Policy and partnership to advance health care.

State laws affecting health insurance can affect whether Ohio employers and workers can afford coverage. Some well-intentioned laws do more harm than good, by driving up costs. Policymakers should keep in mind that health insurance premiums aren’t pulled from thin air; by law they must be high enough to cover projected costs. In addition, the amount health plans can collect beyond the cost of service is limited by law. Coverage mandates drive up costs, which drive up premiums and make health insurance unaffordable for some.

Ohio’s health plans are major contributors to Ohio’s economy, innovators of programs to improve the health of Ohioans and avenues for individuals, employers, and the state to get the best value for the health care services they need. The Ohio Association of Health Plans (OAHP), which is comprised of 16 member plans, is the voice for Ohio’s health insurance industry. Our members provide health care coverage to more than 9 million Ohioans through the private, commercial coverage and are committed partners in public programs, such as Medicaid, the Health Insurance Exchange and Medicare.

Facility fees at hospitals are higher than those charged at independently owned outpatient facilities because of hospitals’ intensive, 24/7 equipment and staffing needs. That’s fair. But many hospital systems are acquiring outpatient facilities such as imaging or surgery centers and are adding hospital-level fees to the cost of care provided, even though the care is no different from that at independently owned facilities. It’s hitting consumers and businesses hard — by one estimate, driving up costs in the commercial insurance market by $60 billion per year.

Prior Authorization is a necessary tool to help ensure patient care is safe, effective and affordable. In Ohio’s competitive health insurance marketplace, many insurers are developing gold-carding programs to attract the proven best-performing providers, by exempting them from prior authorization.