Ohio House lawmakers have approved a measure aimed at banning ranked choice voting. Under the bill, no state election may be conducted with ranked choice and any local government that decides to use a ranked choice system would forfeit state dollars.

Ohio Senate Bill 63 passed the state Senate last May with bipartisan support. The 63-27 vote in state House drew the backing of two Democrats — Ohio state Reps. Lauren McNally, D-Youngstown, and Daniel Troy, D-Willowick. The measure leverages the Local Government Fund, a critical source of revenue for counties and cities around the state, to warn off local ranked choice efforts.

In written statement before the floor vote, Rank the Vote Ohio Executive Director Denise Riley said threatening local funding amounts to coercion. And she expressed disappointment that lawmakers banned the practice when no municipality in the state is actually using it yet. Two cities, Lakewood and Cleveland Heights, have been considering whether to put the practice on the ballot.

As a general matter, Riley argued transferring voters’ support in a ranked choice system “fixes a lot of problems.”

“No more spoilers. No more “wasted votes.” And it encourages positive campaigns, according to the American Bar Association Task Force for American Democracy.”

House lawmakers tacked on an amendment clarifying the petition papers a political candidate submits to make the ballot are a public record. The bill now returns to the Senate.

Floor debate

Ohio state Rep. Sharon Ray, R-Wadsworth, warned ranked choice voting “presents significant implementation problems.”

The approach gives voters the option to select multiple candidates for a single office in order of their preference. Under a typical system, the lowest performing candidate gets eliminated in successive rounds. But if the voters who backed that eliminated candidate have additional candidates listed on their ballot, their vote gets transferred to their next choice in the following round.

Ray, who previously served on the Medina County Board of Elections, pointed to warnings from the Ohio secretary of state.

“While some voting machines might be able to accept the software update needed to tabulate grant choice voting, the update would be significant and costly,” Ray said. “Boards of elections that have older machines would most likely have to be replaced.”

Ohio state Rep. Ron Ferguson, R-Wintersville, warned ranked choice tabulation can take days or even weeks, and offered a tortured defense of the “one person, one vote” principle.

“We aren’t voting for three or four or five people. We’re voting for one person,” he said. “That’s the foundation of this republic.”

Although ranked choice systems allow a voter’s preference to be reflected in multiple rounds of tabulation, that voter still only gets one vote.

Rep. Adam Bird pointed to research suggesting ranked choice doesn’t reduce political polarization and might dilute minority voter representation. He added the public education campaign that would be needed for a new ranked choice system could be expensive.

More than anything, though, he voiced frustration with the idea of transferring votes.

“I can point to Alaska,” he said. “This happened in 2022, where there were three candidates, the two Republican candidates got 60 to 70% of the vote. But yet, after the process is implemented, the Democrat wins that.”

“In Maine in 2018,” Bird continued, “the Republican wins the first round but gets less than 50% of the vote because of the presence of two independents in the process. And so after you have exhausted ballots, you end up with a Democrat who wins that.”

It’s true that in Maine, a Republican got a plurality in the first round, and in successive rounds, the Democrat pulled ahead. But that cuts against Bird’s argument in Alaska.

The 2022 election cycle was closely watched because former Republican nominee for Vice President Sarah Palin decided to run in a special election for the U.S. House. If Bird was referring to that race, it’s true that the GOP candidates combined got a majority of votes in the first round, but the Democrat, former U.S. Rep. Mary Peltola got the most votes of any candidate. In successive rounds, her margins grew until she cleared 50%.

When she ran again in that year’s general election, Peltola won again and actually improved on her margins.

Pushback

The only lawmaker to speak out against the proposal was Ohio state Rep. Ashley Bryant Bailey, D-Cincinnati. She argued the version of ranked choice Cincinnati used for local elections from 1925 to 1957 helped boost minority representation.

“This system reduced the domination of a single political machine and made Council representation more proportional,” Bryant Bailey said. “Under that system, African American candidates began being elected to council.”

One beneficiary was Ted Berry, who went on to become Cincinnati’s first Black mayor, Bryant Bailey explained.

She pushed back on Bird’s research, explaining she’d seen plenty of peer-reviewed studies demonstrating minorities do just fine, and maybe even participate at higher rates, under ranked choice.

