As efforts to extend health insurance subsidies have stalled, one negotiator, Ohio Republican U.S. Sen. Bernie Moreno seemed to blame former President Barack Obama’s signature health care law, the Affordable Care Act.

“You gotta remember, Democrats created Obamacare,” NPR reported him as saying in late January. “It’s been an abject failure in terms of lowering costs.”

Is that really the case?

Congressional Republicans allowed subsidies for more than 400,000 Ohioans buying insurance under the Affordable Care Act to expire at the end of last year. 

Costs for the average person more than doubled with the loss of the subsidies. In their wake, an estimated 113,000 Ohioans have already lost coverage altogether.

Nationally, about 42 million Americans were using the subsidies when they expired.

More than 1 million have lost coverage already, KFF reported earlier this month, and 4.8 million are expected to become uninsured by the end of the year, the Urban Institute reported in September.

Moreno and other Republicans in Congress allowed those subsidies to expire months after they renewed President Donald Trump’s 2017 tax cuts, which are heavily weighted in favor of the wealthiest Americans.

Extending the subsidies would have cost about $350 billion over the next 10 years, while the tax cuts will provide a $1 trillion windfall just to the richest 1% over the same period.

The ACA subsidies mostly benefitted lower-income Americans, with 70% of recipients earning less than 250% of federal poverty guidelines.

For an individual, that’s just under $40,000 a year.

The Trump spending law also took a huge bite out of programs for the poorest Americans.

It cut Medicaid spending by nearly $1 trillion over 10 years, and it cut $186 billion from a federal food assistance program under which many states are already doing a woeful job of serving eligible people.

Bipartisan talks to revive the subsidies stalled late last month.

Moreno accused Democrats of not wanting a solution, but an issue to run on.

For their part, Democrats accused Republicans of inserting a poison pill in the form of anti-abortion rules governing health savings accounts.

It’s in this context that Moreno claimed that the Affordable Care Act has failed its promises to save money. 

When they heard the claim, several critics were quick to point out that in 2009 Republicans opposed the “public option” — a measure in the original ACA that supporters said was one of the most potent ways of bringing down health care costs.

It would have been a government-sponsored plan offered on the insurance exchanges that would compete with private plans and leverage the government’s buying power to drive down prices charged by providers.

There is also considerable evidence that while the ACA didn’t make health care cheaper on a nominal basis, it made prices rise less quickly.

This fact check points to a 2020 study by the Journal of the American Medical Association finding that out-of-pocket health costs rose on average of 3.4% a year over the decade before the ACA.

That rate slowed to 1.9% a year over the nine-year period after its passage, the fact check said.

Ezekiel Emanuel, an oncologist and co-director of the Health Care Transformation Institute at the University of Pennsylvania, wrote a 2023 opinion column in Stat News giving his take on why medical inflation slowed in the wake of the ACA’s passage.

The law created incentives for doctors to control costs, he said.

“The mindset of American physicians and other clinicians has changed, from ignoring costs to trying to cut them,” Emanuel wrote.

“Instead of figuring out more expensive medical tests and treatments, doctors are now asking whether a test or treatment will improve a patient’s health and how a service can be performed more efficiently by shifting where and how it is administered.“

Moreno’s office was asked whether he agreed the ACA had slowed the rate of medical inflation.

“The facts don’t lie: the Affordable Care Act was never affordable,” Communications Director Reagan McCarthy said in an email.

“Premiums and deductibles for individuals and families have skyrocketed while Democrats’ signature legislation bailed out health insurance companies on the back of taxpayers. It’s a shame that Chuck Schumer rejected a good-faith, bipartisan effort to lower health care costs.”

McCarthy didn’t point to any evidence that medical inflation accelerated as a consequence of the ACA. 

When it comes to per-capita, out-of-pocket costs, they’ve grown from $1,299 in 2010 to $1,514 in 2023 when the amounts are expressed in 2023 dollars, KFF reported.

That’s about a 17% increase.

Over a similar period before the ACA, they rose from $979 in 1997 to $1,314 in 2009 — a 34% increase.

When you look at total national health spending in terms of 2023 dollars on a per-capita basis, they grew about 57% between 1997 and 2010, and about 29% between 2010 and 2023.

McCarthy didn’t respond directly when asked whether creating millions more uninsured people will cost all Americans. 

With the passage of the ACA, the rate of uninsured Americans has plummeted from 17.8% in 2010 to 9.5% in 2023, KFF reported.

In 2009, about 46.5 million Americans were uninsured. By 2023, the number of uninsured Americans was down to 25.3 million, a historic low.

Several experts predict that the expiration of ACA subsidies and the Trump spending bill will create millions more uninsured, and rates of uninsurance will return to where they were in the early years of the ACA.

One direct cost from having high rates of uninsured Americans is “uncompensated care” — the bills everybody else has to cover when people can’t pay themselves. 

The Congressional Budget Office last year predicted that the spending law alone will add 11 million Americans and 440,000 Ohioans to the ranks of the uninsured by 2034.

The Center for American Progress last year did an analysis indicating that that would increase uncompensated care costs by nearly $1 billion in Ohio that year and $36 billion nationally.

Emergency departments feel the particular brunt of uncompensated care because they can’t turn people away based on their ability to pay.

Last year, Ohio emergency room doctors warned that increasing uncompensated care would increase wait times for all patients and push some already-stressed rural hospitals out of business.

