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Many Challenges Ahead for Ohio Health Insurance

Tracy Mcmanamon

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With the Obama administration getting a second term in office, the stage is set for the further implementation of the Affordable Care Act. However, there are still many unanswered questions about the controversial health reform and how it will work to benefit Americans. The Ohio health insurance scene will see major changes as the state plans to have a federally-run health insurance exchange. This will have many implications for health insurance in Ohio, and while some of these changes are positive, others may not be so.

Impact of Health Care Reform on Health Insurance Ohio

The Positives
- No more denials for pre-existing conditions: Starting 2014, Ohioans who were denied coverage in the past due to pre-existing conditions or given an exclusion period, will have more security. Insurers cannot deny children and teenagers coverage because of their health history. They cannot charge a higher premium based on a person’s health history. Premiums may differ by age, but not by health status.

- No more gender discrimination: Currently, Ohio health insurance plans charge a higher premium for women. This unfair practice will end in 2014 and women will be able to pay the same price as men for a policy.

- Extended coverage for young adults: Young adults without job-based coverage can now stay on their parents’ plans till age 26.

- Reduced penalties for older people: Starting January 2014, older Americans not yet on Medicare, will pay premiums that are lower than at present.

- Preventive care coverage expanded: According to the U. S. Department of Health & Human Services, about 2,138,000 people in Ohio gained guaranteed access to preventive service coverage with no cost-sharing in 2011, including 1,852,561 women. Low income populations in Oho have also benefited from the expansion of Medicaid programs.

- More affordable prescription drug coverage: Senior residents in Ohio with Medicare have saved up to $222,428,162 on their prescription drugs since the healthcare law was enacted. Thousands of these citizens benefited from a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole, the limit after which they are responsible for the full cost of their drugs. The law will close the donut hole in 2020.

Despite these positives, experts point out that the current state of the group, individual, and public health insurance markets will see drastic changes that will alter the Ohio health plan scenario.

The Issues
- Decrease in physician income: Obamacare has left physicians unhappy. By extending Medicaid coverage, health reform will impact doctors’ income - reimbursement rates for Medicaid are lower than the rates doctors receive from patients with private health insurance OH . Physicians are also worried about losing their decision-making capacity to government officials. Increasing paperwork burdens are causing many of them to move from private practice to working in hospitals or groups.

- Health insurance industry: Many Ohio health insurance companies have merged so as to be able to offer government plans. Insurers’ profits have fallen, at least, in the short-term. Government payments to Medicare Advantage plans have been reduced and insurers stand to lose due to the law which prevents them from selling Ohio health insurance plans with lifetime caps, denying coverage to children with preexisting conditions and withdrawing coverage for adults who fall sick.

Ohio has given the go-ahead for the setting up of a federally run health insurance exchange, subject to state regulatory authority. With the individual mandate requiring all Ohioans to purchase coverage, there is a lot of worry regarding the fate of private health insurance companies and brokerages.

There are many other issues for which there are no clear answers at present: whether employers will continue to cover their workers, rising insurance premiums, extension of coverage for people with serious illnesses, and much more.

All the provisions of health reform will come into effect in 2014. Till then, the best way forward is to stay safe by staying covered. Choose the right health insurance in Ohio by getting professional support.


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