The Ohio Academy of Family Physicians (OAFP) advocacy team monitors healthcare related legislation, rule changes, and legislative updates for Ohio’s family physicians.
To access the OAFP Bill Tracker, visit the OAFP Public Policy webpage and click on the Bill Tracker icon.
Read on for this week’s updates and contact Advocacy Coordinator Kaela Springhetti with questions or for ways to get involved.
Speak Out: Fix Medicare Physician Payment Now
Source: The American Academy of Family Physicians
The American Academy of Family Physicians (AAFP) is asking members to join its efforts in fighting for better Medicare physician payment policies. Family physicians continue to face unsustainable Medicare payment policies that threaten the viability of primary care practices nationwide.
While CMS’s proposed Calendar Year (CY) 2026 rule includes two separate conversion factors, $33.59 for qualifying Advanced Alternative Payment Models (APM) participants (+3.83%) and $33.42 for all other clinicians (+3.3%), the majority of these modest increases will expire at the end of 2026 and are not enough to address the structural flaws in the Medicare payment system.
Rising practice costs, workforce shortages, and administrative burdens are pushing many practices to the brink, especially in rural and underserved communities. The proposed efficiency adjustments and behavioral health integration supports are promising. Still, without comprehensive, long-term reform, more family medicine practices will be forced to reduce services, limit patient access, or close their doors altogether.
- Prevent future Medicare payment cuts that destabilize care delivery
- Implement an adequate, permanent inflationary update that reflects the real cost of delivering care
- Advance comprehensive payment reform that supports high-quality, team-based primary care and rewards value over volume.
Please take two minutes to participate in this Speak Out. Together, we can ensure a stronger healthcare system for all.
Tracking Medicaid Patients’ Work Status May Prove Difficult for States
Source: Ohio Capital Journal
States must begin verifying millions of Medicaid enrollees’ monthly work status by the end of next year — a task some critics say states will have a hard time carrying out.
A provision in the tax and spending bill President Donald Trump signed into law on July 4 will require the 40 states plus Washington, D.C., that have expanded Medicaid to check paperwork at least twice a year to ensure those enrollees are volunteering or working at least 80 hours a month or attending school at least half time.
The new law provides states $200 million for fiscal year 2026 to get their systems up and running. But some experts say states will have difficulty meeting the deadline with that funding and worry enrollees might lose their health benefits as a result.
A year and a half to comply is likely not going to be enough time for most states, especially since the federal government must craft guidance on how they should implement their programs, said Benjamin Sommers, MD, PhD, a health economist at Harvard T.H. Chan School of Public Health. He predicted it will be difficult to create technology simple enough — such as a phone app — to streamline the process for all enrollees.
“Two hundred million [dollars] is not going to cover the 40 expansion states that we have,” he told Stateline. “There is not a silver bullet here, and there isn’t a single app out there that’s going to keep people who should be in Medicaid from losing coverage. That’s just not realistic.”
Read the full article in The Ohio Capital Journal.
Ohio Lawmakers Push to Restore State Employee Access to Ozempic, Weight Loss Drugs
Source: Ohio Capital Journal
Lawmakers are trying to restore access to GLP-1 weight loss drugs, like Ozempic and Wegovy, after Ohio removed medical coverage for state employees.
When he was 21 years old, Josh Williams fell 30 feet off the side of a train, crushing his spine — causing 20 years of pain.
“I underwent a lot of back surgeries and at one point I grew to 458 pounds in my heaviest,” Josh Williams said. “I was on prescription opiates for over a decade, and it ruined my metabolism.”
His struggle to lose the weight exacerbated his back pain, he said, but one drug made all the difference.
“It really did save my life,” he added. “It allowed me to get out of bed and get back into the workforce.”
Josh Williams, a Republican state representative, is now introducing legislation to help other state employees access the medication.
The Ohio Department of Administrative Services (DAS) announced that starting July 1, GLP-1 medications would no longer be covered by the state’s benefits plan for weight loss. It will still be covered for diabetes.
“The State of Ohio covered GLP-1 medications for weight loss since July 2022; however, the costs for GLP-1 medications for weight loss continued to escalate despite the implementation of cost containment measures,” DAS spokesperson J.C. Benton said in an email statement. “The decision to stop coverage was a difficult, but a fiscally necessary one…DAS has worked tirelessly to maintain a generous, competitive benefits plan for all 106,000 state employees and their dependents.”
Read the full article in The Ohio Capital Journal.
Medicaid Cuts Could Have Big Consequences for Rural Hospitals
Source: WOSU Public Media
Democratic lawmakers and liberal policy analysts say changes to Medicaid in President Donald Trump’s massive tax cut and spending bill could mean big trouble for rural hospitals.
Medicaid, a $900 billion state and federal health insurance program, covers low-income and disabled people. It accounts for about 19% of spending on hospital care nationwide. About 20% of patients who visit hospitals in Ohio use Medicaid, according to the Ohio Hospitals Association (OHA), which represents all of Ohio’s more than 250 hospitals.
“Medicaid is pretty significant,” said John Palmer, director of media and public relations for the OHA. “We get reimbursed a lot through the Medicaid program.”
John Palmer said about 60 hospitals in Ohio are designated as ‘rural’ or ‘critical access’ facilities. In 2024, 88% of the state’s rural hospitals had an operating margin of 2% or less. About 72% had a margin of 0% or less.
“Medicaid is what keeps many of these facilities afloat. And they are going to have to either cease operations, close down, or consolidate,” said Alex Jacquez with Groundwork Collaborative, a progressive economic policy group in Washington, D.C.
Alex Jacquez said the Kaiser Family Foundation and the Center for Budget and Policy Priorities estimate that around 489,000 Ohioans are at risk of losing their Medicaid coverage under the new law. The nonpartisan Congressional Budget Office has said that overall, federal Medicaid spending will be reduced by about $1 trillion over the next decade.
Read the full article in WOSU.