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Ohio and Health Reform

Ohio’s governor decided to default the state health insurance exchange to the federal government, though the state still regulates private insurance plans. Contributing a slight amount to the health care reform endeavor initially, Ohio accepted federal funds to plan its own exchange, taking responsibility for plan management duties.

The final result was a partnership marketplace in which the Department of Health and Human Services essentially runs the whole program. The state claimed the Affordable Care Act would be a detriment to the insurance industry and people of Ohio. The site tells Ohio consumers:

Multiple studies commissioned by the Ohio Department of Insurance determined Ohio’s competitive marketplace would be negatively impacted by the ACA. The studies concluded that premiums will increase for consumers and Ohio will absorb significant costs… Based on the cost of a state-based exchange, lack of flexibility and the lack of guidance from the federal government, Ohio has decided to not run an exchange.

Medicaid expansion may occur in Ohio, as they can opt in at a later date for lesser funding. Other states agreeing to expand Medicaid accepted federal funding in 2013 or earlier to allow for higher enrollment. The state is placing this innovation on the back burner for until 2015, according to the budget bill currently being discussed. State officials have mentioned that Medicaid reform on the state’s own terms may be the best course for Ohio’s public health insurance program, though not necessarily expansion through the new law.

Despite opposition to the ACA, Ohio insurers and residents are still impacted by its provisions. Once the law was signed on March 23, 2010, new laws were added and created more coverage opportunities for Ohioans. From 2014-2015 when the law is further implemented, many more changes will cause a shift in healthcare and insurance, providing more access to coverage, which is even more affordable.


Health Care Reforms in Ohio: 2010-2013

Although many minute details changed in insurance, taxes, and healthcare during the so-called transitional period of health reform, we’ll take note of the most important and relevant adjustments for insurance. Since 2010, insurers have been unable to rescind policies unless a policyholder is doing something illegal, preventing them from canceling benefits if a person becomes sick. Another update to coverage is the removal of lifetime maximums on any private health plan. Annual benefit limits are on their way to elimination, and have been increased over the years until non-existent in 2014. This helps insured Ohioans stay covered, even after they have spent a certain amount on out-of-pocket costs.

Insurers are also legally bound to providing higher quality services, as the medical loss ratio prevents them from spending more than 15-20 percent on internal costs. If an Ohio insurer does spend over this limit, they are required to send their members a rebate check for the cost difference. The first set of rebate checks was sent in August 2012, and each September they will be sent out by insurers who do not comply during the year.

As for coverage, dependents on their parent’s policy have been able to stay insured until age 26 thanks to the new law. In the first two years of this new provision, 11.7 million more young adults have been able to get insured. In Ohio, 97,000 people in this age group stayed covered within the first year. Children have also been able to maintain coverage, as the law makes it illegal for any health plan to turn down an applicant or dependent under age 18, regardless of their health. This was the first in the changes to underwriting for pre-existing conditions.

Preventive care is now provided at no cost through in-network providers under your health plan. If you are insured, you are not required to pay an extra fee for necessary services such as immunizations, annual exams, and recommended cancer screenings. New additions to the list of preventive services make it possible for insured women to obtain free birth control pills and supplies, as well as prenatal screenings and mammograms.


Ohio Health Reform in 2014

The most important changes were scheduled for implementation in 2014 and later. These changes include allowing individuals with pre-existing conditions to purchase any private health plan without increased rates or an automatic decline. Rates are only increased for age and tobacco use, also allowing women and people with risky occupations to get fair coverage. While most insurers expect this to be far too costly to handle, the government has increased a few taxes to make it more possible. Insurers throughout Ohio will also have to cover ten categories of essential health benefits (EHBs), which make emergency care, hospital, maternity, and other forms of care mandatory. Many of these are already state-mandated.

In addition to private coverage being available to all, Ohio will have a state insurance exchange, operated by the federal government. This marketplace is an online directory of health plans available in the state, from Medicaid and Medicare to a new set of individual and small group health plans. These plans will include a large set of benefits and also accept anyone regardless of their health. Available in Bronze, Silver, Gold, and Platinum levels of coverage, people with a certain household income (between 100 – 400 percent of federal poverty level) may qualify for a tax credit to help knock down the cost of premiums. The subsidies will vary in dollar amount based on your income, age, and family size.

Medicaid may expand in Ohio, after a few years of observing how it works in other states and weighing options. The health law provides each state the option to increase the eligibility guidelines of their medical assistance program to include adults without children with income up to 138 percent of the current poverty level. According to the current FPL, this would be $15,856 per year for a single earner. Millions of uninsured Ohioans would be able to obtain coverage this way, yet the state is still weighing the possibility.





1. Ohio.gov. Ohio Insurance Exchange.

2. Kaiser Health Reform. State exchange profile: Ohio.

3. Healthcare.gov. How the Health Care Law is Making a Difference for the People of Ohio.