This story originally appeared at ohiocapitaljournal.com.

The post Ohio Republican U.S. Sen. Bernie Moreno has claimed the ACA didn’t save money. But is that true? appeared first on Cincinnati CityBeat.

Federal authorities in recent weeks have taken huge steps aimed at curbing the practices of drug middlemen known as pharmacy benefit managers, or PBMs.

The steps come after years of complaints from small pharmacies and attempts to rein in the huge corporations by lawmakers in Ohio and other states. 

PBMs act on behalf of insurers — including those working in Medicare and Medicaid — to administer drug transactions.

The three biggest — Express Scripts, CVS Caremark and OptumRx — are each part of one of the 13 largest corporations in the United States. 

Together, the three companies control nearly 80% of drug transactions, prompting suspicions that the sector is not competitive. 

PBMs create “formularies,” meaning they decide which drugs are covered by insurance.

Because they control access to millions of patients, they’re able to negotiate huge, often non-transparent rebates from drugmakers.

The companies claim they use this power to get better deals for consumers. But critics say it creates an incentive not to put the cheapest, best drugs on their formularies, but those for which they get the fattest rebates.

Another basic function of PBMs is to create pharmacy networks. They decide how much to reimburse them for the drugs they dispense and they charge pharmacies various fees.

But there’s a seeming conflict. 

Each of the PBMs’ owners also owns a mail-order pharmacy and CVS owns the nation’s largest retail chain.

So the conglomerates are deciding fees and how much to reimburse their own pharmacies and those of their competition.

Again, because the big PBMs control access to so many patients, independent and small-chain pharmacies usually conclude that they have no choice but to do business with them on whatever terms the PBMs offer.

They say it’s no coincidence that thousands of pharmacies have closed their doors over the past decade.

To end the conflict, a bipartisan bill was filed this month that would prohibit the health conglomerates from owning providers such as pharmacies and doctors’ offices at the same time they own insurance companies and PBMs, which control how much consumers have to pay them.

While that bill has a long way to go, other big changes are now law. President Donald Trump on Feb. 3 signed a bipartisan spending bill containing reforms that the National Community Pharmacists Association called “the first major PBM reform in decades.” 

Among its provisions, the new law:

• Prohibits PBMs from being compensated by Medicare Part D plans as a percentage of the price of a drug or from manufacturer rebates. The idea is to remove incentives to cover higher-priced drugs over cheaper ones as PBMs chase profits. The companies will now be paid a “‘bona fide service fee’, which will be a flat dollar amount that reflects the fair market value of services provided by PBMs, beginning January 1, 2028,” reported KFF, the independent health-information provider.
• Requires PBMs serving Part D plans to disclose details of their contracts with drugmakers, their deals with pharmacies owned by the same company, and their pricing. The intent is to shed light on what previously were opaque transactions.
• Requires PBMs serving employer plans covered by the Employee Retirement Income Security Act, or ERISA, to pass 100% of any manufacturer rebates back to health plans instead of pocketing often-undisclosed amounts as they have in the past.
• Requires PBMs serving Part D plans to contract with any pharmacy on terms deemed to be “reasonable and relevant.”

The PBM industry reacted bitterly to the law’s passage.

A spokesman, Brendan Buck, issued a statement on behalf of their industry group, the Pharmaceutical Care Management Association.

“It’s a remarkable moment,” he wrote. “Not for the impact on drug prices (higher). But rather because it is the culmination of a years-long effort by drugmakers to convince Congress that PBMs are the problem with high drug costs.”

Buck said the law wasn’t the product of good policy, but of effective lobbying by drugmakers.

“The pharmaceutical industry deserves serious credit for this campaign, which managed to persuade people that discounts are in fact bad, and PBM transparency, somehow, is the roadblock to falling drug prices,” he said. “It’s absurd on its face. But it worked. So good for them.”

Antonio Ciaccia is a Columbus-based drug-pricing expert. He consults with employers and government payers on how to reduce their drug costs.

He’s worked with lawmakers and attorneys general in Ohio and other states on reforms that he said the middlemen often quickly circumvented.

“Whether we think that these things are going to be effective or not, there is no mistaking that this is an unprecedented, multifaceted assault on the legacy PBM business model,” Ciaccia said. “It is coming from multiple directions… We haven’t seen anything at this level in the federal space ever.”

In another major development, the Federal Trade Commission earlier this month settled a lawsuit against Express Scripts over insulin pricing.

The suit accused the PBM — as well as CVS Caremark and OptumRx — of excluding cheaper forms of the lifesaving drug from its formularies.

The settlement requires an end to the practice, and that Express Scripts report its costs for drugs alongside pharmacy reimbursement, among other measures.

The suit against the other two big PBMs is ongoing.

Ciaccia said that as with the new PBM law, the intent was to remove incentives for middlemen and drugmakers to raise prices.

“If the PBM is the buyer and the manufacturer is the seller, both are making more money off of higher list prices…,” he said.

“It’s a perverse incentive if the buyer is relying on more money through a higher list price. This would move them to a more fee-oriented structure, which is intended to make them more agnostic when faced with a high list-price drug with a high rebate versus a low list-price drug with a low rebate.”

This story originally appeared at ohiocapitaljournal.com.

