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Some Answers Questioned – Some Questions Answered

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I have many answers to questions, and many questions to answers. Here are a few of them and my apologies for straying off-topic for the first time. I think I’m allowed to do this once.

Kathleen Sebelius (Health & Human Services Secretary) said she was talking with the National Football League (NFL) about helping them promote the new healthcare legislation? Of course, we all knew the NFL would have no part of it. And why would they? Obamacare badly need the help of young healthy men, which happen to make up a large portion of NFL viewership.

Not surprisingly, the NFL released a statement directly contradicting Sebelius, saying they had no interest in promoting the legislation, and were never had any discussions regarding the matter.


Corn on the cob  is ridiculously cheap. At about 10-15 cents per ear, it has to be one of the great bargains in food. If it were healthy enough to eat all of the time…imagine your grocery bill. About $1 per day. Then again, I love Chinese food too much to try the corn experiment. I could easily eat Garlic Chicken every day.


Kings Island, Hershey Park, Disney World and Disneyland. I have been to all of them. Guess which one I prefer? OK, it is true that Kings Island is only 25 minutes away, but if you live within five hours of Mason (Ohio), start planning your trip there.

Some of the newer attractions include the world’s largest animatronic dinosaur, Reds Hall Of Fame Restaurant, and Charlie Brown’s Jungle Journey. Admittedly, our teenagers enjoy the park more than we do, but you could easily spend a few days between the main park and the water park. And, you’re just 25 minutes from Cincinnati, where there are many other activities that the entire family could enjoy.


Best Rides In Ohio

What A Beast!

Fantasy Football season is almost here. NFL training camp begins in July, the first pre-season games are in August, and the regular-season games begin in September. Drafts are typically held in late August so the research and information-gathering will shortly begin.

For many males, it’s the time of the year, where nothing else matters. Work, eating, vacation and other daily necessities suddenly no longer matter. For non-playing family members, it’s a time to put up with random questions, such as “Honey…Do you think the Broncos will have a running back by committee this year?”

And when the three-hour draft begins…Don’t bother us, unless the house is on fire. Of course, we will still make our selection and grab our laptop before we exit the house.


Ohio State University is a phenomenal college. I never admitted it until we visited the campus with our daughter last year. She was a high-school junior and everybody (including her) thought she was headed to Miami (University) in Oxford. And why not? It’s my Alma mater and I still love the college.

But admittedly, Ohio State was incredibly impressive. And it is indeed a big place. But whether you like academics, athletics, the campus, or many other considerations, it’s hard to say no, once you have visited OSU. I may not root for the Buckeyes when they play Miami in hockey, but other than that, I’m officially a Bucknut.


OSU Football Winning Tradition

The Ohio State University

I love golf. However, if anybody reads the “About Me” in my websites and blogs, you may notice a reference to my “One Of  The 10 Worst Golfers On Campus” award I won in college. Well…I’m still awful, probably because I rarely play. I have been an avid tennis player for my entire life and it’s difficult to break old habits.

But I am committed (somewhat) to  becoming a good golfer. I suppose I need to practice more than the current one bucket of balls every other month.  It’s a shame there isn’t a virtual online training session that could knock 20 strokes off my score after an hour of viewing.


Vision Insurance. If you have it, keep it. If you don’t own this type of coverage, you may not be missing anything. Most policies cost about $100-$300 per year. The value of the benefits you receive are ironically…about $100-$300 per year. That’s right. A wash. Typically, you get a copay on a yearly preventive exam and perhaps some additional benefits for a frame of glasses every few years.

But many persons choose to simply find seasonal deals for a package that includes an office visit plus frames or contact lenses. Also, Sears, Penneys, Sam’s Warehouse and Costco often offer good prices, flexible hours and licensed Ophthalmologists. A typical exam is inexpensive, and you can choose to buy your glasses at the conclusion of the exam, or order online from several reputable options.


That’s enough rambling for now. Back to writing about healthcare, which, although is not quite as fun, is still very challenging since it is constantly changing.

Health Insurance Rates In Ohio Jumping 88% Due To Obamacare

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The Ohio Department Of Insurance (DOI) announced today that health insurance policies sold in the upcoming Exchange will cost (on average) 88% more than current plans. The large increases are due to mandatory essential benefits required by Obamacare and The Affordable Care Act legislation. The  projected were provided by the Society Of Actuaries.

These increases do not take into account federal tax subsidies that many individuals and families may qualify for. Families with incomes under $96,000 and individuals with incomes under $34,000 should qualify for assistance. This cost-sharing formula is based on 400% of the  Federal Poverty Level (FPL). Each year, the income levels and subsidies are recalculated to adjust for inflation. Cost-sharing assistance will also potentially reduce copays, coinsurance and deductibles.

Need Department Of Insurance Approval

The proposed prices still must be studied and approved by the DOI. This process will probably take approximately four weeks. When the rates are issued, they could be different than the original submitted rates. Also, insurers could decide to reduce the number of policies they are offering, or completely withdraw for the Exchange Marketplace.