“We all can find something to validate our plans,” Bryant Bailey said.

She concluded by explaining she’s not advocating for a ranked choice system and that she didn’t believe the debate was actually about ranked choice.

“This bill is not about protecting voters. It’s about control,” she said. “What this bill does is effectively ban ranked choice, but more than that, it tells our cities and our voters that we do not trust them to govern themselves.”

This story originally appeared at ohiocapitaljournal.com.

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Of the 350,000 Ohio High School Athletic Association student-athletes, only 32 name, image, or likeness deals have been reported, according to OHSAA Executive Director Doug Ute. 

He recently testified as an interested party on a bill that would ban high school and middle school athletes from making NIL deals. Both people in favor of and those opposed to Ohio House Bill 661 spoke during Ohio House Education Committee Meetings this month. 

State Reps. Adam Bird, R-New Richmond, and Mike Odioso, R-Green Twp., introduced H.B. 661. Ohio is one of 45 states that allows high school athletes to have NIL deals. 

“Roughly half of those involve commission-based arrangements tied to promotional codes shared on social media platforms,” Ute said. “Of the remaining agreements, the vast majority consist of modest combinations of products and limited compensation, with a total value generally under $1,000. These opportunities allow students, who also happen to be athletes, to explore legitimate entrepreneurial opportunities within carefully established, education-based guardrails.”

Ohio House Speaker Matt Huffman, R-Lima, said it’s a complex issue. 

“If a local business decides to pay all the kids who go to one high school in a city who want to play on this high school’s football team, I don’t know how ultimately you can control that,” he told reporters Wednesday. “You can put limits on that and attempt to enforce it, but it makes it even harder.”

Proponent testimony 

St. Xavier High School Football Coach Steve Specht spoke out in favor of the bill, but clarified he is not against NIL. 

“What I am against is pay-to-play,” he said. “And I think my biggest concern with NIL in the high school level is, where does the money come from? …Where are the guardrails at the high school level?”

Mason City Schools Superintendent Jonathan Cooper said the bill would allow Ohio to look at the long-term impacts for students and ultimately create a policy “that reflects both opportunity and protection.”

“Rather than reacting to momentum, our state can thoughtfully shape a model that protects student-athletes, preserves educational priorities, and sets a responsible example nationally,” he said. “If we don’t have the proper guardrails and the thoughtfulness around this, I think what we could possibly produce is unhealthy behaviors that actually place our kids into more dangerous situations than we really can even anticipate today.” 

H.B. 661 does not close doors for student-athletes, but rather it creates space, Cooper said. 

“Space to build safeguards,” he said. “Space to ensure that any future direction reflects the educational purpose of high school athletics.”

Opponent testimony

NIL at the high school level is not like NIL at the college level, said Luke Fedlam, a partner at the Columbus law firm Amundsen Davis and co-chair of Entertainment, Sports, and Media Law practice group. 

“When people hear NIL … we immediately start to think and picture the college marketplace, booster collectives, transfer portal incentives, six and seven figure deals, conference and television contracts in the millions of dollars,” he said. “That environment does not exist at the high school level and it is not pay to play.”

Ohio state Rep. Phil Robinson, D-Solon, asked what the downside would be if middle and high school students could not receive NIL compensation. 

Talented student-athletes could leave Ohio, Fedlam said. 

“Student-athletes, especially in border cities, could go to Michigan, they could go to West Virginia, they could go to Pennsylvania or Kentucky, and be able to earn that compensation by just simply moving across the border,” he said. 

Eugene Miller, a former state rep. who is running as a Democratic candidate for Ohio House District 20, spoke out against the bill. 

“If you have somebody in the band, the band person can make money on the side,” he said. “If you have someone who’s a DJ, they can make money on the side. Why should we punish athletes based on their likability by eliminating NIL opportunities?” 

Ohio High School Athletic Association 

A Franklin County judge issued a temporary restraining order preventing the OHSAA from enforcing its ban against high school athletes benefiting from NIL in October. 

Jasmine Brown had filed the lawsuit on behalf of her son Jamier Brown, an Ohio State Buckeyes football commit from the Dayton area.

He is a top-ranked wide receiver from Wayne High School in Huber Heights who is transferring to Big Walnut High School in Sunbury for his senior year.