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A bipartisan bill filed in the U.S. Senate last week seeks to lower health costs by eliminating incentives huge conglomerates have to raise them. It would do so by prohibiting companies from being both the provider of health services and the entity that determines how much consumers ultimately have to pay for them.

Introduced by Sens. Josh Hawly, R-Mo., and Elizabeth Warren, D-Mass., the Break Up Big Medicine Act would be the biggest antitrust measure undertaken in decades.

American per-capita health spending is by far the highest in the world, yet it produces greatly inferior outcomes. So it’s hard not to suspect that somebody’s skimming exploding amounts of money without adding much in the way of value.

Three conglomerates — UnitedHealth Group, CVS Health and Cigna-Express Scripts — are among the 13 largest companies by revenue in the United States.

And they’re dominant players in many parts of the health sector. They own huge insurers and pharmacy middlemen as well as thousands of pharmacies and doctors’ offices.

In a written statement, Warren said that such “vertical integration” gave the companies an incentive to raise prices. That might be seen as especially true because regardless of whether care is financed by employers, the government or individuals, the ultimate payer is the public.

“There’s no question that massive health care companies have created layers of complexity to jack up the price of everything from prescription drugs to a visit to the doctor,” Warren said. “The only way to make health care more affordable is to break up these health care conglomerates. Our bill would be a monumental step towards ending the stranglehold that corporate giants have on our broken health care system.”

The bill would prohibit companies from owning medical providers such as doctors’ offices and pharmacies while simultaneously owning insurers and their representatives such as middlemen known as pharmacy benefit managers, or PBMs. It would empower the Justice Department, the Federal Trade Commission, the Department of Health and Human Services, state attorneys general and private parties to sue claiming violations.

To illustrate how owning so many sides of a medical transaction might drive up prices, consider drug middlemen.

The PBMs owned by the three big conglomerates control nearly 80% of the insured prescription transactions in the United States. They work on behalf of big insurers. Importantly, each of the big PBMs is a sister company to one of the eight biggest insurers by market share.

PBMs decide which drugs are covered and that gives them massive leverage to negotiate non-transparent rebates from manufacturers who want insured patients to buy their products.

Research has shown that increasing rebates gives drugmakers a strong incentive to raise list prices. Delinking rebates and list prices would reduce annual drug spending by nearly $100 billion, the University of Southern California’s Schaeffer Center reported last summer.

In addition, all three conglomerates own mail-order pharmacies and CVS also owns the nation’s largest retail chain. Their PBMs decide how much to reimburse their own pharmacies as well as those of their competitors.

Many see this as an inherent conflict. For the past decade, independent and small-chain pharmacies have accused the big PBMs of discriminating against them and driving them out of business in droves.

Last year, those suspicions led the Federal Trade Commission to accuse the PBMs of wild price hikes and discriminatory practices meant to drive customers away from competitors and into their own pharmacies.

Asked for comment on the Hawley-Warren bill, UnitedHealth Group and Cigna-Express Scripts didn’t immediately respond. CVS Health referred to a statement made by CEO Dave Joyner on a Tuesday earnings call. A spokesman said the statement was unrelated to the bill. 

“Our commitment to reimagining the health care experience has never been stronger,” said Joyner, who made $18 million in 2024. “We are taking the lead to address some of the biggest challenges in the U.S. health care system — its cost, its complexity, and the fragmentation that exists today.”

Rather than raising health costs, Joyner said CVS Health’s size and its many roles allow it to bring them down.

“By combining our unique set of capabilities, we can provide a connected solution for consumers that delivers better experiences and improves health outcomes at lower cost,” he said, arguing that it was actually better for consumers if CVS acts on patients’ behalf as both buyer and seller. 

CVS’s health insurer Aetna’s “members who consistently use CVS Pharmacy have higher medication adherence and lower (emergency room) utilization,” Joyner said.

Hawley, the Republican cosponsor of the bill that would break up CVS, doesn’t seem to buy that argument.

“Americans are paying more and more for health care while the quality of care gets worse and worse.” he said in a written statement. “In their quest to put profits over people, Big Pharma and the insurance companies continue to gobble up every independent health care provider and pharmacy they can find. Working Americans deserve better. This bipartisan legislation is a massive step towards making health care affordable for every American.”

Antonio Ciaccia is a Columbus-based drug-pricing expert who consults with employers and government agencies on how to bring down their costs. He said the Warren-Hawley bill would eliminate the conflict at the center of most prescription transactions.

“If you hire a PBM to manage pharmacy spending and network design when they have their own pharmacy that can benefit from the decisions they make, it’s an obvious conflict,” he said in a text message. “This legislation aims to restore PBMs to their originally intended role as an unconflicted fighter of high drug prices.”

In another illustration of how a health conglomerate can control every aspect of a health transaction, consider UnitedHealth Group, now the third-largest corporation in the United States.

With 42% market share, it has the largest health insurer. A patient insured by UnitedHealth could easily go to a doctors’ office owned by United’s Optum, now the nation’s largest employer of physicians.

If the Optum doctor writes that patient a prescription, UnitedHealth’s OptumRx will handle it because that is the PBM exclusively used by the insurer. The patient could then be forced to avoid the neighborhood pharmacy and fill that prescription through UnitedHealth’s mail order pharmacy.

In other words, insurers and PBMs have long claimed to bring down costs by using their size to negotiate discounts from providers. But if they own the providers, the parent companies are, in essence, negotiating with themselves. 