One of the principal reasons that  individual health insurance rates are increasing so substantially, is because of all the numerous “mandated” (required by law) benefits that must be included for every applicant. For example, prior to 2014, if maternity was not wanted or needed, the benefit could be easily excluded from the private policy you purchased. The savings was often as much as $3,000 per year. Many carriers didn’t offer the benefit.

Get Low Rates For Ohio Healthcare

Obamacare Hits Ohio!

And at a monthly premium of between $270-$800 per month (Just for maternity!), it was a coverage most Ohioans did not want at the time of purchase. Out-patient mental health and chiropractic  visits were also often limited or excluded, saving fairly significant dollars.

It is only fair to point out that many individuals and families will benefit by the new legislation. Applicants from low-income households or with serious medical issues (or both) will probably pay less than what they typically would have been forced to pay. However, if they are still uninsured, the designated Open Enrollment periods are the only times to purchase federally-mandated coverage.

Fewer Choices With Marketplace Plans

But after 2014, you won’t have a choice. That’s one huge reason why prices are going up…and substantially, for many residents of the Buckeye state. The four available types of “medal” plans: Platinum, Gold, Silver and Bronze, will all contain many features that might never be used. But it’s the law now. Obamacare at your service.

There may be some affordable alternatives, such as buying a policy outside of the Exchange Marketplace. Otherwise, by selecting a “Bronze” medal policy, you avoid the most costly Ohio  options. Of course, by qualifying for financial assistance, premiums will reduce.

Kaiser Permanente Out – Catholic Health Partners In

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Kaiser Permanente of Ohio is selling its health insurance operations to Catholic Health Partners (CHP), one of the largest healthcare system in the state and the US. With more than 24 hospitals  and numerous additional facilities, they specialize in providing affordable quality care in the communities they service.

More than 75,000 persons are currently covered by Kaiser in the Akron, Canton and northeastern portion of Ohio. Along with Anthem Blue Cross, UnitedHealthcare and Medical Mutual, CHP has a large market presence in the area. They are highly-respected and are active participants in local community events.

Although it will take a few months for the entire process to be completed, no glitches are expected and patients will be able to make a very smooth transition. The risk of lost jobs (which is not new to the area) is virtually guaranteed although the exact number is not known. Although there are some employment opportunities in the immediate area, many workers will have to move elsewhere are transition to a new occupation.

No Marketplace Plans For Kaiser

Ohio Catholic Health Partners Information

Catholic Health Partners Expanding In Ohio

This move will probably eliminate the possibility that Kaiser participates in the Ohio Health Insurance Exchange Open Enrollment in October. Policy and rate filings must be submitted within the next few months, and already, a few major carriers have decided to sit out 2014 and instead study the success (or lack of success) of their competitors.

CHP has been busy, as earlier in the year, they purchased  a portion of Summa Health Systems, which is also located in the northern part of the state. This purchase will work in conjunction with their hospitals in the area (Lorain, Youngstown, Warren and Toledo). Meanwhile, much of its business in Pennsylvania was sold. Competition was stiff, with UPMC and Highmark dominating the Western Pennsylvania market.

The Size Of CHP

With more than 30,000 work associates in the area, Catholic Health Partners is a “Quiet Giant” that is significantly  larger than most residents realize. In addition to the hospitals previously mentioned, they operate 15 senior living facilities, eight home-health programs and five hospice programs.

Some of the most notable hospital facilities include Mercy Health, Mercy Health Partners, St. Rita’s Health partners and Humility Of Mary Health Partners. Patient satisfaction statistics have always been excellent and the quality of treatment has never been an issue. Equipment also seems to be modernized on a regular basis.


June 2014: Catholic Health Partners is expanding by building its new corporate head office in Cincinnati (Bond Hill area). Construction will be completed in 2016 and will provide employment for between 900 and 1,100 workers. The existing home office in Mount Adams and the Blue Ash offices will consolidate.

The Cincinnati City Council is expected to approve the move, which will allow construction and planning to quickly begin. CHP specializes in providing medical treatment for the poor and persons that don’t have access to treatment.

July 2014: CHP has changed their name to Mercy Health and continues to be the fourth-largest employer in the state. Currently, the name “Mercy” is utilized in many areas including  Cincinnati, Springfield and Toledo. The Ministry has also changed to a different website domain ( to better reflect the transition.

Company spokespersons said they wished to simplify their operating structure to better utilize existing resources. Ultimately, their customers would be the biggest benefactor. Mercy provides more than $25 million each month to patients that typically can not afford to pay for their services.

February 2016 – Kaiser medical coverage is still not available in Ohio, although they continue to offer individual plans in many states. Unless the existing healthcare system is overhauled, we don’t expect them to return to the Buckeye State.

US Government Will Take Over State High Risk Program

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The US Government will take over Ohio’s high  risk health insurance program administered by Medical Mutual. Initially, the special “pool” was created to assist persons that could not obtain healthcare because of medical issues, or were not eligible for Medicare or Medicaid. More than 3000 state residents are currently covered under these “risk pool” plans. Although prices are high, provided benefits pay for most expenses.

