I was suffering from insomnia and hoped reading through the proposed Ohio universal health care bill would help me sleep, but as you will see the details kept me up.
Sec. 3922.04. (A) The Ohio health care board is responsible for directing the Ohio health care agency in the performance of all duties, the exercise of all powers, and the assumption and discharge of all functions vested in the Ohio health care agency. The Ohio health care board shall adopt rules in accordance with Chapter 119. of the Revised Code as needed to carry out the purposes of, and to enforce, Chapter 3922. of the Revised Code.
(B) The duties and functions of the Ohio health care board include, but are not limited to, the following:
(1) Implementing statutory eligibility standards for benefits
Sec. 3922.06. (A) The executive director of the Ohio health care agency shall determine the duties of the administrator of planning, research, and development. Those duties shall include, but not be limited to, the following:
(1) Establishing policy on medical issues, population-based public health issues, research priorities, scope of services, the expansion of participants’ access to health care services, and evaluating the performance of the Ohio health care plan
Examining the extent to which individual health care facilities in a region meet the needs of the community in which they are located
(4) Identifying treatments and medications that are unsafe or have no proven value
To me this seems to put 15 people in charge of making all decisions on treatments, and availability of services in the seven regions that they divide Ohio into. I ask this? shouldn’t the patient and doctor determine if a treatment has no proven value? Also what are the criteria of a region meeting the needs of their community? Is it 1 hospital per 100,000 population? more or less? does that mean the rural areas will be losing hospital’s? It does not make that clear, but it is clear that 15 people will be making these decisions.
Who is eligible?
Sec. 3922.07. (A) All Ohio residents and individuals employed in Ohio, including the homeless and migrant workers, are eligible for coverage under the Ohio health care plan. The Ohio health care board shall establish standards and a simplified procedure to demonstrate proof of residency>.(how are they going to do that with Migrant workers, and do migrant workers pay taxes?) The Ohio health care board shall establish a procedure to enroll eligible residents and employees and to provide each individual covered under the Ohio health care plan with identification that providers may use to determine eligibility for health care services under the Ohio health care plan.
(E) The Ohio health care plan shall reimburse Ohio health care board approved providers practicing outside of Ohio at Ohio health care plan rates for health care services rendered to a plan participant while the participant is out of state. (does this not bring the federal government into the plan, through the misuse of the interstate commerce clause?)
(G) Any institution of higher education, as defined in section 2741.01 of the Revised Code, located in Ohio may purchase coverage under the Ohio health care plan for a student who does not otherwise have status as a resident of this state. (So now we are going to cover college kids from outside the state? maybe that will increase enrollment!)
The first thing that comes to my mind when i saw this section was wow this is ripe for fraud! How does the state plan to identify the homeless and migrant workers? It goes against common sense, someone who is transient, does not leave a paper trail of were they have been or were they are going, it would be impossible to keep track of the ever changing Homeless and migrant population, so why put this in? is it just political or is there something I am missing?
And to provide this benefit to out of state college kids? The Bill state’s ‘any institution of higher education…. may purchase coverage’ so college’s are not cash strapped enough that now they are going to have to buy medical insurance for their students? most college already provided campus clinics, so why is this necessary? So the state has more control? Control = Power.
What are the benefits?
Sec. 3922.08. (A) The Ohio health care board shall establish a single health benefits package that shall include, but not be limited to, all of the following:
(1) Inpatient and outpatient provider care, both primary and secondary;
(2) Emergency services, as defined in division (A) of section 3923.65 of the Revised Code, twenty-four hours each day on a prudent layperson standard. Residents who are temporarily out of state may receive benefits for emergency services rendered in that state. The Ohio health care agency shall make timely emergency services, including hospital care and triage, available to all Ohio residents, including all residents not enrolled in the Ohio health care plan. >(if they are not enrolled in the OHCP shouldn’t their insurance pay? or does that mean that the emergency services will all be controlled by the state?)
(3) Emergency and other transportation services to covered health care services, subject to division (B) of this section;
(4) Rehabilitation services, including speech, occupational, and physical therapy;
(5) Inpatient and outpatient mental health services and substance abuse treatment;
(6) Hospice care;
(7) Prescription drugs and prescribed medical nutrition;
(8) Vision care, aids, and equipment;
(9) Hearing care, hearing aids, and equipment;
(10) Diagnostic medical tests, including laboratory tests and imaging procedures;
(11) Medical supplies and prescribed medical equipment, both durable and nondurable;
(12) Immunizations, preventive care, health maintenance care, and screening;
(13) Dental care;
(14) Home health care services.