There has been heavy consolidation in the health sector over the past decade, and the results were predictable, said Emma Freer, senior policy analyst for healthcare at the American Economic Liberties Project. Her group started the drumbeat to “break up big medicine” more than a year ago.

“For decades, policymakers in both parties have incentivized vertical consolidation in health care, resulting in Big Medicine behemoths that exploit conflicts of interest to drive costs up, quality down, and independent providers out of business,” Freer said in an email. “This is why we launched the Break Up Big Medicine initiative last year, and we are proud to support the Break Up Big Medicine Act, which will eliminate these conflicts while restoring power over our healthcare system to patients and the providers who care for them.”

Freer added that bipartisan support for the bill is growing. 

U.S. Reps. Jake Auchincloss, D-Mass., Diana Harshbarger, R-Tenn., Val Hoyle, D-Ore., Pramila Jayapal, D-Wash., and Pat Ryan, D-N.Y., have co-sponsored similar legislation in the House. And Greg Murphy, R-N.C., and Alexandria Ocasio-Cortez, D-N.Y., have endorsed the concept, Freer said.

This story originally appeared at ohiocapitaljournal.com.

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A new analysis shows that credit card debt in Ohio and elsewhere continues to grow — another indicator that average people’s financial security continues to diminish as affordability and income inequality become increasingly potent issues.

A WalletHub analysis published earlier this month found that in nominal terms, Americans had the greatest credit card debt in history during the third quarter of 2025 — $1.35 trillion.

When adjusted for inflation, it was exceeded in the third quarter of 2008 — as the Great Recession hit — when it was 8% greater.

In addition, the report said, credit card finance charges increased 36% from a pre-pandemic high in the fourth quarter of 2019 to $180 billion in the fourth quarter of 2025. 

The findings were based on data from the Federal Reserve and the U.S. Bureau of Labor Statistics.

The news comes after a November analysis found that Ohioans’ credit-card delinquencies were rising at the fifth-highest rate in the United States.

With 20% of credit cards delinquent in the second quarter of 2025, Ohio saw an increase of 29% over a year earlier.

The median credit card debt for an Ohioan is $2,476.

The growth in credit-card debt and delinquencies indicates that for many consumers, the U.S. economy is not in a good place.

“The fact that the record amount of credit card debt we currently owe isn’t really an inflation-adjusted record probably won’t do much to make consumers feel better, John Kiernan of WalletHub said in a written statement.

“We still have a ton of debt, and it remains extremely expensive — as do prices in general — with no savings in sight.”

Urging people with debt to budget carefully, he added, ​​”Nearly two in five people are already resigned to having even more credit card debt by the end of 2026…, and 42% of people expect to have credit card debt for their entire life.”

As the 2026 election year takes shape, issues such as affordability and inequality are likely to play a major role.

A New York Times-Siena University poll published on Thursday said that 64% of respondents disapproved of President Donald Trump’s handling of the economy.

That was the second-highest level of disapproval he received on any issue.

Sixty-eight percent disapproved of Trump’s handling of the Epstein files.

A Gallup poll conducted at the end of December found that Americans’ economic confidence had slipped to lows not seen since the depths of the pandemic.

Two-thirds of Gallup respondents picked issues such as inflation, the cost of housing, low wages, health care costs, and debt as their most pressing issues.

Health care is a leading cause of economic anxiety.

The December KFF Health Tracking Poll found that just under half of Americans have difficulty affording care, and that 36% reported putting off care in the prior year due to worries about affordability.

And as credit-card debt grows, large majorities of Americans are saying income inequality is a problem. 

A YouGov poll published earlier this month found that 80% of respondents believed the gap between the rich and poor was a very big or somewhat big problem.

That includes 60% of self-identified MAGA Republicans and 57% of those who identify as very conservative.

This story originally appeared at ohiocapitaljournal.com.

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New job reports are out, and two think tanks are calling the Ohio employment picture “sluggish” and “flat.”

The think tank analysis of the numbers comes after more than a decade in which the state’s Republican leaders have diverted billions from taxpayers to wealthy interests on promises that it would create jobs.

The Ohio Department of Job and Family Services on Friday released employment figures for December.

It said the state added just 3,500 jobs in the last month of 2025, and that the unemployment rate remained stuck at 4.5%, which continues to rank in the bottom half of states.

Those who stop seeking work aren’t counted in the unemployment rate because they’re not considered part of the labor force.

Rea S. Hederman Jr., vice president of policy at the Buckeye Institute, said more Ohioans need to join the labor force and more private-sector jobs need to be added.

“With national job gains slowing, Ohio’s sluggish private-sector job growth is not surprising,” Hederman said in a written statement.

“And while the unemployment rate is strong by historical measures, more Ohioans need to be in the job market, and more jobs need to be created if Ohio, its communities, and its workers are going to thrive.”

Ohio’s job market is dragging after decades of exploding inequality across the United States. 

The nonpartisan Rand Corporation last year reported that if the bottom 90% of Americans’ share of national income had remained what it was in 1975 (66%), that group would have gotten $80 trillion more by 2023.

The group comprising 9 in 10 Americans would have gotten $3.9 trillion more — or $13,000 for every person regardless of age or employment status — in 2023 alone, the analysis said.