Brown, a member of the class of 2027, has missed out on more than $100,000 in potential deals, according to the lawsuit. 

In November, high school athletic association member schools passed an emergency referendum allowing NIL. In that referendum, 447 schools voted in favor of athletes receiving NIL deals, 121 schools voted against it, and 247 schools abstained. 

“I think it’s very safe to assume that those who abstained did so because they were a no vote,” Bird said. “I think that it is very clear to me and others who are listening to school leaders across the state of Ohio that this is that we’re going down a path that schools in Ohio do not want to go.” 

Ute, however, said he does not consider the schools that did not vote abstentions. 

“They just didn’t vote,” he said. 

This story originally appeared at ohiocapitaljournal.com.

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Ohio’s mental health landscape is consistently seeing increases in demand, including among medical professionals like nurses and physicians, who are asking for more help.

“We just know health care comes with additional stresses,” said Dr. Laurie Hommema, family medicine physician and senior medical director of well-being at OhioHealth.

OhioHealth created the Well-Being Center, where employees access services, including individual counseling, group services, and “critical incident response.”

Last year, the health care system said it increased the number of “covered counseling visits” for employees from eight to 12 annually.

Hommema and the Well-Being Center then saw an 8% increase in counseling requests from employees in the first nine months of the year, compared with the entirety of 2024.

In Ohio as a whole, requests for behavioral health services have gone up significantly over the years.

According to data from the state of Ohio, demand for the services went up more than 350% from 2013 to 2019, an average increase of 29% per year.

The data showed mental health services accounted for 52% of the total behavioral health demand in Ohio.

The data comes as the state suffers from a mental health shortage in nearly all of its 88 counties, contributing to the struggle for Ohioans to access the care they need.

“With this information, it became clear that there was a need to focus on building up a strong workforce equipped to handle the mental health and addiction needs of Ohioans,” the Ohio Department of Behavioral Health found in the research.

While the demand for a workforce to help with mental health has increased, research over the years has also shown a need for more mental health when it comes to medical professionals.

A 2025 study published in the International Nursing Review found anxiety and depression rates ranging from 23% to 61% among nurses in 35 countries.

About 18% of those who self-reported mental health needs said they experienced symptoms of “burnout.”

Burnout is considered an “occupational phenomenon” by the World Health Organization, where chronic workplace stress can cause exhaustion and other struggles related to one’s work.

In the research published in the study, nurses noted “more frequently engaging with self-care practices” compared with engagement before the COVID-19 pandemic.

Almost half of the nurses participating in the study also reported “experiencing public aggression due to their identity as a nurse.”

Over the past five years OhioHealth has had its well-being program, Hommema said they’ve gone from about 8,000 employee interactions per year to 28,000.

With a landscape of health in Ohio that includes large facilities and very small clinics, from urban settings to deeply rural areas, health care workers have all kinds of experiences that could warrant the need for mental health assistance, ranging from daily health trauma to stressors connected to care access, or lack thereof.

“I think the tension around care delivery and patients needing to be far away from home to get care, it’s a kind of unique health care environment in Ohio,” Hommema said.

“I definitely think you see some tensions from that, that sometimes manifest perhaps in workplace violence or tensions amongst the health care team.”

The struggles of medical professionals continue as federal budget cuts to Medicaid and expired tax subsidies from the Affordable Care Act reduce the ability for Ohioans and Americans to receive coverage, thus increasing the likelihood of a sicker public. Hommema said that adds a “moral distress component” to the nurses and doctors’ work.

One of the original designers of the Affordable Care Act, former New Jersey congressman Robert Andrews, said the country has seen a positive shift in ideas around mental health, but hasn’t seen the shift needed to deal with the issue comprehensively.

Therapy for medical professionals and others should be understood by the government as an “investment,” just like easy access to care should be seen that way, he said.

“The caregivers don’t do a great job giving care if they themselves are unhealthy,” Andrews said.

The former congressman now heads up the Health Transformation Alliance, a coalition that seeks to improve health care access through American employers.

The alliance praised Hommema’s work for prioritizing mental health in the medical health care field. Andrews said the care should be replicated throughout the country, so the stigma of mental health, and the perceived separation between the mental and physical health can be eliminated.

“The idea that there is mental health on one side and health on the other just isn’t true,” Andrews said. “A synonym for mental health is health.”

