By Marc Kovac
and William K. Alcorn
An estimated 916,000 Ohioans, many of them part of working families, are eligible for tax subsidies to purchase health insurance via provisions in the federal Affordable Care Act that take effect next year.
The projection was released Thursday as part of a study commissioned by the national health care advocacy group Families USA, which is promoting the positive impacts of President Barack Obama’s signature legislation and pushing for support for Medicaid-expansion efforts in Ohio and elsewhere.
“These subsidies are going to help a huge number of people,” said Ron Pollack, Families USA’s executive director. “They will make health coverage affordable to huge numbers of uninsured families.”
Under the federal law, commonly referred to as Obamacare, residents with annual incomes up to 400 percent of poverty level (roughly $46,000 for an individual, $94,200 for a family of four) are eligible for tax subsidies to purchase private health insurance.
The tax credits will be offered on a sliding scale, with individuals and families in lower income brackets receiving larger subsidies.
Sign-ups begin in October, with policies taking effect next year.
Cuyahoga, Franklin and Hamilton counties have the highest number of potential enrollees, at 96,290, 88,270 and 60,950, respectively.
Mahoning and Trumbull counties have a combined 35,100 eligible residents, with 10,540 in Columbiana County and 34,450 in Stark and Carroll counties.
The coverage is in addition to Ohioans who could be covered by Medicaid, if Gov. John Kasich’s proposed increases to eligibility are enacted.
County health commissioners have had many discussions trying to determine what adjustments in staff and services public health departments will have to make when the Affordable Care Act takes effect in 2014.
The problems, said Wes Vins, commissioner of the Columbiana County Health Department, are the conflicting information they are receiving and uncertainty about correctly interpreting the law’s language.
Public health is the traditional safety net for the poor, particularly those without any health insurance.
There also is concern that the complexity of the new health care reform may have a negative impact on small health care providers in rural areas such as Columbiana County.
“Are we going to see the loss of health care providers who can’t afford to institute computer systems and hire additional staff to conform to the requirements of the law? It may put primary- care physicians out of business,” Vins said.
“We’ve had some providers tell us they are going to hang it up. The potential lack of access to care and loss of jobs in our small communities has us worried,” he said.
Public health departments are trying to figure out how they may have to realign staff to meet the gaps in health care they are trying to identify. There may be more or less demand, Vins said.
“In general, we’re hopeful the changes will in the end result in a healthier community. The question is how do we get there. It’s a moving target. The only way the process will work is if public health continues to work in concert with everybody in the health care system,” he said.
Mahoning County District Board of Health Commissioner Patricia Sweeney said she is less concerned about the immediate impact on public health services than she is pleased that a larger portion of the population will have access to preventive and primary health care and cannot be dismissed because of a pre-existing condition.
There is some confusion about what role public health will play under the new law. But if there is a need beyond the traditional safety net, perhaps there will be a move toward providing primary health care, Sweeney said.
“I think that we can work as patient navigators, something our nurses do very well with children now, in cooperation with hospitals to reduce the need for re-admissions,” she said.
For example, Sweeney said, public health nurses could monitor diabetic patients to make sure they are following their doctor’s instructions and are educated about diet.
The new law should work out well in the long run, but there will be some growing pains, Sweeney said.
The Families USA report was released on the same day that the National Federation of Independent Businesses offered its own Obamacare study, projecting a loss of 2,999 to 5,345 jobs and a sales drop of “at least $1.5 billion” because of increased health coverage costs.
“Businesses in Ohio are struggling under unprecedented costs from taxes and regulations,” Roger Geiger, NFIB Ohio director, said in a released statement. “We need to do all that we can to increase jobs, not reduce them. This destructive tax simply must go, if we are ever to return to the thriving culture of growth and entrepreneurship that Ohioans are accustomed to.”