Special Advocacy update
Jan Lanier, JD, RN
The months of May and June will see lots of activity at the statehouse. Prior to leaving for a prolonged summer break beginning in July, lawmakers must enact the state budget bill (HB 96) and are likely to bring more bills forward. Because of its breadth, HB 96 is an ideal vehicle for including multiple proposals –the proverbial “Christmas Tree Bill” — that will mark the end of the budget-focused segment of the 136th General Assembly. Several of the bills that are being heard by various standing committees may be candidates for inclusion in the final version of the budget bill that is ultimately agreed to by both chambers.
Looking at the state budget through a healthcare lens:
In the words of one journalist, “The 5,000-plus page biennial budget was never really about improving the common good of everyday Ohioans. It’s about advancing the hard right priorities of powerful politicians who answer to big money and not constituents.” (Source: Balmert, J. (April 22, 2025) Ohio lawmakers wanted to keep kids on Medicaid. Then they changed course. Cincinnati Inquirer retrieved from https://www.cincinnati.com/story/news/politics/2025/04/23/ohio-house-budget-would-ax-medicaid-change-that-aimed-to-help-kids/83123029007/) Whether you agree with that statement or not, it is hard to argue that the health of Ohioans in general will be improved by the house-passed version of the bill. For example:
- Clean drinking water initiatives, food assistance programs, and health care coverage for the poor are all on the chopping block.
- Cutting $22 million from Help Me Grow Programs covering in-home visits to newborn babies-a 26% reduction in fiscal year (FY) 2027.
- Cutting Infant vitality programs $3 million in FYs 26 and 27, which will impact efforts to address the state’s infant mortality problem.
- Scrubbing efforts to give Ohio’s children a healthy start by keeping them on Medicaid through their 4th birthdays, regardless of their circumstances, will limit children’s access to timely health care. Finance committee chair, Brian Stewart (R-Ashville), explained that the republicans’ rationale for this change was based on the need not to open the door to runaway Medicaid costs. “It is a slippery slope of more spending, ” he said.
- Including a trigger to eliminate the Medicaid expansion program enables the state to back out of Medicaid expansion if federal funding is cut even slightly. Ohio agreed to participate in the program in 2013 as a way to provide access to health care for 770,000 newly eligible adults. The federal government was responsible for 100% of the cost, with that percentage decreasing gradually until the federal share capped at 90% of the cost. If expansion is eliminated these so-called group VIII individuals could become part of Ohio’s roster of (Sources: Tebben, S. (4-22-25) Ohio public health one of the worst funded in the country, faces further cuts. Ohio Capital Journal.
Kasich, J. (4/10/25) House-pass trigger that would end Medicaid expansion if federal funds are cut. Retrieved from https://www.news5cleveland.com/news/local-news/house-passed-budget-includes-medicaid-trigger-that-would-end-medicaid-expansion-if-federal-funds-are-cut
Given the uncertainty at the federal level the future of Medicaid expansion is unclear forcing many states that expanded their Medicaid programs to add the expansion issue to the agenda in their respective state legislatures. The Center for Community Solutions analyzed each state senate district to determine how many individuals in a particular district rely on expanded Medicaid eligibility for their health coverage. The findings show that each of the 33 Ohio senate districts have a minimum of 10,000 people that use the option. District 19 represented by Sen. Andy Brenner (R-Delaware) has the fewest people, likely because the area includes wealthy Delaware County and Holmes County, which has a large Amish population. On the other end of the spectrum, District 25 in Columbus represented by Sen. Bill DeMora has the highest, 44,589. (Source: Gongwer News Service (5-5-25) Health and Human Services. Gongwer-Ohio.)