This story originally appeared at ohiocapitaljournal.com.

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Ohio House Democrats jammed up a tax bill Wednesday after Republicans rejected a suite of changes – most pointedly, a provision benefitting investors who make millions of dollars investing in startups. 

Senate Bill 9, the state legislation, would direct Ohio Department of Taxation officials to conform to federal tax cuts enacted by President Donald Trump via the One Big Beautiful Bill Act. 

Democrats in the state House targeted one provision in particular – the expansion of the “qualified small business stock gain exclusion,” a tax cut for early investors into companies that succeed and grow in value up to $75 million.  

The change will affect fewer than 1,000 taxpayers, according to Legislative Budget Office estimates shared with Signal Ohio. Of all such payers nationally, 94% of them report household income of more than $1 million per year, according to the Institute on Taxation and Economic Policy, a progressive think tank. 

By the back-of-the-napkin math from Rep. Chris Glassburn, a Cleveland-area Democrat, those 1,000 payers (mostly millionaires) comprise .008% of the 11.88 million Ohioans. 

“This is not just a perfunctory measure, this is a large, policy-changing bill that removes money available for the state government to do other business,” he said in a floor speech. “This is a deduction of the 1% of the 1%.”

Republicans control 65 of 99 House seats, meaning they rarely need Democratic buy-in to effectuate their agenda. But legislation can’t take effect within 90 days without what’s known as an “emergency clause,” which requires a two-thirds vote. The emergency clause failed by three votes. The House passed the bill regardless, but its fate is less certain as Tax Day approaches. 

“We can bring it up for another vote in a future session, perhaps next Wednesday,” House Speaker Matt Huffman, an Allen County Republican, said, according to Gongwer News Service. “Or if Democrats aren’t going to agree to the emergency clause, then folks will just have a harder time filing their income tax returns this year.”

House Finance Chair Brian Stewart, a central Ohio Republican, said on X that the Democrats’ “temper tantrum is going to cost Ohioans millions of dollars in needless tax-filing & preparation charges.” So much for “affordability,” he added. 

Rep. Dan Troy, a Lake County Democrat, called the measure an “egregious” giveaway to the ultrawealthy. He noted that some conservative states like Alabama and Mississippi, and mixed political states like Wisconsin, have rejected the tax break. He said Ohio should do so, as the state did in the 1980s in rebuffing certain Ronald Reagan-era tax changes. 

The state isn’t required to adopt the federal changes. But they support big and small businesses and residents, according to GOP House Ways and Means Chair Bill Roemer. And the conformity makes tax season easier for people, businesses and the tax department, which means less expensive as well. 

The bill as a whole is estimated to cost Ohio $63.3 million in revenue in 2026 and $29.5 million in 2027, according to the Legislative Service Commission. 

Democrats, citing Tax Department estimates, say the qualified small business stock gain exclusion alone will cost Ohio $22 million over a decade. And that might be a lowball, given Wisconsin, as it adopted the tax change, pegged the 10-year cost estimate around $86 million.

Republicans said they didn’t reject the Democrats’ amendment on the merits. Rather, according to a ruling from Huffman, later backed up by a party-line vote of the House, ruled the Democrats’ amendment contained other changes that were not germane to the bill. Their full amendment would have redirected some of the $22 million to support military families of dead soldiers, food assistance and others. 

This story originally appeared at signalohio.com.

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This story is about suicide. If you or someone you know needs support now, call, text or chat the 988 Lifeline. 

At least four Ohio children have used artificial intelligence to write their suicide notes. 

“That’s four too many,” Ohio state Rep. Christine Cockley, D-Columbus, said during a press conference Wednesday. 

She introduced a bipartisan bill that would prevent anyone from creating an AI model in Ohio that encourages users to engage in self-harm or harm another person. 

“This legislation will ensure that tech companies are actively and consistently training their language models to not encourage or support users suicide ideation or violent thoughts,” Cockley said. 

Ohio House Bill 524 would empower the Ohio Attorney General’s office to investigate and prosecute anyone who creates AI models that are responsible for creating technology that encourage self-harm, she said. 

Cockley introduced the bill with Ohio state Rep. Ty D. Mathews, R-Findlay, and the legislation recently had its third hearing in the Ohio House Technology and Innovation Committee. The bill received no opposition testimony. 