Molly Bryden, a researcher at Policy Matters Ohio, said some of that inequality is showing up in Ohio’s most recent jobs report.

“The accommodation and food service sector saw steep losses overall in 2025, shedding 9,500 jobs in the past year,” she said in a written statement.

“Uneven growth in the service industry overall implicates growing income inequality among working Ohioans. Employment in higher-paying professions in professional and business services grew by 13,100 in 2025, coinciding with the hiring slowdown for lower-wage jobs in accommodation and food services.”

Bryden added that inequality itself is helping to drag down the economy.

“Losses in accommodation and food service jobs could indicate that rising prices have generated challenges for businesses to maintain hiring levels, along with lower demand for accommodation and food services among Ohio families, as inflation continues to strain household budgets,” she said.

“Persistent weakness in the accommodation and food service sector — an important economic driver — could have spillover effects, further stalling Ohio’s economic growth.”

There appears to be a strong political imperative to ease economic inequality.

A YouGov poll taken this month found that 80% of respondents believed that the gap between rich and poor is a very big or somewhat big problem.

That view commanded majorities across the ideological and political spectrum. 

Despite those views, however, Ohio’s Republican leadership has used claims of job creation to redistribute taxpayer dollars upward since John Kasich became governor in 2011. 

He led the creation of JobsOhio that year. The entity claims to be a private corporation even though it was created by the state government and allowed to lease the state’s liquor franchise for less than it was worth.

JobsOhio now has a large, well-paid staff, and it’s passed out more than $1 billion in what used to be state dollars to private corporations. But the agency’s leaders have struggled to prove that its activities have created any jobs.

In 2013, the Republican-led legislature created a tax break for limited liability corporations, again on claims that it, too, would create jobs. 

It’s costing the state more than $1 billion a year, with the bulk of the benefit going to the wealthy. But its supporters can’t show that it’s delivered on its job-creation promises.

The LLC tax break is part of $12 billion in annual tax cuts tilted in favor of the wealthy, Policy Matters Ohio reported last year.

The latest jobs report might be seen as evidence that those cuts and JobsOhio have been ineffective.

So could the fact that the Ohio Department of Development expects the state’s population to decline by 675,000 by 2050.

This story originally appeared at ohiocapitaljournal.com.

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As Americans struggle to afford groceries and utilities, a new study finds that three Ohio cities are among the most expensive for another essential — medical care. 

Cleveland, Toledo and Cincinnati are in the top 11 in terms of how big a bite medical expenses take out of their incomes, according to a WalletHub analysis of the 100 largest American cities.

For decades, inflating health care costs have far outpaced inflation in the economy as a whole. Between 2000 and 2024, the cost of medical care rose 121%, compared to 86% for the overall economy, according to the Peterson-KFF Health Tracker. 

Meanwhile, grocery prices have jumped more than 29% since 2020 with “no end in sight,” NPR reported in September. And many Ohio electricity consumers have seen increases as high as 44% just this year, according to Consumer Energy Solutions.

Ohioans’ pay hasn’t kept up. Adjusted for inflation, median annual income has actually dropped from about $71,000 in 2019 to $67,873 four years later, according to the Ohio Housing Finance Agency.

All of that is leaving families in a bind, the WalletHub report said.

“As health care gets increasingly more expensive, more and more people find themselves struggling to afford essential services and medicines,” it quoted analyst Chip Lupo as saying. “While some cities have lower prices than others, the average income in many places still may not be enough to keep up with the costs, especially when consumers have also faced inflated prices across all other facets of their budgets over the past few years.”

So it’s not great news that some Ohio cities are among the nation’s most expensive when it comes to health care. 

WalletHub analyzed data collected in November by the Census Bureau and the Council for Community and Economic Research. 

It compared the cost of doctor, dentist and optometrist visits as well the prices of ibuprofen and insulin glargine in each of the 100 largest cities. It then expressed those costs as a percentage of the cities’ median annual incomes.

Cleveland had the dubious distinction of coming in second, with medical costs making up 11.35% of median monthly household income. 

“This is largely due to the fact that Cleveland has the lowest median household income in the country, at $39,187 per year,” the report said, adding that medicine prices were relatively high in the city, while the cost of provider visits was relatively low.

Toledo came in fourth on the list, with medical costs making up 11.03% of median monthly income, and Cincinnati was 11th, at 8.98%. Columbus was 64th at 6.09%, putting it in the lower-cost half of big cities.

This story was originally published by the Ohio Capital Journal and republished here with permission.

The post Ohio Cities Rank Among the Most Medically Expensive, Analysis Finds appeared first on Cincinnati CityBeat.

It now seems nearly inevitable that health insurance costs will spike at the end of the month for nearly 600,000 Ohioans and 23 million Americans. An Ohio family doctor and colleagues in other states are blasting Republicans in Congress for not doing more to stop it.

Subsidies for health care purchased on exchanges created under the Affordable Care Act are set to expire Jan. 1, causing health expenses to more than double for millions.

“Without the ACA tax credits, they just can’t make health care work in their budget. So they’ll put off screenings… they won’t just split pills, they won’t take them at all,” said Catherine Romanos, a Columbus family doctor. 

She was speaking during a virtual press conference last week sponsored by the Committee to Protect Health Care, a nonprofit advocacy group of 36,000 doctors that says it doesn’t accept funding from for-profit health care corporations. 

