This article originally appeared January 19, 2017 on Gongwer and can be found here.
With Budget Talks Pending, Health Care Industry Groups Focused On Fate Of ACA; Transparency, Opioid Crisis Among Other Priorities
by Jon Reed
Whatever health policy debates look like during the 132nd General Assembly, a lot will be shaped by what happens to the Affordable Care Act.
Ahead of the state budget deliberations, industry groups are closely watching plans by Congressional Republicans to repeal and replace the federal health care law, as the form that replacement takes will likely have ripple effects throughout the health care industry.
In Ohio, groups are specifically watching how those plans would affect the Medicaid eligibility expansion component of the law that added 700,000 people to the program.
“I think we’re all focused on what’s happening at the federal level with respect to federal health care reform,” Miranda Motter, president and CEO of the Ohio Association of Health Plans, said in an interview.
Ohio Hospital Association spokesman John Palmer said his group has emphasized ensuring coverage is maintained under whatever replacement plan is put in place. OHA staff members have gone to Washington to lobby for maintaining coverage levels.
“What we’ve really been focused on is that when a repeal happens, that a replacement happens, and when that happens making sure it maintains coverage – specifically the expansion,” he said in an interview.
Lori Chovanak, CEO of the Ohio Nurses Association, said maintaining the Medicaid expansion would be essential to ensuring coordinated care leading to better outcomes for patients.
“We’re not just advocates for nursing, but we’re advocates for patients,” she said. “We maintain our support of Medicaid expansion.”
Beyond what happens in Washington and the pending introduction of Gov. John Kasich‘s final biennial budget, industry representatives pointed to a number of issues they expect to pursue in the coming year.
Tim Maglione, senior director for government relations for the Ohio State Medical Association, said his group is going to keep an eye on the implementation of prior authorization legislation that passed last General Assembly. (See Gongwer Ohio Report, June 13, 2016)
“We’re going to want to make sure that the intent of the law is followed as the requirements become effective,” he said.
On the opioid epidemic, Mr. Maglione said he expects more of a focus on the treatment and recovery side of drug abuse.
“We want to look at how, for example, health insurers cover treatment options like medication-assisted treatment and counseling services,” he said, “whether or not there might be barriers within the insurance plans that are preventing people from getting access to services.”
OSMA will also be keeping an eye on proposals that have arisen in the past, such as the Healthy Ohio plan to create more individual responsibility in Medicaid through patient payments into modified health savings accounts. (See Gongwer Ohio Report, September 19, 2016)
“We support the idea of patient responsibility in terms of financial considerations when making health care decisions, but the proposal that actually got rejected by CMS had a provision that essentially kicked people out of the Medicaid program if they were unable to pay their premium,” he said. “The concept of creating financial incentives or considerations when deciding to utilize health care is not something that we are opposed to, but it’s the details of how that will work.”
The three top priorities for the Hospital Association, Mr. Palmer said, are the state budget, the ACA and price transparency.
On the budget side, he said OHA is concentrating on protecting Medicaid rates and watching changes for the hospital franchise fee.
Regarding price transparency, Mr. Palmer pointed to a court case regarding a health care price transparency law slated for a hearing this week. (See Gongwer Ohio Report, December 23, 2016)
Beyond those three issues, the OHA said it will be involved in any issue that affects patients and hospitals, such as discussions about the future of the state’s trauma system.
“We have to be ready to jump on anything and everything affecting health care and hospitals and consumers,” he said.
Ms. Motter said OAHP is primarily focused on what’s coming regarding the federal health care law. Price transparency, particularly regarding prescription drugs, is one other area of emphasis she expects for the coming session.
“Insurance is but a reflection or a mirror of what it costs to purchase health care services,” she said. “While a lot of the conversation at the federal level is focused on insurance reform, there is still a lot to be done to reform underlying health care to really get at costs. Unless we do that, health insurance costs are not going to go down.
“Unless we get at understanding why those drugs cost what they do and getting at those underlying costs, we’re not really going to impact the costs of health insurance,” she added.
She also suggested the state should look into implementing best practices offered by the federal Centers for Disease Control and Prevention regarding opioid prescriptions as a way to reduce the number of opioid painkillers given out.
“We really believe that will get at the volume of drugs that are in Ohio today,” she said.
The Ohio Pharmacists Association will focus on the scope of practice for pharmacists, Executive Director Ernie Boyd said. Pharmacists are being entrusted with the ability to administer more and more types of drugs, including long-acting drugs added to their scope by a law last GA aimed at infant mortality. While they’re allowed to administer these drugs, according to the OPA, they aren’t necessarily able to bill for the work.
OPA will work, through rules and maybe through legislation, to ensure pharmacists can bill for the administration of drugs within their scope of practice, Antonio Ciaccia, the group’s director of government and public affairs, said.
Mr. Boyd said encouraging pharmacists to administer these drugs will improve prescription adherence, which keeps people healthier and reduces readmissions.
“One of the big problems we have with medications and treating chronically ill people is they don’t take their drugs properly,” he said.
Expanding provider status to pharmacists, as has been introduced at the federal level, could also increase the incentives for pharmacists to sit down with patients to go over their prescriptions and proper use, reducing overdoses and drug interactions, Mr. Boyd said.
Mr. Boyd also said they will work on policies to ensure patients can choose which pharmacy they go to.
“Our association has always felt that the patient should be able to use the pharmacy that they’re most comfortable with,” he said.
Ms. Chovanak at the Nurses Association said her group will emphasize staffing, ensuring that health care providers have enough nursing staff and the proper mix of staff. She said the state’s current staffing language is not sufficient.
“It’s clearly not addressing the issues, but it’s something that we can build from,” she said.
Along with keeping the Medicaid expansion, Ms. Chovanak said the group supported the state’s behavioral health Medicaid redesign process, which could improve the coordination of patient care, she said.
“The challenge in that is not just redesigning and rolling that into Medicaid, but then additionally we need to address the number of providers,” she said.
On the behavioral health front, Cheri Walter, CEO of the Ohio Association of County Behavioral Health Authorities, said her group’s policy focus will be on ensuring adequate resources to fight the drug abuse problem and ensuring sufficient crisis services for mental health issues.
“We’re seeing not only an increase in opiate deaths, we’re seeing an increase in suicides. We’re concerned about making sure we have crisis services available,” she said. “In both of those cases, we’re probably looking at very short-term, some kind of residential treatment.”
The opiate crisis is at the top of the priority lists for many lawmakers, Ms. Walter said, and local authorities are trying to ensure there are plenty of beds for people who need recovery services.
“Our boards are trying to figure out ways that we can increase capacity as quickly as possible,” she said.
Aging and long-term care issues are expected to be a focus in the General Assembly, with the House creating a committee dedicated to the topic, and Barbara Riley, a former director of the Department of Aging and head of the Ohio Aging Advocacy Coalition, outlined a few policy priorities in the area.
Ms. Riley said one emphasis will be on providing seniors with the resources to age at home rather than in nursing homes.
“Clearly the aim more than anything else is to be able to allow our seniors to age at home and to have choices about where they receive care and the care they receive,” she said in an interview.
Doing so could reduce costs for the state, she said, because long-term care accounts for a significant amount of the program’s spending.
“We can really control the cost of Medicaid both in terms of helping people not get on it but also the costs of providing the services just by controlling the folks who ultimately move to Medicaid,” she said. “A number of other states have been very successful at providing in-home services and services like assisted living.”