Incoming health care changes mean more overall struggles for Ohioans, advocates say
Health care advocates and researchers say the new year will be a challenging one for Ohioans with federal changes to health care coming with surety but uncertainty.
The Health Care Policy Institute of Ohio has conducted research throughout the years analyzing the impact of the Affordable Care Act and Medicaid funding on the ability for Ohioans to afford insurance, on top of all the others costs that households shoulder, such as food expenses and child care.
The uninsured rate in the state has dropped “substantially” since 2010, due in large part to the Affordable Care Act, according to Brian O’Rourke, a health care policy analyst for the institute. He also said in a recent webinar on the affordability of health care that more than one in five Ohioans had trouble paying off medical bills in 2023.
That rate was unsurprisingly higher among uninsured residents, but people with insurance also struggled, according to O’Rourke.
“Health expenditures are only one component of an Ohio household’s budget,” O’Rourke said during the webinar.
He cited United Way data that found a family of four in Ohio with two children in child care would need $79,224 per year to afford health care and other “essential needs.”
According to U.S. News and World Report, Ohio’s median income currently stands at $42,343.
Federal cuts to Medicaid mean Ohio is expected to lose $33 billion over the next decade, something Gov. Mike DeWine acknowledged will be an issue going forward.
“I think it’s going to pose some very significant challenges, and we’re looking at that,” DeWine said in a Thursday meeting with media. “…We’re aware of that and we have some tough decisions ahead of us, the state does.”
Health care workers and advocates are also bracing for change amid a deadlock in the U.S. Senate on proposals surrounding the Affordable Care Act. The lack of action makes it more than likely that the enhanced tax credits that are currently a part of the Affordable Care Act will expire in 2026.
According to the Health Policy Institute of Ohio, increased Affordable Care Act premiums stemming from the expiring tax credits could mean annual premiums will more than double in 2026, compared to 2025 rates.
Those increases are already showing up for those who go to Healthcare.gov to renew or purchase a plan during the open enrollment period, which lasts until Jan. 15. Increased premiums also include rate increases from insurers, according to O’Rourke.
So, with Medicaid cuts already set to impact Ohioans, and upcoming changes stemming from the federal budget reconciliation bill passed in July, Ohioans may have to make some tough calls when it comes to affording health care and anything else their households need.
The federal reconciliation bill also brings in new work requirements for Medicaid recipients and more frequent reassessments of eligibility for those in the system, something that will cause a lot of administrative and individual burden for Ohioans.
“Not only are (the changes) likely to lead to coverage loss, but we’re anticipating there will be significant churn where people are coming off and on coverage more regularly,” said Rose Frech, director of external affairs for the southeastern Ohio-based Integrated Services for Behavioral Health.
Having to abruptly end treatment for something like a substance abuse disorder because of coverage changes or a lack thereof “can become really life-threatening,” Frech said, and with services like hers in Southeast Ohio already operating on thin margins, adding another layer to the workload will only make matters harder where struggle already exists.
“This is just going to be kind of another strain,” Frech said. “And these things are things that families are experiencing in the compound.”
Families will face complicated decisions between medication, health care, transportation, food, and other things they need, not just one thing at a time, something advocates say policymakers need to keep in mind as they mull funding decisions.
“Very quickly we have seen … (news of the changes lead) to panic attacks, very high anxiety,” said Summer Kirby, chief executive officer of Portsmouth’s Compass Community Health. “There were experiences where medication affordability was just not an option.”
Choosing between food and other needs is something some Ohioans are already familiar with, as demand for help from food banks continues to rise.
“We are days removed from the federal (government) shutdown and still coming out of crisis response mode across our network,” said Grace Wagner, director of health initiatives at the Ohio Association of Foodbanks.
During the shutdown, the association saw a 46% increase in the number of individuals reaching out for emergency services, partly due to a pause in SNAP benefits as a result of the shutdown.
This was on top of demand that was already 41% higher than in 2022, and amid reductions in contributions from the USDA to food banks.
The food banks and health care workers are also working hard to give people the most up to date information, but the changes and uncertainty in how the changes will play out on a state level mean the groups are “weighing information paralysis,” as Wagner put it.
As the new year comes, Kirby said she and her team “consistently try to level-set” with the most current information, and ensure they have the contacts that are needed so people can get answers on all of the struggles that come with federal funding changes.
Advocates say they’re hoping for more interaction between legislators and the individuals who are impacted by the changes, so representatives can speak to their constituents’ entire struggles.
“We encourage policymakers to think about Ohioans as whole people,” Wagner said.
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