“It’s about drawing a clear line that innovation cannot come at the expense of human life and children’s safety by encouraging developers to use a mental health framework when building and training AI,” Cockley said. 

The Ohio Suicide Prevention Foundation is anecdotally hearing about AI’s influence with children suicide, said executive director Tony Coder. 

“I want to state that we’re not anti-technology,” he said. “I’m not anti AI. … I believe and support advances in technology that could, with some imagination, do amazing things that could impact society in positive ways, but we also must protect kids from the consequences, especially as you develop relationships with AI chatbots and put their trust into these entities.”

According to a 2025 report from Common Sense Media, 72% of teenagers have used AI companions at least once, 52% interact with these platforms at least a few times a month, and 12% of teens use AI for emotional or mental health support. 

Sewell Setzer III, a 14-year-old Florida teenager, died by suicide in 2024 after he had an extended virtual relationship with a Character.AI chatbot.

Juliana Peralta, a 13-year-old Colorado teenager, died by suicide in 2023 when she was 13 after sharing her suicidal thoughts with a Character.AI chatbot. 

Adam Raine, a 16-year-old California teenager, died by suicide in 2024 after sharing his suicidal thoughts with ChatGPT. 

In 2023, 1,777 Ohioans died by suicide, according to the Ohio Department of Health.

“What scares me about AI Chatbot is that research has shown that when a child asks about a mental health concern and asks about what they can be doing, only 22% of the time the answer that was given was correct from these AI files,” Coder said. 

Lack of access to mental health resources could be driving people to turn to AI, Cockley said. 

“Oftentimes, myself included, growing up in rural Ohio, it’s hard to get access to mental health care, and so I do think that having a barrier to access does drive people to find what can make me feel better, and sometimes that might be a chatbot that tells you exactly what you want to hear,” she said. 

Out of Ohio’s 88 counties, 75 are mental health shortage areas, according to a recent study from the Health Policy Institute of Ohio.

President Donald Trump issued an executive order in December to create a national AI policy and deter state level AI regulation.

“We’re hoping this bill would still survive,” Mathews said. “We’re looking at the activities being produced because of that. We’re not targeting the research and development of the model or the product more so the activity.”

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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.

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Ohio received a bump in funding for child care last week, a small win in a sector that is still facing uncertainty and an affordability crisis.

Analysis by advocacy group Groundwork Ohio shows average child care costs in Ohio as of 2023 at more than $9,500 per year for preschool-age care, more than $11,000 per year for toddler care, and more than $12,000 a year for infant care.

The Ohio Department of Children and Youth was awarded $14.7 million in federal grants “to support access to early care and education services,” according to a press release from Ohio Gov. Mike DeWine.

The federal funding comes from the Preschool Development Grant – Birth to Five, distributed by the U.S. Department of Health and Human Services.

“This funding will help Ohio better support families and make sure young children have access to quality care and learning opportunities during their most important years,” DeWine said in a statement.

The state said the money will be used to upgrade technology and research, help early childhood education workers with curriculum development, professional learning opportunities, and “business support resources.”

A total of $250 million was distributed through the federal grant program, and Ohio’s director of the Department of Children and Youth, Kara Wente, said the grant would allow the state “to build on the work already happening in communities across the state.”

“By improving coordination and planning, we can make it easier for families to find the services they need and ensure young children get a strong start,” she said in a statement.

The state General Assembly approved funding for child care through its most recent budget, with funding going to the Child Care Choice voucher program and a pilot cost-sharing child care model.

But advocates were disappointed when eligibility for Publicly Funded Child care was left at 145% of the federal poverty level, despite pushes to raise the level to 160% or 200%.

Programs to provide state grant funding for recruitment and child care provider mentorship went down from previous budget drafts, ending up with $2.85 million in funds over the two years of the budget, passed in 2025.

Lynanne Gutierrez, president and CEO of child advocacy group Groundwork Ohio, has said Ohio faces a budgetary shortfall of $600 million after one-time federal dollars fade away for good in 2028.

State child care advocates have been pushing the federal government to bring current and further funding to the sector.

