Tag: yost

Ohio Attorney General Pushes to Reform Drug Pricing By Focusing on Middlemen

Andrew Shirley

Ohio Attorney General Dave Yost blasted the middlemen responsible for negotiating drug prices on behalf of the state Monday, calling for immediate legislative action. The move comes a month after the state formally launched a lawsuit against the pharmacy benefit managers (PBM) responsible for the negotiations. Currently, Ohio cannot directly negotiate with major prescription drug manufacturers. The only means by which the prices of prescription drugs can be addressed in the Buckeye State is through PBMs or drug negotiators. Since they are compensated by the state, it’s expected of them to put the priority of Ohioans above all else. In June of last year, then Attorney General Mike DeWine, now governor, formally launched an investigation into the organizations, alleging that they were putting their own interests before the state. DeWine noted: Since the end of 2017, my office has been reviewing and investigating issues regarding PBMs and their contracts with Ohio agencies, such as the Ohio Department of Medicaid, the Ohio Bureau of Workers’ Compensation, the Ohio Department of Administrative Services, and our numerous pension systems. It is clear that the conduct by PBMs in these areas remains a major concern, and we anticipate that our investigation will result in…

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Report: Ohioans Enrolled in Obamacare Had 20 Percent of Medical Claims Denied Despite Coverage

Andrew Shirley

A new report from the Kaiser Family Foundation has found that, from 2015-2017, 20% of all claims made by individuals covered under the Affordable Care Act, commonly known as Obamacare, have been denied. This has led to thousands of patients going “out of pocket” to cover expensive procedures or putting themselves at risk by not getting the procedures performed at all. The report analyzed “transparency data released by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers offering individual market coverage on healthcare.gov from 2015-2017.” In 2017, 19% of all health claims filed were rejected. When a claim is rejected, an individual has a right to appeal the decision. However, less than one half of a percent of individuals choose to do so. Of the few that do file an appeal, only 14% are overturned. Depending on the insurer, claim denial rates ranged from 1% to 45%. Due to transparency limitations by insurers, there is little data to suggest why the claims were denied: Issuers use standardized reason codes for claims adjustments and denials; without this information, one cannot distinguish claims denied for reasons of medical necessity, for example, from those denied due to an incorrect…

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Ohio Senator Sherrod Brown Blasts Trump on Obamacare Repeal, Calls on Governor and Attorney General to ‘Do More’

Andrew Shirley

Monday, Ohio Democratic Senator Sherrod Brown and Columbus City Attorney Zach Klein, in a joint press conference at PrimaryOne Health in Ohio, pledged to oppose President Trump’s recent efforts to repeal the Affordable Care Act (ACA), nicknamed “Obamacare.” As previously reported, the court case Texas v. Azar ruled that the ACA was unconstitutional. The Supreme Court had previously ruled that the Individual Mandate component of the law was “unconstitutional under the Interstate Commerce Clause, but could fairly be read as an exercise of Congress’ Tax Power,” but upheld the bulk of the law. From this, Texas Federal District Court Judge Reed O’Connor ruled that because the mandate was unconstitutional, the ACA is, by default, unconstitutional. For several months, the ruling has sat pending with the U.S. Fifth Circuit Court of Appeals. In late March, the Department of Justice, at the behest of President Trump sent a letter to the court, stating that they agreed with the Fifth Circuit Court’s ruling and, “Because the United States is not urging that any portion of the district court’s judgment be reversed, the government intends to file a brief on the appellees’ schedule.” Should the court affirm this ruling, the ACA could be overturned within the year. On August…

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Ohio Republican Joins Cannibus Caucus in Pushing for Greater Marijuana Protection from Federal Government

Andrew Shirley

Ohio Republican Rep. Dave Joyce (R-OH-14), along with the entire Congressional Cannabis Caucus, introduced a bill Wednesday that seeks to protect state marijuana policies by strengthening states’ rights. The Strengthening the Tenth Amendment Through Entrusting States Act, the “STATES Act” for short, would function to amend existing laws, specifically the Controlled Substances Act. It would, essentially, give states that have set their own policies on marijuana regulation the right to have those laws take precedence over the existing federal laws. Even as various forms of marijuana use become legal across the country, it remains illegal at the federal level. As previously reported: The 2018 Farm Bill, passed with bipartisan support, legalized the production of industrial hemp. This is the primary source of CBD Oil. Hemp producers immediately jumped into producing the substance. Though products containing THC cannot cross state lines, THC products derived from hemp face no similar restriction. Supporting the bill, the Drug Enforcement Agency DEA removed CBD as a Schedule 1 narcotic. As a result, it is no longer considered among the most dangerous of drug products. While CBD seemed poised for national expansion, the Food and Drug Administration (FDA) still has the authority to regulate the sale of CBD and have aggressively stepped up efforts…

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Ohio Attorney General Opposes Scrapping All of Obamacare, Breaking With President Trump

Andrew Shirley

Ohio Republican Attorney General Dave Yost announced Wednesday he would oppose President Donald Trump’s plan to completely repeal the Affordable Care Act (ACA), better known as Obamacare. On December 14, 2018, shortly before the 2019 open enrollment period ended, a contentious and controversial case was finally ruled on by the U.S. Supreme Court. Texas v. Azar challenged that the entire Affordable Care Act was unconstitutional. The case noted that the Supreme Court previously ruled “the Individual Mandate was unconstitutional under the Interstate Commerce Clause but could fairly be read as an exercise of Congress’ Tax Power because it triggered a tax.” However, the Tax Cuts and Jobs Act “eliminated that tax,” and “thus compels the conclusion that the Individual Mandate may no longer be upheld under the Tax Power.” “And because the Individual Mandate continues to mandate the purchase of health insurance, it remains unsustainable under the Interstate Commerce Clause—as the Supreme Court already held,” the case added. Based on this, Texas Federal District Court Judge Reed O’Connor made three conclusions: First, the Court finds the Parties satisfy the applicable standing requirements. Second, the Court finds the Individual Mandate can no longer be fairly read as an exercise of Congress’s Tax Power and is…

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Federal Judge Temporarily Halts Ohio Abortion Limit Passed Last Year

Andrew Shirley

A Senior District Judge is placing a two-week hold on a key provision of an Ohio abortion limit passed in December of last year. On December 13, 2018, then-Governor John Kasich signed Senate Bill 145 (SB 145), commonly referred to as a Dismemberment Abortion Ban into law. It is, as reported at the time, “an act that restricts one of the most common methods in which second-trimester abortions are performed.  The Dismemberment Abortion Ban, as the bill is known, restricts doctors from performing procedures in which dismemberment of the fetus occurs.” Mike Gonidakis, president of Ohio Right to Life, hailed the decision, stating: “Ohioans can sleep easier tonight, knowing that the horrendous practice of dismemberment abortions is behind us…Pro-Life Ohio will not stop until the Abortion Report reads: Zero. Nothing to report” That same day, Kasich vetoed an abortion bill that would have banned all abortions after a fetal heartbeat can be detected. Shortly after being signed, Planned Parenthood filed suit against the state on the grounds that the law was unconstitutional. They argued that this law places an “undue burden” on women, one that is explicitly outlawed by Roe v. Wade, stating: Should the Act be allowed to take effect, Plaintiffs’ patients’ health…

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