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Ohio business reaction to abortion ban underscores link between economy and health care

Ohio business reaction to abortion ban underscores link between economy and health care

The Statehouse News Bureau | By Andy Chow
Published June 28, 2022 at 5:48 PM EDT

A handful of Ohio’s top employers are offering to pay their workers’ travel costs if they need to leave the state for abortion services, now that Ohio’s new abortion ban — as early as six weeks into a pregnancy — is in effect.

Following the U.S. Supreme Court decision that overturned Roe v. Wade, memos from different companies started to surface that offered to pay travel expenses for employees who live in states that ban abortion.

That included reported memos from Kroger, Amazon, and JPMorgan Chase — three of Ohio’s top ten employers.

Abortion rights and health care advocates commended businesses that are offering to fill the gaps in available services.

“They’re making sure that their employees that have reproductive health needs — that can’t be met in that state — that they are able to access them, not in the best of ways, but in at least some way,” said Steve Wagner, Universal Health Care Action Network Ohio executive director.

Wagner noted that health care and employment have been “inextricably linked” in the U.S. Wagner said that kind of system can have its pros and cons but he said it’s helpful given the current situation with companies located in different states with varying policies on abortion.

There is a Republican supermajority in the Ohio House and Ohio Senate. Given that power balance, passing bills that expand abortion restrictions and bills that cultivate a pro-business climate have been among the top priorities of the legislature.

Wagner said the reaction from businesses to help connect employees with abortion services out-of-state shows how banning abortion can have a negative impact on the state’s economic growth.

“If you’ve got a state legislature that is making it challenging for employees to want to stay in Ohio and work, then that makes it challenging for businesses to get the people they need,” Wagner said. “If the state of Ohio continues to hurt the employees by making it so that there can’t be good health care that takes care of women, then why would businesses want to be here?”

Mike Gonidakis, Ohio Right to Life president, called the move by some Ohio businesses to offer to pay travel costs for abortion services “unfortunate” and said the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health will have “zero impact” on the economy.

“Recent polling demonstrates that shareholders of public companies want corporations they invest in to stay out of the cultural policy arena and focus on the core business mission,” said Gonidakis.

Gonidakis also noted Ohio’s current unemployment rate and that plans are still under way for Intel’s major computer chipmaking facility in central Ohio.

Andy Chow
Contact Andy at achow@statehousenews.org.
See stories by Andy Chow

Federal Medicaid Block Grant Offer Draws Interest, Worries

Friday, January 31, 2020

Federal Medicaid Block Grant Offer Draws Interest, Worries

From Gongwer

Critics this week warned that the block granting of Medicaid could lead to more liability for the state and the loss of federal dollars.

“The federal offer of program flexibility is an illusory benefit, CMS is offering not much more than a flexibility to cut coverage and benefits for those who depend on Medicaid to access health care,” Steve Wagner, executive director of UHCAN Ohio, said in a statement.

Mr. Wagner said the cost of Medicaid is currently shared between the state and federal government, with the federal share covering a fixed percentage of costs while states cover certain services and individuals.

“It is a bad move to take on all the liability for changes in costs the state can’t control,” he said. “The federal government would not increase block grant funding if increases in disease (e.g. rising diabetes rates or aging population), new diseases (e.g. WuHan coronavirus), or a new treatment (e.g. curing hepatitis C) increased health care costs for Ohio. UHCAN Ohio is hopeful that Governor DeWine sees Medicaid block grants for the bad deal that they are.”

Block Granting Of Medicaid Will Cause People To Lose Their Healthcare

FOR IMMEDIATE RELEASE: CONTACT

29 January 2020

(614) 505-9460

It is expected that the Centers for Medicare and Medicaid Services (CMS) will announce

Thursday its plan to allow states to receive a block grant for the Medicaid program

instead of paying the federal share of Medicaid expenses. Steve Wagner, Executive

Director for UHCAN Ohio, noted “if Ohio pursued a Medicaid block grant it would

increase the fiscal liability for the state and lead to loss of federal dollars. The federal

offer of program flexibility is an illusory benefit, CMS is offering not much more than a

flexibility to cut coverage and benefits for those who depend on Medicaid to access

health care.”

Currently, Ohio shares the cost of Medicaid with the federal government.

The federal funding is guaranteed to cover a set percent of costs, but in return, states

must cover certain services and people — for instance, children, pregnant women who

meet income criteria and parents with dependent children.

Under a block grant Ohio would get a lump sum from the federal government and then

manage Medicaid any way officials chose. Since most Medicaid dollars go to covering

those with disabilities, older adults in nursing homes, and children; increases in health

costs or number of enrollees eligible would threaten their coverage and care.