The future of public health—Stopping problems before they start
Many of the budget cuts proposed in the House version of HB 96 represent cuts to public health initiatives. The Health Policy Institute of Ohio using 2021 data from the State Health Access Data Assessment Center, found Ohio spent $24/person on public health. This is lower than most other states. Only 12 states were worse with Missouri being the lowest spender ($6.54/person) and Washington, D.C. the highest ($370.56). Public health dollars are used to fund vaccine administration clinics and outreach initiatives, senior fall prevention programs, health education, food and water safety programs, car seat installation programs, drug overdose reversal initiatives and more. Public health employees include nurses at school-based health centers, restaurant inspectors, epidemiologists, and nutritionists. These initiatives yield an average return on investments (ROI) of $14 for every dollar spent. Improved health outcomes, reduced health care costs, and increased productivity contribute to these savings. However, even with the economic benefits, public health advocates are once again having to convince policy makers of the value of public health initiatives and the importance of adequately funding these programs. (Source: Tebben, S. (4-22-25) Ohio public health one of the worst funded in the country, faces further cuts in state budget. Ohio Capital Journal)
What else is happening at the statehouse?
Once HB 96 was approved by the full house, that chamber turned its attention to numerous other bills that had taken a backseat to the budget. One of the busiest committees has been the house health committee to which 16 bills have been referred thus far. Committee chair Rep. Jean Schmidt (R-Miami Twp) has scheduled multiple hearings on HB 8 sponsored by Rep. Andrea White (R-Kettering). The bill requires health benefit plans and Medicaid coverage of biomarker testing, The bill was considered by two previous general assemblies (HB 24—134th GA and HB 608 –135th GA) and the sponsor is committed to getting the current version across the finish line. Despite her dedication, she was not willing to include a cap on costs in exchange for a staunch opponent (the National Federation of Independent Businesses-Ohio) remaining neutral on the bill. The Ohio Association of Health Plans has maintained its opposition throughout, although the Chamber of Commerce became a proponent when language was added to ensure biomarker testing would be used only when it was medically necessary, and a competitive market exists. Opponents argue that a mandate would drive up costs and undercut efforts to negotiate prices thus hurting Ohio businesses. Rep. While counters that putting a cost cap on biomarker testing without looking at the health system as a whole is not the way to legislate. (Source: Gongwer-Ohio (4/30/25) Biomarker bill sponsor against adding cost cap. Gongwer News Service, Columbus, OH).
Also before the health committee is HB 12 sponsored by Reps. Jennifer Gross (R-West Chester) and D.J. Swearingen (R-Huron). It addresses prescribing, dispensing, and administering drugs used for off-label purposes in hospitals and some other long term care facilities. This issue was also considered by the previous general assembly. (HB 73). Although it passed both the house and senate last year, the changes made by the senate were not agreed to by the house sponsors thus leading the house to refuse to consider concurrence with the senate-passed version. Fast forward to 2025. ANA-Ohio is following HB 12 closely like it did with HB 73. Its members’ concerns continue to center on whether the bill’s language provides adequate legal protections for nurses who administer these drugs. ANA-Ohio testimony was submitted for inclusion at the May 7th committee hearing on HB 12.
HB 141 would create pediatric extended care centers, also known as medical day cares. The bill’s sponsors are Reps. Cindy Abrams (R-Harrison) and Rachel Baker (D-Cincinnati). These facilities are non-residential, community-based day care centers for children with complex needs that offer both day care and early childhood education. Currently, Ohio does not have any PPCEs. If approved they would be part of Medicaid home and community-based waivers. The bill has had one hearing before the house health committee with a second hearing slated for May 7th.
(Source: Gongwer-Ohio (4/30/25) House committee hearings-health committee. Gongwer News Service. Columbus, OH).
Other bills before the health committee include HB 52 that would revise CRNA’s practice; HB 128, the Reproductive Care Act; HB 162, My Child My Chart Act; HB 172, that would prohibit mental health services to minors without parental or guardian consent, HB 224 to regulate the practice of certified and licensed midwives, and HB 237 that would protect assisted reproductive care. All these bills are included on ANA-Ohio’s bill tracker dated April 15th that is available on ANA-Ohio’s website at the advocacy tab.
