Ohio Health Policy News

New state laws designed to protect patients from being hit with steep out-of-network medical bills may contribute to higher health care costs and premiums, some researchers warn (Source: “Laws to Curb Surprise Medical Bills Might Be Inflating Health Care Costs,” Stateline, May 20).

Lawmakers and advocates who pushed for surprise billing laws say the measures have protected consumers from some of the most egregious bills, which can climb into the hundreds of thousands of dollars. But some researchers recently have raised alarms that doctors and other medical providers are leveraging state laws that rely on arbitration to increase in-network fees, thereby raising health care costs for everyone.

Eighteen states (including Ohio) have passed surprise billing laws since 2014, most of them in the past three years. Last year, former President Donald Trump signed a federal version that covers self-funded health plans, including those offered by many employers, as opposed to the individual and commercial health plans regulated by states.

The Health Policy Institute of Ohio has released the fourth in a series of scorecards analyzing Ohio's policy response to the addiction crisis and outlining areas where the state could be more effective.

The report, "Ohio Addiction Policy Scorecard: Children, Youth and Families," provides policymakers and other stakeholders with the information needed to take stock of Ohio's policy response to the crisis by reviewing state-level policy changes enacted in Ohio from 2013 to 2019. 

In conjunction with the release of the latest scorecard, HPIO has created a two-page fact sheet featuring excerpts from the report titled “Changes on the Horizon: Hopeful Trends.” A second fact sheet outlines three federal child welfare laws that were enacted or amended from 2016 to 2018.

The Health Policy Institute of Ohio has released the latest tool from its Addiction Evidence Project: An online evidence resource page on the impact of addiction on children, youth and families. The resource page includes expert guidance and evidence-informed programs to ease the impact of the addiction crisis on young people and their families, including resources that address the foster care system, kinship caregiving and prenatal drug exposure.

While progress is being made across the country and in Ohio, more can be done to identify and implement effective strategies to address the addiction epidemic. A key component of the Addiction Evidence Project, HPIO evidence resource pages bring together the best evidence on how to combat addiction and serve as the foundational resource for stakeholders engaged in this work.    

HPIO has previously released evidence resource pages on:

• Prevention, treatment and recovery
• Overdose reversal and other forms of harm reduction
• Law enforcement and the criminal justice system

The number of prescriptions to a life-saving overdose reversal medication grew in Ohio grew by 2,328% following a state law change in 2015 (Source: “Ohio law dramatically increases access to overdose reversal meds,” Dayton Daily News, Feb. 4, 2020).

The Ohio law was changed to help reduce the number of overdoses in the state by allowing pharmacists to dispense naloxone without patients first going to a doctor for a prescription. After the change, University of Cincinnati researchers found dramatically higher naloxone dispensing at Ohio pharmacies.

“Our study shows that this change in the Ohio law allowed pharmacists to have more opportunity to participate in the management of patients addicted to opioids,” study’s lead faculty researcher Pam Heaton, a professor of pharmacy practice at UC’s Winkle College, said in a statement.

In order to provide policymakers and other stakeholders with the information needed to take stock of Ohio's policy response to addiction, HPIO released a policy scorecard on overdose reversal and other forms of harm reduction. The scorecard is part of HPIO’s Addiction Evidence Project.

A Madison County judge has struck down a state law granting minority-owned medical marijuana businesses a leg up during the competitive licensing process (Source: “Ohio medical marijuana: Minority quota for dispensary licenses struck down,” Cincinnati Enquirer, Nov. 7, 2019).

The ruling against Ohio's "racial quota" is the latest blow to state lawmakers' attempt at making the industry more diverse. It could lead to more dispensary licenses being issued beyond the current total of 56 statewide.

Ohio's 2016 medical marijuana law required 15% of all licenses to grow, process and sell marijuana be awarded to companies majority-owned and operated by a racial minority. A Franklin County judge struck down the provision as it applied to cultivators and processors in November 2018.

This week's ruling applies to dispensaries, which are regulated by the Ohio State Board of Pharmacy. A board spokeswoman said the agency is still reviewing the judge’s ruling and determining next steps.