“I don’t blame them,” Romanos said of her patients. “Everything is expensive — rent, child care, groceries. Something has to give. I blame the leaders in Washington. They had an opportunity to help out patients like the ones I see every day. They had an opportunity to ensure that their constituents would continue seeing the doctor… but they chose not to.”

The office of Ohio Republican U.S. Sen. Bernie Moreno attacked Romanos on political grounds and said he was working on a compromise extension of the subsidies. The office of Ohio Republican U.S. Sen. Jon Husted did not respond to a request for comment.

Despite President Donald Trump’s promises to quickly stop inflation, it continues nearly a year into his second term.

Meanwhile, when adjusted for inflation, median annual income actually dropped from about $71,000 in 2019 to $67,873 four years later, according to the Ohio Housing Finance Agency.

Even so, Husted and Moreno this summer voted for Trump’s One Big Beautiful Bill Act. It extended Trump’s 2017 tax cuts, at a cost of $4 trillion over 10 years, with $1 trillion of that benefit flowing to the richest 1% of Americans. It will add an estimated $3.4 trillion to the deficit.

At the same time, it cuts more than $1 trillion in medical and food assistance to low-income Americans over the same period. Even though they extended the tax cuts, congressional Republicans opted not to extend 2021 subsidies to people buying health insurance on the ACA exchanges.

The struggle over the subsidies was at the center of a 43-day government shutdown that ended Nov. 12. Husted said he didn’t want to put the $350 billion cost to extend them 10 years “on the national credit card for a program that we know is dysfunctional.”

Those subsidies average about $700 a year, but they can be as high as $20,000 for some. They’re credited with helping to bring the rate of uninsured Americans to an all-time low. 

Republicans have thus far thwarted Democratic attempts to renew the subsidies, but huge majorities of Americans support doing so. Vulnerable Republicans in Congress have defied their leaders and joined an effort to force a vote on an extension sometime in January. 

Moreno has been participating in bipartisan talks about a compromise. And he and Sen. Susan Collins, R-Maine, in December made a proposal for a two-year extension that didn’t go anywhere.

If an agreement is struck in January, it can be made retroactive. But by then, the damage will already be piling up.

The health-analysis nonprofit KFF estimates that average premiums for 23 million Americans will more than double in the absence of the subsidies. And nearly 5 million are expected to drop coverage and join the ranks of the uninsured.

The time to have extended the subsidies was months ago, before the government shutdown, Rob Davidson said. He’s an emergency doctor in western Michigan who spoke during the Committee to Protect Health Care press conference. 

“This didn’t sneak up on us,” he said. “Democrats and health care advocates have been calling for months — pretty much all year — for Congress to take action and extend the ACA tax credits, but congressional Republicans have chosen to do nothing.” 

He said the expiration of the subsidies would hurt everybody. 

Emergency doctors in Ohio have said that just because people lose insurance, that doesn’t mean they’ll stop getting sick. And emergency departments have to treat them regardless of their ability to pay.

That will sap hospital budgets and increase wait times and compromise care for all, they said.

“This isn’t just a crisis for Americans who get their health care through the ACA,” Davidson said. “When millions of Americans can no longer afford their plans, and when millions more lose their health care because of Republican cuts to Medicaid, hospitals operating on thin margins will be forced to close.”

Romanos, the Columbus family doctor, said patients themselves will become sicker if skyrocketing premiums make them poorer. The vast majority of those receiving subsidies already are in the bottom half of the income distribution. 

About 70% of the people using the ACA exchanges make 250% or less of the federal poverty guidelines. For a family of four, that’s $80,375 a year, or a third less than the median income for a family of that size in Ohio.

Romanos said patients will ration their own care if they think they can’t afford it.

“Maybe they don’t get all the lab tests that I want, or they don’t take all the medicine I prescribe,” she said. “Some just can’t afford the health care I recommend.”

She said it all could have been prevented months ago.

“Here in Ohio, our senators, Jon Husted and Bernie Moreno, voted against helping Ohioans afford health insurance,” Romanos said.

“They voted to let premiums skyrocket. Earlier this year, senators Moreno and Husted voted to give tax breaks to billionaires, but I guess health care for working families is just too expensive. What a slap in the face for my patients. Ohioans deserve leaders who look out for them, not billionaires like Donald Trump, who mocks affordability.”

Reagan McCarthy, Moreno’s communications director, responded with a statement focused on politics instead of the ACA subsidies.

“Catherine Romanos is a progressive activist and longtime Democrat donor who supported (former Democratic Vice President) Kamala Harris (and former Democratic Ohio Sen.) Sherrod Brown,” McCarthy said in an email.

“Romanos even served as a surrogate for the Ohio Democrat(ic) Party and falsely attacked Senator Moreno repeatedly. Someone who ‘fell in love with the idea of being an abortion provider’ is hardly an objective source for this garbage ‘journalism.’ Once again, the Ohio Capital Journal chooses to shamelessly prop up Ohio Democrats rather than report the facts.”

Husted’s office didn’t respond to a request for comment. 

After the government shutdown ended in November, Husted proposed a “freeze” that would have extended the subsidies while cutting benefits, the number of people who could get them or both.