(will there be any limits on the amount of these service that can be used? Of course not, until they run out of money, like Britain and Canada, then they will ration)
(B) The Ohio health care plan shall provide necessary transportation in each county to covered health care services. Independent transportation providers shall be reimbursed on a fee-for-service basis. Fee schedules for covered transportation may take into account the recognized differences among geographic areas regarding cost. A covered transportation benefits account is hereby created within the Ohio health care fund.
(C) The Ohio health care plan shall not exclude or limit coverage of its participants’ pre-existing conditions. (WOW, that wont be expensive)
(D) Residents enrolled in the Ohio health care plan are not subject to copayments, point-of-service charges, or any other fee or charge, and shall not be directly billed by providers for covered health care services provided to the resident.
Well again common sense tells us that there is no possible way that we can afford this? This is better than just about any employer provided HCP, and we all know how they cost have risen for those. There is no way that services will not have to be rationed. Again this does not pass the common sense test.
The impact, the rationing, and the mean to fund:
Sec. 3922.11. (A) The department of job and family services shall determine which residents of this state employed by a health care insurer, health insuring corporation, or other health care related business, have lost employment as a result of the implementation and operation of the Ohio health care plan>.(so unemployment is not bad enough? and who will be unemployed? Doctors? Nurses?) The department also shall determine the amount of monthly wages that the resident lost due to the plan’s implementation. The department shall attempt to position these displaced workers in comparable positions of employment with the Ohio health care agency. (Lets create more state employee’s, that is always a good idea)
(B) The department of job and family services shall forward the information on the amount of monthly wages lost by Ohio residents due to the implementation of the Ohio health care plan to the Ohio health care agency. The Ohio health care agency shall determine the amount of compensation and training that each displaced worker shall receive and shall submit a claim to the Ohio health care fund for payment. A displaced worker, however, shall not receive compensation from the Ohio health care fund in excess of sixty thousand dollars per year for two years. (again that state has a monster budget defitciet, adn we are now going to pay for those that the state knowingly put out of a job? where has the common sense gone?) Compensation paid to the displaced worker under this section shall serve as a supplement to any compensation the worker receives from the department of job and family services.
I do not even know what to say
Sec. 3922.12. (A) Any employer operating in Ohio and providing employees with benefits under a public or private health care policy, plan, or agreement as of the date that benefits are initially provided pursuant to Chapter 3922. of the Revised Code, which benefits are less valuable than those provided by the Ohio health care plan, may participate in the Ohio health care plan or shall provide additional benefits so that, until the expiration of the policy, plan, or agreement, the benefits provided by the employer at least equal the amount and scope of the benefits provided by the Ohio health care plan. If an employer chooses to provide additional benefits to match or exceed the benefits provided by the Ohio health care plan the additional benefits shall include the employer’s payment of any employee premium contributions, copayments, and deductible payments called for by the policy, contract, or agreement. ( so if an employer provides better insurance than the state they are punished, that should encourage all employers to turn health care over to the state, I believe that must be the states goal) Employers are exempt from all health taxes imposed under Chapter 3922. of the Revised Code until the expiration of the policy, plan, or agreement, (a little carrot for the employer’s) at which point the employer and the employer’s employees become participants in the Ohio health care plan.
Sec. 3922.22(B) The Ohio health care board shall implement cost control measures pursuant to division (A) of this section. However, no cost control measure shall limit access to care that is needed on an emergency basis or that is determined by a patient’s provider to be medically appropriate for a patient’s condition.
Mandatory cost control measures include, but are not limited to, some or all of the following:
(1) Postponement of the introduction of new benefits or benefit improvements;
(2) Postponement of new capital investment;
(3) Adjustment of provider budgets to correct for inappropriate provider utilization;
(4) Establishment of a limit on provider reimbursement above a specified amount of aggregate billing;
(5) Deferred funding of the reserve account;
(6) Establishment of a limit on aggregate reimbursements to pharmaceutical manufacturers;
(7) Imposition of an eligibility waiting period in the event of substantial influx of individuals into the state for purposes of obtaining health care through the Ohio health care plan.
As you can see they know that they will not be able to afford this so in the bill they put in mandatory cost cutting, what is another name for cost cutting???? oh yeah rationing