Health policy expert explains what Ohio voters should know about health care policy ahead of the election

As Ohio voters prepare to participate in the upcoming election, health care policy decisions could have significant implications for Medicaid coverage, rural hospitals, mental health services and the affordability of care, with changes at the federal and state levels that could shape access to services for years to come.

Dan Skinner, professor of Health Policy at Ohio University, said voters should look beyond campaign messaging to understand how candidates’ proposals could affect Ohioans, particularly as new federal requirements and funding changes create challenges for the state’s health care system.

“The One Big Beautiful Bill will pose a series of challenges to Ohio’s health and human services, and Ohio’s next governor is going to have to take decisive action,” Skinner said.

One of the biggest changes involves Medicaid, the public health insurance program that covers millions of Americans, including low-income adults, children, people with disabilities and older adults. Beginning Jan. 1, 2027, many adults enrolled through Medicaid expansion will have to document at least 80 hours per month of work, volunteering, schooling or other approved activities to maintain eligibility.

Skinner noted that projections suggest hundreds of thousands of Ohio Medicaid enrollees could lose coverage as the requirements take effect. In addition to the burdens these reporting requirements will place on patients, Skinner says they could also create administrative challenges for county agencies responsible for processing eligibility checks and verifying compliance.

“The most immediate effects come from implementing Medicaid work requirements and eligibility checks,” Skinner said, adding that state budget decisions will also play an important role in determining how Ohio responds to the changes.

Beyond Medicaid, health care affordability and access to services for older Ohioans deserve attention. During Medicare open enrollment, seniors are evaluating their coverage options amid changes in the availability of Medicare Advantage plans, the privately administered alternative to traditional Medicare. These changes could be particularly significant in rural counties, where residents may already have fewer choices for care.

As Skinner explained, “With open enrollment for Medicare now underway, we are seeing a steady decline in options for Ohio seniors on Medicare Advantage, the privatized alternative to traditional Medicare. We don’t yet know what this will ultimately mean for Ohio seniors, but we do know that many – especially in rural Ohio counties – have fewer choices.”

Rural hospitals and access to care
Rural health care is another area where election outcomes and state policy decisions could have lasting consequences. Rural hospitals are already facing financial challenges, with 72% reporting operating losses since 2022, according to Skinner. If more Ohioans become uninsured, hospitals could face additional uncompensated care costs while patients continue to contend with provider shortages and long travel distances.

Federal funding could help address some of these challenges. The federal government has established a $50 billion rural health fund; however, providers will not automatically receive those resources. Instead, funding will be distributed through state-level programs. How Ohio allocates its share and invests in its health care workforce could have a substantial impact.

“The state decisions on how to spend it, on workforce pipelines and on telehealth will matter a great deal,” Skinner said.

However, the consequences of policy decisions may not be immediately apparent. While Medicaid eligibility changes and state budget choices could affect coverage relatively quickly, hospital closures, workforce shortages and changes in chronic disease outcomes may take years to emerge, and according to Skinner, once those problems develop, they can be difficult to reverse.

Mental health and addiction treatment
Medicaid policy will also influence access to mental health and addiction services. The program is a major source of funding for Ohio’s behavioral health system, making eligibility and funding decisions especially important as the state continues responding to substance use challenges.

Skinner explained that although overdose deaths have declined, Ohio continues to face complex substance use problems. According to the Ohio Department of Health, unintentional drug overdose deaths in Ohio fell 34% in 2024, to 2,931 deaths. However, declining fatalities do not eliminate the need for treatment, prevention and recovery services.

The next governor and legislature will help determine how the state directs opioid settlement funds, including $45.7 million in OneOhio opioid grants, and whether that money supplements existing treatment resources or replaces other funding.

“Medicaid is also the backbone of Ohio's behavioral health system, so decisions about eligibility and funding will shape who can reach treatment, even as overdose deaths decline and the state faces more complex substance use problems,” Skinner said.

What Ohio voters should look for
For Ohio voters evaluating health care policy, Skinner recommends examining the details behind candidates’ public statements, including how plans would be funded, how many people they would affect and what steps candidates would take if projected coverage losses or hospital closures occur.

He also encourages voters to consider whether candidates have credible plans for administering programs, particularly given the responsibilities that will fall to county agencies, hospitals and clinics.

“Look for specifics on how a proposal would be paid for, how many people it would cover or affect and what the candidate would do if projected coverage losses or hospital closures materialize,” Skinner said.

Ultimately, Skinner said, voters should consider not only what candidates promise but also the values and tradeoffs reflected in their proposals.