COLUMBUS, Ohio – Whether Ohioans would get to see an itemized list of expenses before a nonemergency medical procedure is one of the differences between the Ohio House and Senate versions of the state budget bill.
“I think we counted somewhere between 400 to 500 differences” in the budget bill, Ohio House President Larry Householder said. “Some are very, very small. Probably our most significant differences are in our health care.”
Members of the Ohio House and Senate are expected to reconcile their versions of the two-year, $69 billion budget bill this week. In addition to the so-called “transparency” measures, another difference between the chambers is support for a program called Healthy Ohio for Medicaid recipients, in which health savings accounts would be created for each recipient, and it would be used to pay for prescriptions, medical devices and other expenses. The program is controversial.
Healthy Ohio was removed from the House version of the budget at the 11th hour, but lawmakers have wide discretion when reconciling the bill to introduce new programs. Householder said last week that he was disappointed that the Senate didn’t put Healthy Ohio into the budget.
Other differences between the House and Senate versions of the budget include mental health money and pharmacy costs.
The House’s requirements could be similar to those announced by President Donald Trump on Monday.
Trump issued an executive order requiring health care providers, insurers and hospitals be more transparent with pricing. The details will be ironed out by the U.S. Department of Health and Human Services, which will create rules, according to NPR.
Price transparency
The Ohio House wants to require health plans and hospitals to provide estimates for nonemergency products, services and procedures. Hospitals would be the first to have to show costs – on July 1 - but all health care providers would have to provide the costs by March 1, 2020.
“All over the country nobody knows what the costs are,” said Rep. Jim Butler, a Dayton-area Republican. “And the health care industry takes advantage of that. So there’s wildly disparate costs, even across the street. That does an extreme disservice to Ohioans who need to know what their costs will be.”
Butler thinks that ultimately, health care costs would go down as a result of transparency.
The turnaround required for hospitals and health plans would vary. But lab blood work costs, for instance, would have to be revealed to a patient 24 hours after a doctor orders a test, Butler said.
The Ohio Senate took out many parts of the House’s version of transparency, after urging by the Ohio Hospital Association, among others.
In the Senate’s version of the budget bill, patients would have to request a verbal or written cost estimate from a hospital. The costs wouldn’t apply if the patient’s insurance fails to supply the information to the hospital within 48 hours of the hospital request. The hospital would have seven days to provide the patient the information, said the hospital association’s John Palmer.
Palmer said that some Ohio hospitals already provide such information upon request.
Palmer said that health care is complex and there are so many unknowns that an immediate, itemized cost list is not possible. For instance, the patient can have other illnesses that create complications that need to be considered – such as diabetes, he said.
Healthy Ohio
The federal government in 2016 rejected the Ohio General Assembly’s first attempt at Healthy Ohio. Members of the House call the latest proposal Healthy Ohio 2.0.
Butler said that Healthy Ohio 2.0 was in the House version of the budget bill until it hit the floor. Then a House amendment killed it.
Butler said he doesn’t know how much of a chance Healthy Ohio has to make a comeback in the budget negotiations.
In addition to the health savings accounts, which is based on a program in Indiana, Healthy Ohio would give the managed care organizations involved in Medicaid an incentive for making the population healthier and saving the state money.
Healthy Ohio could affect 1 million people.
Left-leaning Policy Matters Ohio said Healthy Ohio would affect all parts of the state and families of all races.
Healthy Ohio "would impose confusing requirements that would increase administrative costs and create barriers for poor families in getting health care, undermining the whole purpose of Medicaid. It would hurt families of all races and in all corners of the state,” Policy Matters Ohio’s Wendy Patton wrote.
The right-leaning Buckeye Institute said Healthy Ohio 2.0 has been unfairly maligned.
“But even if a Medicaid recipient chooses not to contribute to their HSA account, they will not lose essential medical care through the Medicaid program,” Buckeye’s Greg Lawson wrote recently.
Ohio Sen. David Burke, a Marysville Republican, said the Senate isn’t interested in putting any version of Healthy Ohio into the budget. There’s no empirical evidence it would be successful, he said.
“I think we’re focusing on the more high-level issues out there,” he said, “the pharmacy issue, transparency, surprise billing.”
Surprise billing
Burke explained that “surprise billing,” occurs when a patient has thoughtfully researched before visiting a hospital or clinic to ensure her provider and facility would be in-network. Then a different provider, such as an anesthesiologist, ends up treating her, who is out of network.
In the Senate version of the bill, insurers must reimburse out-of-network providers for unanticipated out-of-network care when performed at an in-network hospital when the patient didn’t have the ability to request services from an in-network provider.
Pharmacy costs
The House is trying to control the cost of drug prices by limiting the state to one pharmacy benefit manager, the middle-man industry that negotiates drug prices and rebates between the state and Ohio Medicaid.
The Senate removed that provision.
Burke, a pharmacist, said the Senate wants to provide pharmacists who have a high percentage of Medicaid patients -- 30 percent or higher -- portions of $30 million.
The amount would be tiered, based on how many Medicaid patients are served, he said. Medicaid reimbursement tends to be lower than private insurance reimbursement to pharmacists.
Mental health
Gov. Mike DeWine requested $36 million be invested in mental health -- $18 million for K-12 prevention programs and an $18 million media campaign to raise awareness and end the stigma of seeking help for mental illness and addiction.
The House kept the request intact. The Senate removed it.
The Ohio Council of Behavioral Health & Family Services Providers wants the money restored.
“These investments are necessary to help children, families, schools and communities develop services, reduce trauma, address stigma and promote resilience,” Teresa Lampl, the council’s CEO, wrote in a letter to the conference committee.