Makunda Abdul-Mbacke is an OB-GYN in Rockingham County, a rural area in the North Carolina Piedmont. She said taking away the ACA subsidies and slashing Medicaid spending will drive many already-struggling rural hospitals out of business, and that will force struggling patients to drive farther for preventative care, such as Pap smears and mammograms.

“Without a mammogram, we will not be able to pick up breast cancer when it’s early,” Abdul-Mbacke said.

“We will pick it up when it’s stage three or stage four and that means that someone is losing their mother. Someone is losing their aunt or their sister or their daughter. It just appears as though the Republicans we elected just don’t care about those things as long as it’s not their family.”

This story was originally published by the Ohio Capital Journal and republished here with permission.

The post Ohio Doc, Colleagues Bash GOP Senators for Failing to Stop Insurance Hikes appeared first on Cincinnati CityBeat.

It’s probably no coincidence that so many major holidays occur around this time of year. In addition to Christmas and Hanukkah, at least five other traditional celebrations in the Americas, Europe, the Middle East, and East Asia take place this month. 

All fall around the shortest day of the year, the winter solstice, and in Ohio people have been marking it for at least 2,000 years. More than 100 are expected to go to Fort Ancient in southwest Ohio Sunday to mark it yet again. 

It’s unknown exactly why Hopewell peoples went to such great lengths to mark celestial phenomena, but it’s beyond question that they did. 

For centuries after A.D. 1, peace reigned across what is now the eastern United States as people of different cultures shared the same belief system. They made periodic pilgrimages to the Ohio Valley to build vast monuments that are so mathematically and astronomically precise that in 2023, the Hopewell Ceremonial Earthworks were named Ohio’s only World Heritage Site.

Requiring more than a century to plan and build, the Octagon Earthworks at Newark mark the 18-year cycle of the moon.

More than 100 miles to the southwest, Fort Ancient charts the phases of the sun.

The 110-acre hilltop site is enclosed by 3.5 miles of earthen walls, some as high as 23 feet, said Neil Thompson, a spokesman for the Ohio History Connection, which runs and cares for the site.

Construction was an immense effort, given that the walls had to be built one basket of earth at a time — and had to be built sturdily enough to last for millennia.

“There’s no place in the world quite like this,” Thompson said. “They made the hilltop enclosure so the earthen walls followed the hilltop, and they were still able to code the solar alignment in what they did. I think it’s another human testament to the creative genius that made these places.”

Fort Ancient isn’t just some big, crude structure looking out over the Little Miami Valley.

“At Fort Ancient, the builders literally carved the rhythm of time into the land,” the History Connection’s website says. “Two of the distinctive limestone-capped mounds align to the summer solstice sunrise, and two align to the winter solstice sunrise. These days must have held deep importance for the site’s builders.”

Stand behind one of the mounds on Sunday and you’ll watch the sun rise through the exact center of a gap built into an earthen wall hundreds of yards away.

Doing so is free and open to the public, and you’ll likely be with people who have traveled from other continents just to see it.

As with other Hopewell sites, artifacts have been found at Fort Ancient that came from as far away as the Rocky Mountains, the Atlantic Ocean, modern Canada and the Gulf Coast.

That means that vast, intricate trading networks existed when it was built — although there’s no known written record from the time describing them.

Also due to the lack of a written record, it’s unknown why the movements of the sun and moon were so important to the Hopewell people that they’d undertake such a gargantuan effort to mark them. 

But we know why the winter solstice was important to other cultures.

As the shortest day of the year, it could be a time to check grain and hay stores and decide what animals to slaughter so the rest could survive until spring.

That might call for a feast. And just being in the depths of the gloomiest part of the year might be reason enough for a celebration of light and rebirth and renewal.

Fort Ancient will open at 7 a.m. Sunday, with sunrise to come 50 minutes later. A guide will be there. Click here for a map and directions.

Weather in the area is expected to be clear and in the upper 20s. The museum will be open from 7 a.m. to 10 a.m. and bathrooms are available. The park is open until 5 p.m.

This story was originally published by the Ohio Capital Journal and republished here with permission.

The post How to Mark the Ohio Holidays Super Old-School appeared first on Cincinnati CityBeat.

One Ohio-based Immigration and Customs Enforcement officer was convicted this year of abusing women and another was arrested on such charges. That has an advocate for immigrants calling on the agency to explain what it’s doing to screen agents as it seeks to rapidly grow its ranks.

ICE didn’t respond when asked that question.

President Donald Trump came into office promising to deport what he claimed were undocumented, violent criminals.

But NPR reported last week that more than a third of those arrested — about 74,000 — had no criminal records. 

Of the rest, about half have pending charges and half have convictions. Most of the convictions are for low-level offenses such as traffic violations, the news organization reported. 

As they’ve tried to conduct mass detentions and deportations, the conduct of ICE agents has been controversial. 

They’ve been accused of violently arresting people, including some who are in the country legally. And CBS News reported that masked agents have used tactics during protests that violate federal policy and a court order.

Lynn Tramonte, founder of the Ohio Immigrant Alliance, said ICE agents have been accused of violence against women closer to home.

In March, a federal judge sentenced deportation agent Andrew Golobic to 12 years in prison.

A jury convicted him of “using his position to solicit and coerce sex from vulnerable women under his supervision” during his 14 years in the Blue Ash ICE office, federal prosecutors said.

In October, NBC reported that in the agency’s rush to staff up, some agents have reported for training without being fully vetted.