Ohioans must wait until age 21 to legally buy cigarettes, cigars, vape pens and other tobacco products, under a provision in the state budget bill signed Thursday morning by Gov. Mike DeWine (Source: “Ohio raises legal smoking age to 21,” Cleveland Plain Dealer, July 18, 2019).

The new law also applies to rolling papers, filters, blunt wrappers, liquids and other accessories involved with smoking or vaping. DeWine on Thursday vetoed a provision that would have phased the higher age in for anyone who turns 18 years old before Oct. 1.

The state budget also creates a new tax on vaping products assessed at 10 cents per milliliter.

In signing the state's biennial budget Thursday morning, DeWine also issued 25 line-item vetoes, most of which were health-care related (Source: “Ohio Gov. Mike DeWine signs state budget bill; nixes ‘price transparency’ measures,” Cleveland Plain Dealer, July 18, 2019).

Among the items he nixed were “price transparency” measures requiring hospitals to provide patients with billing estimates in advance, and “surprise billing” language that required insurers to reimburse out-of-network medical services when performed at an in-network facility.

State lawmakers have pursued these types of reforms for years over objections from state hospitals and other health-care providers.

In his veto message, DeWine wrote he supports the idea of making medical billing more transparent, but said the measures were potentially duplicative of those happening at the federal level.

Gov. Mike DeWine and his top administrators on Wednesday called for Ohio to increase the purchase age for tobacco and vape products to 21 (Source: “Gov. DeWine issues warning on vaping, wants to raise smoking age,” Dayton Daily News, April 17, 2019).

“This is a public health crisis,” DeWine said.

In his proposed two-year operating budget, DeWine included a provision to raise the tobacco purchase age, including vape materials, to 21. The current purchase age is 18, although more than 30 Ohio cities have passed local ordinances setting the age at 21.

Ohio ranks in the bottom quartile for adult smoking and children living in a household with a smoker, according to HPIO’s recently released 2019 Health Value Dashboard. Analysis of the rankings found that tobacco use and secondhand smoke exposure contribute to many of Ohio’s greatest health challenges, including infant mortality, cardiovascular disease, cancer and asthma.

New Ohio laws in the past decade have widened access to alcohol, a move that’s allowed the beer, wine and liquor industry to flourish. But, leaders in addiction prevention say the rapid expansion may threaten public health (Source: “Latest Ohio alcohol laws bolster business,” Dayton Daily News, April 7, 2019).

A Dayton Daily News investigation found Ohio’s governor has signed into law at least 12 bills that further relaxed alcohol restrictions statewide since 2012. They included everything from allowing microdistilleries to offer visitors a taste of their products and sell limited quantities for carryout to lowering the permit fees for craft breweries and allowing open containers of alcohol at outdoor events.

Liquor sales in Ohio have jumped more than $500 million in the past decade, and since 2012, the number of craft brewers in the state have increased more than 400%.

As Ohio’s alcohol laws have changed, however, binge drinking rates have creeped higher and increased access may be to blame. Binge drinking is commonly defined as four drinks for a woman and five for a man within a two-hour period, according to the National Institute on Alcohol Abuse and Alcoholism. 

The overall percentage of Ohioans who binge drink increased from 17% in 2011 to 19% as of this year, according to a survey from the University of Wisconsin Population Health Institute.

As Ohio prepares for its first legal sale of marijuana in the coming weeks, a state committee has identified six additional conditions that could be added to the list eligible for medical marijuana (Source: “Medical marijuana: Opioid addiction, autism, four other ailments to get more study as qualifying conditions,” Cincinnati Enquirer, Jan. 9, 2019).

Ohio law set 21 qualifying conditions for patients to get medical marijuana, but opens an annual window for suggestions to add to the list. In November and December, Ohioans submitted 110 petitions suggesting a wide spectrum of conditions. Opioid addiction, autism, general anxiety, chronic anxiety, depression and insomnia were selected Wednesday by a committee of the Ohio State Medical Board for more study as potential qualifying conditions for medical marijuana.

The committee will consult with medical specialists as well as experts in other medical marijuana programs and is expected to make recommendations to the full Medical Board by June 30.