addressed in our state. Children would do better in school if their dental treatment needs were met, which would enhance their ability to learn, which in turn makes them better citizens.”

Barb explained that ODHA endorses the Dental Access Now! campaign “because we see the need in this state to get dental care to those who are unable to get care. Dental care contributes to our overall health. The better we take care of our mouths, the healthier we will be for a longer period in our lives.”

From our conversations with dental hygienists, we recognize that changes in law and practice are needed to allow them to work to the full extent of their training, including providing services when a dentist is not physically present. We support these changes as necessary to our goal of expanding dental care. Expanding the reach of hygienists will enable them to reach more children and adults with more preventive care and education. We’re proud to have ODHA as a partner and supporter in our mission to increase dental access in every community in Ohio.

Next week a broad coalition of advocates for improved access to dental care will be meeting with their legislators to deliver a message of hope. We will also provide details about how dental therapists and dental hygienist therapists can change the way dental care is delivered while assuring high quality services with an evidence-based provider model. For more details, contact David Maywhoor at dmaywhoor@uhcanohio.org.

UHCAN Ohio is excited to welcome our four new board members! We’ll be profiling each of them in our newsletter so that you can get to know them.

Susan Rogers has been a leader in Southeastern Ohio for more than three decades. For 19 years, Susan has served as Director of RSVP of the Ohio Valley with the Corporation for Ohio Appalachian Development. Volunteers serving with RSVP tutor children, model parenting skills to teen parents, plan community gardens, and deliver meals.

Susan became involved with UHCAN Ohio through her work advocating for the people of Appalachia. “Living in a low-income area where many people struggle to have affordable health care, access is critically important to those we serve. We have seen families nearly bankrupted by health care costs; people go without care because of the costs; people having to travel great distances (that they can’t afford) to find top quality health care,” Susan said, explaining her interest in bringing attention to the needs of low-income Ohioans living in rural areas.

In addition to her work with UHCAN Ohio, Susan serves on the steering committee for Advocates for Ohio’s Future and as Board Chair of the Gallia-Jackson-Meigs Board of Alcohol, Drug Addiction, & Mental Health Services. She has also previously served as Board Chair or President for numerous other organizations, including the Ohio Commission on Service and Volunteerism, the Ohio RSVP Association, and the Jackson County Board of Developmental Disabilities, among others. Susan’s extensive experience leading the boards of community organizations will be a valuable asset in her work with the board of UHCAN Ohio.

Please join UHCAN Ohio in welcoming Susan and thanking her for her commitment to helping UHCAN Ohio make health care work for all Ohioans!

From the beginning of MyCare Ohio, there has been a push to ensure all enrollees signed their All Service Plan (ASP). The ASP is a document that the Case Manager (CM) develops with the input of the Interdisciplinary Team and the enrollee. It specifies all the services necessary for the member to remain in their home. The ASP lists the goals, the needed services, the service providers, the cost of services, who is liable for payment, any decision regarding the member’s options, and the enrollee’s home care team members. It is important the member and providers receive a copy of the ASP and understand its contents.

For too long, we were hearing from enrollees that they hadn’t seen or signed their ASP. The Ohio Consumer Voice for Integrated Care (OCVIC), a coalition of UHCAN Ohio, worked with the Managed Care Organizations (MCO) and the Ohio Department of Medicaid (ODM) to put in place a mechanism that ensures each enrollee’s ASP has the required signature. That signature ensures the enrollee has reviewed, understood, and agreed to the contents of the ASP.

OCVIC has learned that the signature is an audit item for ODM. With this change, enrollees will have greater access to effect change and remain in a setting of their choosing, making health care work better for them. OCVIC thanks ODM for putting in place this additional oversight to help improve lives of all consumers.