They have signed on to a letter with dozens of other child care organizations around the country to urge the government to continue funding the Child Care Development Block Grant, along with $10 billion in funding that was frozen in certain states after fraud allegations about Minnesota child care facilities were circulated by a right-wing YouTuber earlier this year.

The funding freeze for Minnesota and other states was blocked temporarily by a federal judge in January, but the lawsuit in which the ruling was made continues.

As funding comes and goes, the cost of child care continues to balloon, and a lack of access and affordability is costing the country billions, according to a new analysis by ReadyNation, a research group partnered with the Institute for Child Success.

The study, released this week, showed insufficient child care for children younger than 5 costs the U.S. economy $172 billion per year in “lost earnings, productivity, and economic activity.”

It showed a $5.3 billion economic impact for Ohio alone.

“Challenges mount over time: with less training and less experience, these parents face diminished career prospects, reducing their earning potential,” the study stated. “And less parent income, along with parental stress, can have harmful short and long-term impacts on children.”

National polling also shows bipartisan support for further child care support and changes to the system.

A poll conducted in the beginning of January on behalf of the national First Five Years Fund showed 80% of voters find the ability to find and afford child care as “either in a state of crisis or a major problem.”

The polling also showed 75% of participants believe child care funding should be increased or at least kept at current levels, with 75% of Republicans, 97% of Democrats, and 85% of independents giving that opinion.

A majority in all political parties polled said funding for child care “is an important and good use of tax dollars.”

This story originally appeared at ohiocapitaljournal.com.

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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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According to the health care advocacy group Protect Our Care, more than 113,000 Ohioans are forgoing health care coverage on the federal Marketplace because of a congressional decision requested by the Trump administration to let tax credits expire on Affordable Care Act premiums.

An Ohio legislator, a fellow doctor, and a retired Ohioan all said drops in enrollment to the Affordable Care Act due to the loss of federal assistance could cause longterm issues in the state.

The Ohio drop is the fourth highest in the country, behind North Carolina, Georgia, and Florida, a study from the group found. Nationally, 1.2 million people have left the federal program.

The expiration of those tax credits meant increases in the amount Americans are paying for the Affordable Care Act coverage, sometimes doubling the amount needed to pay for the coverage.

“For me, the way I look at it, I have to pay $1,000 a month for the privilege of spending $10,000 a year in deductibles, just to have catastrophic coverage,” said Ohioan John Francis, on a virtual briefing hosted by Protect Our Care.

Francis is a retiree who thought the ACA would be a good option as he waited to be eligible for Medicare at age 65. While he has chosen to continue on the insurance plan because he can afford it, he understands how quickly health coverage could become out of reach for Ohioans because of the cost.

He said seeing the cuts to Affordable Care Act tax credits, along with cuts to Medicaid that will amount to a more than $30 billion loss for Ohioans over the next decade, brings about a “moral question” about how America should be helping its own.

“If we’re going to allow people to work full-time and still be at the poverty level, then at least we should have the common decency to cover them with health care,” Francis said. “I don’t know how we can look at it any other way.”

Dr. Anita Somani, an OB/GYN and state representative said the tax credit expiration, along with things like work requirements being instituted into Medicaid, only negatively impact the health of the state and its residents.

“What we’re going to see is people delaying care,” she said.

In her practice, that would mean putting off pre-natal care, mammograms, Pap smears, and other cancer screenings. It could also mean pregnant women with high blood pressure could develop pre-eclampsia, which could lead to a stillbirth.

“Everything points to basically health care costs going up, people getting sicker, people dying,” Somani said.

For Dr. Christopher Brown, an Ohio nephrologist, the changes in federal health care assistance could very well mean issues with his patients getting the care they need for things like strokes and end-stage kidney disease.

“One of the things I really don’t like to see is people that come in with diseases that could have been prevented a long time ago,” Brown said.

The impacts of a lapse in coverage due to affordability could be significant, but Brown said the full ramifications can’t be quantified just yet.

Somani said extending the ACA subsidies and funding to help low-income households, kids who can stay on their parents’ insurance until age 26, and those looking to grow their families could only be helpful for Ohio.

Letting the tax credits expire and keeping the Medicaid cuts will add to an already tenuous health landscape in the state, according to Somani.

“For a (Republican) party that is supposed to be pro-family, these actions are the antithesis of pro-life,” she said.

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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