Hemp regulation bills are being addressed by both the house (HB 198) sponsored by Rep. Brian Stewart (R-Ashville) and the senate (SB 86 sponsored by Sens. Steve Huffman (R-Tipp City and Shane Wilkin (R-Hillsboro)). The regulatory format and details vary, however, between the two bills. The house version is supported by several industry groups such as the Ohio Council of Retail Merchants. Both bills are characterized as “putting guard rails” around the manufacture, distribution, and sale of hemp-derived cannabinoid products, but SB 86 focuses those guardrails on sales of potentially dangerous products that affect and target children. The senate bill gives regulatory authority to the Department of Commerce and bars sales outside of a licensed recreational or medical dispensary with a 10% tax on gross receipts. Drinkable cannabinoid products can be sold only in liquor establishments with a C or D liquor permit. Under the house version, the Department of Agriculture is given regulatory authority, and sales would be open to other retail establishments. Supporters of this approach believe it provides responsible sales while ensuring no financial harm to the stores. Most observers believe that, depending on what the senate does with HB 198, the issues and differences are likely to be resolved through an amendment to HB 96.
Both chambers agree that these products should not be readily available to minors and packaging should not be designed to appeal specifically to them. (Sources: Gongwer-Ohio (4-30-25) Senate advances hemp restrictions, police quota ban. Gongwer News Service Columbus, OH.)
A word about voting
The foundation of the U.S. form of government is the right to vote. Many do not take advantage of that right and may take it for granted. As fundamental as voting is, the right to cast a ballot in a trustworthy election is facing many challenges and charges both federally and at the state level. Several bills have been considered during this session of the Ohio General Assembly, one dealing with ranked choice voting and the other proof of citizenship. Both issues were heard by the previous general assembly but not enacted.
SB 63 sponsored by Sens. Theresa Gavaronne (R-Bowling Green) and William DeMora (D-Columbus) would prohibit rank choice voting in any Ohio election. The bill was introduced February 26th and had four hearings before the senate general government committee. The committee recommended the bill for passage on April 29th. It is backed by the Heritage Foundation, the Honest Elections Project Action led by Leonard Leo of the Federalist Society, and the Opportunity Solutions Project from Florida. Despite the partisanship of these groups, SB 63 has bipartisan support in Ohio and elsewhere. Ranked choice voting is complicated but not impossible. Its supporters say it provides the public more choices than the current approach. For example, multiple candidates would be on the ballot for an office. Voters would rank order their preferences (first choice, second choice, third choice, and so on). Ranking candidates is different from simply selecting one candidate or what is known as plurality voting. If a candidate receives more than half of the first choices, that candidate wins, just like in any other election. However, if there is no majority winner after counting the first choices, the race is decided by an instant runoff. The candidate with the fewest votes is eliminated, and voters who ranked that candidate as their first choice will have their votes count for their next choice. This process continues until a majority winner, a candidate with more than half of the vote, wins. (Source: Ranked Choice Voting Resource Center nd. retrieved from https://www.rcvresources.org/what-is-rcv/)
SB 153 sponsored by Sens. Gavaronne and Andrew Brenner (R-Delaware) would require every voter to show proof of citizenship to register to vote. The bill was introduced March 19th and referred to the general government committee on March 26th. It has had two hearings with only one proponent offering testimony.
The issue of noncitizens voting has been raised by some election officials and partisan think tank organizations; however, the actual instances of non-citizen voting are rare. It is already illegal to vote if one is not a U.S. citizen. Researchers have found that more than 9% of voting age citizens do not have ready access to the documents required by the bill. (Source. Evans, N. (5/5/25) Senator’s advance rank choice prohibition, mull proof of citizenship bill. Ohio Capital Journal).
The bill also places restrictions on the petition process, requires paid canvassers to wear a badge identifying them as being paid and eliminates the use of ballot drop boxes. Sen. Gavaronne in her sponsor testimony described drop boxes as a major weakness in our elections. She believes using a U.S. mailbox is better than the ballot drops box approach.
