How can Ohio support preventative care?

From a health care perspective, I am a fairly young and healthy member of the system. My standard interaction with doctors is an annual visit in January where I find out I'm a little vitamin D deficient.

I am surprised, however, that year after year I end up with a bill for hundreds of dollars from my health care provider, Mount Carmel. Despite the Affordable Care Act's requirement that all health insurance plans in the United States cover a preventative care visit each year, I still end up with "extra" fees tacked on to my visit.

"New patient processing." Fees for blood work. All these seem to be an essential part of preventative care, but the health care system claims they are additional services past preventative care and my insurance companies consistently agree with them.

In a poll released last month by the American Cancer Society, a majority of Ohioans say a candidate's position on access to affordable, comprehensive health coverage is very important for their decisions to vote.

You would think focusing on preventative and primary care would be a priority for a country struggling with keeping health care costs low. Preventative and primary care is cheaper than dealing with complications of diseases down the road. And in a state like Ohio where residents get one of the worst "bang for their buck" health care outcomes for how much they spend, you would think it would be particularly important.

While a lot of health care policy is decided at the federal level, states also have significant latitude in deciding health policy. Medicaid spending, which makes up a significant portion of state spending, gives the state a significant lever for influencing health care markets in the state.

A number of states have been using their authority to influence the provision of primary care for residents. In 2022, the Oklahoma State Legislature enacted legislation to require Medicaid managed care companies to spend at least 11% of their medical expenditures on primary care. This mandate creates an incentive for companies to shift spending from expensive treatment to more affordable prevention.

Other states have taken exploratory first steps to reform beyond the Medicaid sphere. In 2022, Nebraska enacted legislation to create a council to study the rate of primary care spending in the state and make recommendations about an appropriate level of spending in the state and steps toward achieving this goal.

Other states are working with private research firms to study ways to improve primary care for residents. In 2022, Virginia enacted legislation to contract with a private research firm to study the financing, quality, and delivery of primary care to Virginians.

Other states are paving the way for better primary and preventative care for their residents, which will lead to both better outcomes and lower costs for patients. While I don't know the relative effectiveness of these policies, I do know one thing. I can keep coming back for preventative care visits year after year and spending on bills I shouldn't have to pay. But for someone at the federal poverty level, the bill I got hit with is half a paycheck. She has a lot more reason to skip next year's appointment. And next year's appointment might be the important one.