Block granting allows the federal government to cut Medicaid payments it makes to

states each year. If the economy hits a recession and more people need help with

health care, Ohio wouldn’t necessarily get more money to compensate for the increased

enrollment. Steve Wagner, Executive Director for UHCAN Ohio, noted, “It is a bad move

to take on all the liability for changes in costs the state can’t control. The federal

government would not increase block grant funding if increases in disease (e.g. rising

diabetes rates or aging population), new diseases (e.g. WuHan coronavirus), or a new

treatment (e.g. curing hepatitis C) increased health care costs for Ohio. UHCAN Ohio is

hopeful that Governor DeWine sees Medicaid block grants for the bad deal that they

are.”

UHCAN Ohio is a statewide non-partisan, non-profit organization building the voice of

consumers to achieve quality, affordable, accessible health coverage for all Ohioans.

www.uhcanohio.org

‘Nine years later, I still owe $19,000’ — Ohioans struggle with surprise medical bills

‘Nine years later, I still owe $19,000’ — Ohioans struggle with surprise medical bills

Columbus Dispatch

About 1 in 3 Ohioans with private health insurance was surprised by a medical bill in the past year, according to a new survey, and those surprises were not pleasant.

Twice, Greg Pace went to the emergency room for severe stomach pain but was sent home.

The pain got worse, and he went to another hospital, thinking it was in-network. There, he was told that his gall bladder needed to be removed. Pace was given the option of checking into the hospital and having surgery immediately or going home with pain medication and returning after the weekend.

The Columbus engineer chose the latter — a decision that will wreak financial implications for the rest of the 65-year-old’s life.

“If I had checked in to the hospital, the surgery would have been covered as an emergency surgery,” Pace said.

Instead, he got a bill for $27,000.

He said the hospital never explained that, if he went home, his surgery would not be considered an emergency and would not be covered by his insurance.

“Nine years later, I still owe $19,000,” Pace said. “I’m 65 years old now, and I do not anticipate my medical debts will be close to paid off by the time of death, whenever that is.”

….

Steve Wagner, executive director of the nonprofit Universal Health Care Action Network of Ohio, urged lawmakers to address health care costs.

“Without affordability, consumers will not get preventive care and treatment necessary to stay healthy. The problems with affordability significantly contribute to the relative unhealthy status and poor health value that Ohio has in comparison to other states,” he said.

Ohio’s plan to add work requirements for Medicaid gets push back

Ohio’s plan to add work requirements for Medicaid gets push back

Kaitlin Schroeder,  Staff Writer 5:30 p.m Thursday, April 5, 2018
Dozens of medical and social service lobbying groups are pushing back against Ohio Medicaid’s request to create work requirements for able-bodied adults covered through Medicaid expansion.

The Trump administration opened the door for states to add the first-ever work requirements associated with the state-federal health insurance program for the poor. In response, the Republican-dominated legislature inserted language in last summer’s budget bill ordering the Kasich administration to apply.

RELATED: Consumers could save on prescriptions after Ohio bans ‘gag orders’

The state estimates that a little more than 5 percent of the 700,000 Ohioans on expanded Medicaid — or about 36,000 people — would risk losing their health insurance under the proposal. The rest are already working or are exempt from the requirement because of their age, disability, care-taking responsibilities or other factors.

The proposed rules would require beneficiaries to either have a job for at least 20 hours per week, be looking for work, or attending school or job training.

The requests to add work requirements have sparked debate over whether the conditions are necessary to push people toward jobs and out of poverty, or whether the new rules will put unnecessary burdens on the poor and make health outcomes worse.

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Ohio Medicaid says it is reviewing all comments and will prepare a final proposal to be submitted to U.S. Centers for Medicare and Medicaid. The federal government will then hold its own public comment and review period before making a decision.

‘If you’re an able-bodied person you should be working’

The Buckeye Institute, a conservative leaning think tank, submitted one of the few public comments in support of the proposal.

Rea Hederman, Buckeye Institute Vice President for Policy, said one of the negative results of Medicaid expansion — which was made possible by the Affordable Care Act — has been taking able-bodied people out of the labor force. Kasich, a Republican in his last year as governor, fought hard for Medicaid expansion and has advocated for continuing the program after he leaves office.

Hederman argued that entitlement programs like expanded Medicaid have moved away from just covering the truly needy.

“It’s long been part of the American ethos that if you’re an able-bodied person, you should be working,” he said.