But unfortunately, in most states, the amount of money provided to fund the program ran out, since the number and dollar amount of submitted claims was much higher than anticipated. Here in Ohio, the request for financial aid to save the program was denied by Kathleen Sebelius, the Secretary of the US Department Of Health And Human Services. Sebelius insisted that at least $10 million additional dollars be spent by the state.

As a result, it is likely that benefits will no longer be as comprehensive compared to the previous available policies. Network participation is expected to reduce, and out of pocket expenses,such as copays and deductibles, may be increasing. And since there are no alternatives until 2014, consumers in the “high risk” category will have to find a way to pay the extra money. It’s expected that a covered $100,000 claim could increase maximum out-of-pocket expenses between $1,000 and $2,500.

Medicare Not Affected

Get Guranteed Approved Ohio Healthcare

Ohio Children Health Insurance Is Still Available

Medicare recipients will not be impacted by this transition. The fraud unit will continue to monitor payments and other administrative activities in an effort to reduce the overall cost of service. Each year, hundreds of millions of dollars are wasted, and hopefully, more of these funds will be recovered. A small increase in the percentage of returned money will make a big difference.

Starting in October, Buckeye state residents can take advantage of Open Enrollment to the 2014 Guaranteed Approval plans. is a leading website resource for individuals and families to apply for coverage without paying any fees. The new US federal subsidy will also be offered to persons whose income is lower than 400% of the Federal Poverty Level (FPL).

Off-Exchange Options

Contracts will also be offered outside of the official Marketplace. Rates are expected to be released within the next 60 days and it is possible that these options will be very attractive to families with household incomes above $95,000 that do not qualify for tax breaks. Network provider lists (especially specialists) may be larger for plans that do not pay subsidies.

For persons that will be covered under the federal government starting the end of July, Medical Mutual will continue to administer their policies until that date. They will also assist in transitioning from a state-sponsored policy to a federally-sponsored policy. It is possible that many families will qualify for Medicaid coverage  at the end of the year since requirement are being loosened.

Medicaid In Ohio – To Expand Or Not To Expand

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Medicaid in Ohio. To expand or not to expand. That is the question. Governor John Kasich and the Health Policy Institute of Ohio believe the economic benefits derived from expansion far outweigh the risk of federal government funding drying up in the future.

By enlarging the number of Medicaid recipients, it’s anticipated that more than 250,000 residents of the state that make about $15,000 per year (or less) would qualify. Otherwise, these individuals and families would have to try to pay their healthcare benefits themselves, which may be an impossible task. And if they are able to purchase a policy, although preventative benefits would be fully covered, high deductibles would result in potential large out-of-pocket expenses.

Also, more than 40,000 veterans (and family members) would be positively impacted, and more dollars could be utilized for suicide issues, which often plague veterans. Mental healthcare, drug-testing and drug-addiction services are also benefits that would aid many low-income individuals and families. And often, trips to physicians and specialists are quite often.

Can Ohio Afford More Medicaid?

Will Ohio Expand Medicaid?


Senate Bill 17 was recently submitted by Democratic Senator Shirley Smith (Cleveland) that echos Governor Kasich‘s ideas that passage will create many new jobs along with increasing revenue in the Buckeye state. The Governor has mentioned in past interviews that he considers this legislation “personal” and it must be passed.

The critical issue is quite simply the level and amount of funding that will reach the program. The first three years are completely paid by the federal government.  Then it gets tricky. After that, each year, Ohio residents will have to pay for the expansion since the share the state pays increases by 10% until 2020.

Ohio Receives Financial Assistance…For Now

Overall, Ohio would receive more than $12 billion (not million!) in financial assistance. But what happens if there is a shortfall of a few billion dollars? Raising taxes may be the only way to recover the money, which could wipe out many, or all of the gains to be made. And there is no guarantee that the federal government won’t alter the conditions, and substantially reduce their contribution in later years.

The House of Representatives removed it from the budget and it is not expected to return. But an alternative might be possible, that will not interfere with the budget. It’s a bipartisan idea that all lawmakers from the House and Senate will consider in about four months. There also may be some legislation offered before the end of June. But whatever is decided, it will have to be in place by the first of the year when State Open Enrollments begin.


September 2013 –  A new Medicaid website has been created ( that will assist consumers in determining if they are eligible for benefits. Although the criteria for qualifying has not changed, the new website will be more accurate in determining who meets the necessary criteria to be accepted.

October  is the launch date and there may be some synchronization with the Federal Exchange website for persons with higher incomes. Since 20% of Ohio’s residents are considered “low-income,” the new site could potentially help millions of persons. And as an added bonus, personal visits to local offices may no longer be needed.

February 2016 – Federal funding was indeed accepted and Ohio expanded Medicaid in 2014. The federal funding is still flowing and more than 400,000 persons now enjoy coverage, that otherwise may not have had any medical benefits. Last year, it was also reported that  the actual Medicaid spending was about $171 million less than expected. Eligible persons can apply online here.