What The Affordable Care Act Means For Ohioans

In 2007, nearly 13 percent of Ohio residents reported they were unable to see a doctor when necessary due to cost. Between 2003 and 2009, Ohio families saw the price of health insurance rise 30 percent to an annual average premium of $11,870. Single policyholders saw an increase of 25 percent for their health insurance policies over the same period. [1] Of the Ohio residents that have health insurance, 51 percent are covered through their employment. Public programs such as Medicaid and Medicare insure 30 percent of Ohioans, and five percent of residents purchase individual private policies. This leaves more than 1.5 million, 14 percent of the population, uninsured. [2]

Who are the uninsured in Ohio?

Children in Ohio are uninsured at a rate of nine percent. This figure rises to 14 percent for children living in households with incomes less than 139 percent of the Federal Poverty Level. Non-elderly adults, those younger than 65, in these lower-income households are uninsured at a rate of 38 percent. [3] Among the non-elderly Hispanic population, 29 percent lack health insurance. Non-elderly Blacks in Ohio are uninsured at a rate of 21 percent, and 14 percent of White Ohioans are uninsured. [4]

How does the Affordable Care Act affect Ohio residents?

The Affordable Care Act (ACA) requires states provide access to an online marketplace, also called an exchange, where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government.

In November 2012, Ohio governor John Kasich informed the U.S. Department of Health and Human Services (HHS) that Ohio would not establish its own exchange. Kasich cited costs and the failure of HHS to provide adequate information as reasons for this decision. Therefore, the Ohio health insurance exchange is run by the federal government. Kasich asserts that Ohio will retain the authority to regulate the state’s insurance industry.

Under ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services and mental health treatments. Annual wellness checkups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.

Ohio’s health insurance exchange

Ohio residents are able to shop for and enroll in health insurance plans at the federal health insurance marketplace portal HealthCare.gov. All plans offered in the Ohio exchange will cover essential health benefits based on Anthem Blue Cross/Blue Shield’s Blue Access PPO plan. According to Ohio Department of Insurance, 14 companies have submitted 214 plans for inclusion in the Ohio exchange with rates ranging from $282.51 to $577.40 for individual policies. Plans are offered in four categories of coverage levels, with the least expensive plan, the bronze tier, covering 60 percent of medical costs. Plans in the silver tier cover 70 percent of costs. Gold plans cover 80 percent. The most expensive tier, platinum, covers 90 percent of medical costs. The HealthCare.gov website offers information about available tax credits, subsidies and eligibility for free health insurance through Medicaid. For assistance by phone, consumers may reach the call center 24-hours a day at 1-800-318-2596.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Ohio small business owners may access SHOP through HealthCare.gov. For more information about the ACA and small businesses, visit the U.S. Small Business Administration.

Certified in-person enrollment organizations

The U.S. Department of Health and Human Services has approved the health centers below in Ohio for assistance in outreach and enrollment.

For the most current list, visit the U.S. Department of Health and Human Services.

External resources for Ohio residents

See the full list of external resources from CBS Cleveland.


[1] http://www.commonwealthfund.org/Publications/Issue-Briefs/2010/Dec/State-Trends-Premiums-and-Deductibles.aspx
[2] http://kff.org/other/state-indicator/total-population/?state=OH
[3] http://kff.org/state-category/health-coverage-uninsured/?state=OH
[4] http://kff.org/uninsured/state-indicator/rate-by-raceethnicity/?state=OH

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.


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