On Dec. 5, the Hamilton County Prosecutor’s office charged Samuel Saxon, 47, with assault, domestic violence and strangulation of his partner, WVXU reported.

In the 18 months that the ICE agent has been based in Cincinnati, police have been dispatched to his house during disputes 23 times, prosecutors said.

In one incident, Saxon’s partner’s pelvis was fractured, although no charges were filed, they said.

Tramonte said it’s disturbing that a federal agency would put such people in positions of power over others.

“There’s a real problem with gender-based violence by ICE agents, and the agency is not taking it seriously,” Tramonte said last week in a written statement.

“Andrew Golobic used his position of power against women who feared deportation to extort sex. The police have been called to Samuel Saxon’s home 22 times… Anyone familiar with the pattern of domestic violence knows strangulation is part of a pattern of escalating behavior that often ends in murder.” 

Saxon’s attorney told WXIX that his client had been suspended from his job.

Tramonte said ICE needs to explain internal procedures that allowed Saxon to keep his job after having so many brushes with the law.

“This is an agency that demonizes immigrants who have committed no crimes, yet it fails to police its own ranks,” she said.

“The hypocrisy is breathtaking, and the threat to public safety is clear. We want answers from the Detroit ICE Field Office and Cincinnati Local Office: Do ICE agents have to inform their employer when they come under scrutiny by other law enforcement agencies? If no, why not?”

This story was originally published by the Ohio Capital Journal and republished here with permission.

The post Amid ICE Agent Abuse Arrests in Ohio, Advocate Says it ‘Fails to Police its Own Ranks’ appeared first on Cincinnati CityBeat.

Combined with other factors, President Donald Trump’s big tariffs on Chinese goods are costing Ohio farmers and their counterparts in other states heavily, according to a new report. The report shows Ohio farmers lost nearly $76 million of their exports to China this year compared to one year earlier.

Tariffs are taxes on imports, and since the start of his second term, Trump has imposed a shifting array of them on every country in the world — except Russia for some reason, according to the Atlantic Council’s Tariff Tracker.

Economists have said the unpredictability of the measures has slowed some business investment because decision-makers can’t plan. And surveys conducted by the Federal Bank of Cleveland show that regional businesses are seeing higher input costs from them and many are raising prices for their customers. That’s not helpful as Republicans struggle to deal with a national affordability crisis.

Farmers have faced a double whammy. They’ve seen many of their costs go up because of the import taxes. Meanwhile, China — the country’s third-largest trading partner — stopped purchases of American soybeans in May before resuming them last month. The stoppage was in retaliation for the tariffs Trump imposed that are now at 20%, according to the tariff tracker.

That could do lasting harm to Ohio soybean producers by pushing China to grow and cement its trade ties with Brazil — another major producer.

Trump imposed 50% tariffs on the South American country in retaliation for imprisoning an authoritarian president who attempted a coup.

Ohio farmers are feeling the pain.

Steady trade relations with China had already been roiled during the first Trump administration, according to Farm Flavor, a media organization that reports on agriculture.

“Over the past decade, the flow of American agricultural goods to China has shifted from reliable seasonality to stark volatility,” it said in a report that was released on Tuesday.

“From 2014 to 2017, exports followed a predictable rhythm throughout the year, peaking each fall with the soybean harvest. That pattern broke with the onset of the 2018 trade war, then rebounded sharply in 2020 and 2021 after the Phase One trade agreement. With Chinese purchasing commitments in place, monthly exports hit record highs in late 2020 and remained elevated through 2022 — fueling optimism that the relationship had stabilized.”

Then in 2023, Brazil saw record soybean and corn harvests, undercutting prices asked by U.S. farmers. And in the wake of the first Trump trade war, China worked to “de-risk” its agricultural supply by strengthening ties with South America, the report said.

“By 2025, these forces — combined with a renewed trade war — converged into a full collapse,” it said.

“After steady declines in 2024, U.S. agricultural exports to China fell by more than half in the first eight months of 2025. The low point came in May, when monthly exports dropped to just $247 million — the lowest level in over a decade.”

Analyzing export data from the U.S. Department of Agriculture, the Farm Flavor report said that Ohio farmers were the 13th hardest-hit, losing nearly three-quarters, or $76 million, of their exports to China this year compared to a year earlier.

Ohio soybean farmers bore the brunt, losing 85% of their exports to China.

Six of the 10 hardest-hit states voted for Trump last year, and the administration might be feeling the heat. Last Tuesday, the president announced a $12 billion bailout of the sector. But skeptics questioned how a one-time expenditure will make up for a systemic loss that already dwarfs the bailout.

Agricultural trade with China alone is $17 billion less this year than it was last, or 42% more than the total bailout.

Nearly across the board, U.S. agricultural exports to China have been way down this year compared to their 2024 levels, according to USDA data compiled by Farm Flavor.

A sampling, listed in order of total volume:

• Soybeans — 53%
• Cotton — 89%
• Beef — 54%
• Pork — 20%
• Wheat — 100%
• Tree nuts — 88% 
• Dairy products — 2%
• Corn — 99%
• Hides and skins — 34%

This story was originally published by the Ohio Capital Journal and republished here with permission.

The post Ohio Farmers See One-Year, 74% Loss in Chinese Sales Due Largely to Trump Tariffs, Report Shows appeared first on Cincinnati CityBeat.