Most comments: Don’t do this

The other hundreds of comments submitted to the state were mostly critical of the plan.

Universal Health Care Action Network of Ohio, a consumer advocacy group, said work requirements run against the purpose of Medicaid.

Steve Wagner, the group’s executive director, said it’s not in Ohio’s best interest to make it harder for people to afford preventive care, and will result in more emergency room visits that are costly and lead to higher health care costs for everyone.

“If you really want people to have employment, you need to create the capability for them to work,” Wagner said.

The Ohio Hospital Association said Ohio Medicaid should take steps to make sure that documenting eligibility doesn’t become a barrier to coverage.

“We encourage the state to make all possible effort to work with individuals who are not otherwise deemed to be exempt or already meeting the Work and Community Engagement Requirement to ensure that they have the tools and supports they need to comply,” Mike Abrams, president and CEO of the Ohio Hospital Association, said in an emailed comment.

More exemptions sought

Multiple commentators said people leaving prison or jail should be exempted from the requirements, arguing they often face barriers to employment and need the support the Medicaid program provides for a successful re-entry.

Other groups said foster youth aging out of the system should be exempted, allowing them to get a head start on what is often a difficult transition.

Geoffrey Collver, associate director with The Ohio Council of Behavioral Health & Family Services Providers, said his organization has serious concerns that the work requirements would disproportionately affect people with behavioral health conditions. Some among that population lack a permanent address or transportation, or may have trouble finding work because of a criminal conviction, he said.

“All of these factors add to the myriad challenges that people with behavioral health conditions face when confronted with an already complicated eligibility system,” he said.

Several organizations, including Ohio Association of Community Health Centers, submitted concerns over how a person will be deemed “physically or medically unfit” for work, which is one of the exemptions under Ohio Medicaid’s proposal.

The work requirements are intended to reduce costs and increase personal responsibility by pushing more of the 36,000 affected individuals into jobs and away from public assistance. But in verbal testimony to Ohio Medicaid, the Ohio Public Health Association’s Anita Carter questioned whether that will happen.

“Most of those among that 36,000 are hardest to employ,” she stated.

THE STORY SO FAR

PREVIOUSLY: Ohio wants federal approval to add job requirements for those covered through Medicaid expansion.

WHAT’S NEW: The state is reviewing the hundreds of public statements submitted about the proposed work requirements, including dozens from different medical associations against the pending rule changes.

WHAT’S NEXT: The final work rules will be submitted to U.S. Centers for Medicare and Medicaid, which will also gather public comment and then issue a decision.

Ohio groups, officials oppose Medicaid work requirements, as state prepares to submit waiver to federal government

Ohio groups, officials oppose Medicaid work requirements, as state prepares to submit waiver to federal government

CLEVELAND, Ohio – The Ohio Department of Medicaid soon will submit its proposed Medicaid waiver to the federal government, hoping to gain approval to apply work requirements to the Medicaid expansion population.

The waiver requires most able-bodied adults to work or participate in a sanctioned community engagement activity, like Supplemental Nutrition Assistance Program (SNAP) education and training activities, for 80 hours monthly to be eligible for Medicaid.

State think tanks, medical associations and local officials oppose the waiver, saying the work requirements would make healthcare less accessible, cost millions to implement and disproportionately affect black communities.

“I’d be much more comfortable with a program that offered support to people to find employment. I think tying their Medicaid eligibility to that isn’t particularly helpful,” said John Corlett, president and executive director of the Center for Community Solutions, a Cleveland-based think tank, and former state Medicaid director. “We actually think the program could cost more and end up covering less people.”

Cost

Community Solutions estimates the new work requirement would cost county governments $380 million over a five-year period because of the administrative burden of providing case management services to 200,000 new enrollees.

David Merriman, assistant director of the Cuyahoga County Department of Health and Human Services, estimates the new requirements would cost the county more than $10.8 million to administer. That’s more than any other county in the state, according to Community Solutions data.

Merriman, in testimony to the state, voiced concerns about how the state plans to compensate counties for the cost of the waiver.

“Will this be an unfunded mandate that requires counties to financially support? Is this a budget-neutral initiative if it costs counties local funds to implement?” Merriman said.

Access to healthcare

The Center for Health Affairs, a non-profit hospital association that represents Northeast Ohio hospitals like the Cleveland Clinic, MetroHealth and University Hospitals, questioned the state’s estimate that only 18,000 of the 700,000 Ohioans covered by the Medicaid expansion would be unenrolled under the new requirements.

