Topic #1 : ACCESS

Topic #2 : QUALITY

Background

Personal Physician Care, a private for profit company that insured over 30,000 people enrolled in Medicaid HMOs, recently had its contract terminated and is currently being liquidated. Though the signs of PPC's financial trouble could be seen a long time ago, the state took no action until it was too late. For example, though the company failed to turn in four consecutive quarterly financial statements, the government retained its contract with PPC. One consequence is that taxpayers, patients, and health care providers will have to pick up the tab, running up in the millions of dollars. Another consequence is that former clients of PPC are now forced to switch HMOs, which for some will mean that they will not be able to continue to see their current doctors or go to the hospital they now use. There have been numerous rumors that other Medicaid HMOs are similarly in financial trouble.

What do you commit to doing to ensure that those responsible for PPC's collapse are held accountable? Would you support a government investigation into PPC's collapse?

Yvonne FULIMENI, Independent Candidate for State Representative, District 18 : "The responsible persons should be replaced by people who do a much better job of overseeing the government programs."

Dale MILLER, Democratic Candidate for State Representative, District 19 : "[I] Support investigation followed by new legislation on Medicaid HMO's"

Albert OBERST, Republican Candidate for State Representative, District 9 (Phone interview) : "Yes, we need an investigation."

Peter LAWSON JONES, Democratic Candidate for State Representative, District 11 : "In order to ensure that future collapses of Medicaid HMOs are avoided, the state must investigate all such failures and vigorously prosecute those, if any, who are guilty of criminal malfeasance."

Given the troublesome financial history of Medicaid Managed Care organizations, what public accountability mechanisms would you support to ensure that public monies put into private hands are spent responsibly?

Yvonne FULIMENI, Independent Candidate for State Representative, District 18 : "We need someone in authority to oversee the operation. There needs to be a definite chain of command."

Eric FINGERHUT, Democratic Candidate for State Senate, District 25 : "Must increase ODHS' oversight role, which is not taken seriously."

Peter LAWSON JONES, Democratic Candidate for State Representative, District 11 : "I am working now with healthcare experts to craft a bill that will ensure that health insurance considerations perform 'due diligence' before they are permitted to enter into the Medicaid HMO field in the State of Ohio."

Lee FISHER, Democratic Candidate for Governor of Ohio : "My Patients' Bill-of-Rights requires full disclosure by managed care organizations regarding medical loss ratios, executive salaries, bonuses and compensation, advertising expenditures, administrative expenditures and quality. My plan also calls for enhanced penalties for acts of insurance fraud and adoption of the Amended Model Insurance Fraud Act."

Dale MILLER, Democratic Candidate for State Representative, District 19 : "Require prior and on-going scrutiny of Medicaid HMO's and re-evaluate whethher health care costs can be accurately forecast in computer systems."

Albert OBERST, Republican Candidate for State Representative, District 9 (Phone interview) : "Need stronger legislation to monitor HMOs since they are getting so much in state funding. State must put more teeth into the law."

Do you support or oppose the further privatization of public health services?

Yvonne FULIMENI, Independent Candidate for State Representative, District 18 : "We must be sure managed care systems are working properly before we give any more persons this option."

Eric FINGERHUT, Democratic Candidate for State Senate, District 25 : "I will examine legislation on a case by case basis. Any managed care systems require intense oversight."

Lee FISHER, Democratic Candidate for Governor of Ohio : "It is apparent the state has slowed down its earlier plan for moving more and more types of recipients and more and more counties into Medicaid managed care. We know that as we move into more rural areas of the state, choice and access will be problems and as we move disabled and special needs people, setting the capitation rate and case management will become issues. I believe we need to stop and evaluate where we are today and how successful it is before we pursue further expansion.
The Ohio Department of Human Services is responsible for administering the Medicaid program (including the Medicaid HMO program) while the Ohio Department of Insurance is responsible for licensing and regulating managed care organizations. There is a greater need for coordination of roles between these two agencies when it comes to Medicaid HMOs. The state needs to do a better job and be given greater regulatory authority to monitor the financial solvency of plans. With a strengthened and a better-enforced prompt pay law, the state would be in a better position to detect HMO financial problems before they reach a crisis level."

Albert OBERST, Republican Candidate for State Representative, District 9 (Phone interview) : No on privatization of public health sources. Metro Health not doing their job because faculty at University Hospital and Cleveland Clinic use slush fund created taxpayer money to conduct their personal research projects.

Given that the recent troubles occurred with covering a generally healthy population, do you support or oppose moving other special needs populations (children in foster care, mental health patients, people with developmental disabilities) into a managed care system?

Dale MILLER, Democratic Candidate for State Representative, District 19 : "Managed Care should not be mandated. We need to better understand whether managed care improved health care efficiency or whether it reduces services and involves risky predictions or future costs of care."

Albert OBERST, Republican Candidate for State Representative, District 9 (Phone interview) :
Need early detection and care. Better to give some care rather than dump them on the street.

Peter LAWSON JONES, Democratic Candidate for State Representative, District 11 : "Managed care still offers the best opportunity to provide greater access to quality medical care at a reasonable cost to Ohioans. Indeed, my family participates in an HMO plan. We must, however, continue to carefully monitor managed care providers, identify problems with such entities and make the required legislative and regulatory changes to improve the system. For that reason, I am a cosponsor of legislation to enact a "Patients' Bill of Rights."

Background

With the demise of Ohio's Certificate of Need regulation, the marketplace has free reign to build, merge, buy or divest itself of hospitals, other health programs and other community benefits. We have seen the rise of "boutique" hospitals, hospital mergers and the loss of non-profit assets, all without public hearings of the involvement of community stakeholders.

Would you support legislation that requires processes for public involvement such as Certificate of Need and/or community benefits reporting?

C. J. PRENTISS, Democratic Candidate for State Senate District 21 : "I believe public involvement is critical in reaching decisions on when hospitals merge services and/or locations."

Lee FISHER, Democratic Candidate for Governor of Ohio : "I support public involvement and a process to provide information to the public. We need to look at options for specific formats to achieve this.

Peter LAWSON JONES, Democratic Candidate for State Representative, District 11 : "Yes, given the importance of healthcare institutions to a community and healthcare access in a community, mandating public hearings when hospitals merge and periodic community benefits reporting are hardly unduly burdensome requirements."

Will you support adequate state funding for Health System Agencies, currently the only entities monitoring general health status and serving as a balance between regulatory and market forces?

Yvonne FULIMENI, Independent Candidate for State Representative, District 18 : "Yes, Health System Agencies are usually made up of caring individuals who work to really help people."

Lee FISHER, Democratic Candidate for Governor of Ohio : "I understand the Health System Agencies (HSA) Study Committee created in the last state budget has not yet completed its work or filed a final report. The committee is charged with examining the role and functions of HSAs and whether other entities duplicate those roles and functions. I will be interested to see the final report and recommendations from this committee to make a determination of future state funding for them. I do understand that most testimony received by the committee reinforced the important role the HSAs play in their communities."

Peter LAWSON JONES, Democratic Candidate for State Representative, District 11 : "Yes, HSAs continue to serve a valuable purpose."