The looming specter of an $8 billion budget deficit will cast its shadow over nearly everything that happens — or doesn’t happen — in the Ohio legislature this year.
But that won’t stop key interest groups from throughout Ohio’s healthcare community from pushing for (and against) prospective laws that they hold most (or least) dear.
With Republicans in control of the governorship and both houses — and most GOPers having never met a tax cut they didn’t like — it’s virtually certain the deficit will be tamed by deep spending cuts, rather than the addition of more revenues.
For the legislature, it seems that taking the axe to state spending on health and education is all but inevitable. Medicaid, the federal- and state-funded health insurance program for low-income people, represents the state’s largest and fastest-growing expenditure, so it seems like a rather obvious place to begin cutting — but doing so could exact a toll on hospitals and the doctors and nurses they employ.
To get a feel for what’s at the top of their legislative agendas, MedCity News spoke with groups representing the state’s hospitals, nurses, doctors and biomedical companies.
Hospitals: The Ohio Hospital Association‘s (OHA) “main focus” this year will be the state budget, spokeswoman Tiffany Himmelreich said. OHA will work with lawmakers to offer ideas on how to perform the delicate act of balancing the budget while avoiding cuts to Medicaid reimbursement rates that would surely sting hospitals’ finances. OHA supports “systemic change” to the Medicaid program, such as employing the concept of medical homes and placing a greater emphasis on prevention and primary care, Himmelreich said.
Hospitals also are pushing for legislation that would make permanent a moratorium on most-favored-nation clauses between insurers and health providers. The clauses require health providers such as hospitals to charge a payer, such as an insurance company, the same rate they charge other comparable payers. The clauses discourage competition amongst insurers and restrict hospitals’ ability to contract freely with insurers, OHA said. A study commission headed by the Ohio Department of Insurance last year recommended (pdf) the state prohibit or restrict most-favored-nation clauses in healthcare contracts.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Nurses: For the Ohio Nurses Association (ONA), the No. 1 legislative objective is to ensure what it views as adequate nurse staffing levels. Specifically, ONA would like to strengthen a 2008 law that required hospitals to set up “hospital-wide nursing care committees” to provide input to hospital executives on nurse staffing levels. Half of each committee is required to consist of direct-care nurses, according to the law. However, the law imposes no penalties on hospitals that don’t follow it, so ONA is looking for ways to “add some teeth to it,” said Lisa Rankin, ONA’s deputy executive director.
ONA is also hoping to revive a law proposed last session that would increase the punishment for assaulting nurses in the workplace. The proposal never made it to a vote last time. Plus, the group is concerned about the effect of Medicaid cuts on its members.
“Any cuts to Medicaid filter down to health facilities and nursing facilities,” Rankin said.
Doctors: Like physicians everywhere, Ohio doctors consider tort reform a huge issue, according to a spokesman for the Ohio State Medical Association (OSMA), the trade group for doctors in the state. OSMA hopes to see the reintroduction of a bill from last session that would dramatically increase the legal standard to win a civil suit against a doctor working at an emergency department. Physicians would have qualified civil immunity while working in emergency rooms and be subject only to lawsuits if they showed “willful or wanton misconduct” — a high standard for liability usually reserved to determine punitive damages.
The bill is also a top priority for the Ohio Hospital Association. “Qualified immunity would allow hospitals to care for victims of a public crisis without the fear of litigation,” Himmelreich said.
In addition, OSMA would like to see an adjustment to the state’s statute of repose, which is similar to a statute of limitations, as it relates to physician liability. Essentially, OSMA wants the statute of repose — four years for adults — to apply to children as it applies to adults. Currently, children can bring legal claims against physicians up until they turn 19 — even if the procedure in question happened 10 years ago.
Biomedical: Ohio’s biomedical industry had its wishes come true last year when voters extended the state’s Third Frontier program, which provides grants aimed at job creation to high-tech companies. Still, anything that could disrupt funding to the program would be a huge concern to the industry, though there’s no reason — at least now — to think that’s going to happen. Plans by newly elected Gov. John Kasich to at least partially privatize the Ohio Department of Development, which administers Third Frontier, have created a little uncertainty, but not necessarily concern, for the industry. Leaders of two leading economic development groups — BioEnterprise Corp. in Cleveland and BioOhio in Columbus — say they generally support Kasich’s plan.
“With no specifics yet available, it is hard to comment on what we like or do not like about the implementation of the idea,” said Tony Dennis, BioOhio’s president. “Based on the track record of other states’ privatization, it is a mixed bag of results for the bioscience industry.”
As for specific legislation, BioEnterprise President Baiju Shah is hoping for the revival of a bill from last session that would increase the dollar amount of tax credits the Ohio Venture Capital Authority (OVCA) can authorize. The tax credits are used only to offset potential losses incurred by investors in the Ohio Capital Fund, a “fund of funds” that invests state money alongside private funds. Shah said the OVCA program makes it easier to recruit out-of-state venture firms to set up offices in Ohio.
Also in the interest of freeing up investment dollars, Dennis said BioOhio would push for a $100 million-plus venture capital fund that’d be structured as a partnership between the state’s public universities and private industry. Details of exactly how such a fund would work are sketchy, but the concept has a powerful backer in Ohio State University President Gordon Gee.
Kasich is expected to submit a budget proposal in March. The next budget would take effect on July 1, 2011.