“These new requirements create an obvious barrier to accessing healthcare for the consumer. Simply put, the success of the current proposal relies on a number of assumptions which ignore the practical application of this process and how severely it would deter enrollment,” the Center said in comments submitted to the state.

When the state implemented similar work requirements for SNAP, it estimated 134,000 people would lose eligibility. In reality, nearly 370,000 Ohioans were disenrolled, according to Loren Anthes, public policy fellow for Community Solutions.

And putting additional administrative responsibilities on already swamped counties could create a bottleneck for the entire Medicaid system, which covers pregnant women and children among other vulnerable populations, Corlett said.

“If this program creates churn, it will make it more difficult for people to get back into coverage,” Corlett said. “It risks upsetting the entire program.”

For example, Monica Starks of Bedford Heights returned to work as an adjunct sociology professor in March after being off for 1-1/2 years after suffering a stroke. Starks, 46, has end-stage renal failure, a kidney disease and relies on Medicaid for her regular dialysis treatments.

Right now, she’s only teaching one class because of her health.

“One of the benefits of the type of job that I have is it works well with my health,” Starks said. “It’s difficult to work 40 hours a week and do dialysis five days a week.”

She was able to get disability benefits after her stroke but worries what would happen if she were to fall off the Medicaid rolls for some reason.

“I’d probably die because I wouldn’t be able to afford dialysis. There’s no way I could afford dialysis on my own,” Starks said.

But overloaded systems can be burdened by churn, and people often fall in and out of the system, explained Steve Wagner, executive director of UHCAN Ohio, the Universal Health Care Action Network.

“There’s going to be bureaucracy and red tape no matter what, even if they meet one of those exemptions,” Wagner said.

Racial disparity

LaQueta Worley, who lives in the Union-Miles neighborhood of Cleveland, has tried to get on disability since last July, when she had surgery on her foot. For years, she’s had problems with her feet, dealing with bunions and heel spurs.

She had to quit her job as a school crossing guard and as a home healthcare aide because she had trouble standing and walking for long periods of time.

“It was hard,” said Worley, 45, who first started working when she was 14. “I can’t work now.”

She relies on the Greater Cleveland Regional Transit Authority, using bus passes she gets through various programs, to get around, and on her friends and family to help her with bills.

“The way I’m making it now, I depend on friends and family,” she said.

For medical concerns, she turns to Medicaid.

But as a resident of Cuyahoga County, Worley wouldn’t be exempt from the Medicaid work requirements proposed by the state.

“This is the wrong way to go about helping people get out of poverty. It’s bad policy,” said Wendy Patton, senior project director for Policy Matters Ohio, a liberal think tank.

As drafted, the waiver excludes able-bodied adults living in counties with high poverty rates, which excludes Cuyahoga County. These same 26 counties are also exempted from SNAP and Able-Bodied Adults Without Dependents (ABAWD) work requirements.

While Cuyahoga County doesn’t meet exemption requirements based on poverty levels, cities in the county like Cleveland, Euclid and Maple Heights all would, if the state were to base the program on municipalities, rather than counties. As it stands, the county-based structure benefits predominantly white, rural communities and excludes urban areas with black populations, according to Corlett.

“The current Medicaid waiver proposal, and its narrow criteria for unemployment exemptions, doesn’t treat these high unemployment communities the same as largely white communities in other parts of Ohio,” Corlett wrote in a policy brief.

What happens next

The state Medicaid office doesn’t yet have an exact date that it will submit the waiver, and is currently reviewing input from the public comment period, which ended March 18, officials said.

If granted a waiver, Ohio would be the fourth state, following Kentucky, Indiana and Arkansas, to gain approval from the Trump administration to enact work requirements. It would go into effect July 1.

In January, the Centers for Medicare & Medicaid Services issued guidance to state Medicaid directors encouraging them to apply for waivers to establish work or community engagement requirements for Medicaid. Ohio expanded Medicaid to cover an additional 700,000 Ohioans under the Obama administration.

Just the facts

  • Ohio’s proposed waiver requires most able-bodied adults to work or participate in a sanctioned community engagement activity for 80 hours monthly to be eligible for Medicaid.
  • Of the estimated 700,000 Ohioans covered by the Medicaid expansion, the state estimates 18,000 will be disenrolled because of work requirements. Critics say that number is too low.
  • The Center for Community Solutions estimates the new work requirement would cost county governments $380 million over a five-year period because of the administrative burden of providing case management services to 200,000 new enrollees.
  • In January, the Centers for Medicare & Medicaid Services issued guidance to state Medicaid directors encouraging them to apply for waivers to establish work or community engagement requirements for Medicaid.

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