Poverty & Safety Net
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Status of Women: High rates of health care coverage in Ohio, maternal health challenges remain

December 11, 2023
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In our new release of Status of Women, we see the Ohio health insurance coverage rate is 95%. This is almost entirely thanks to Ohio’s decision to expand Medicaid in 2014 and the Affordable Care Act. Clearly, policy changes like this can make an enormous, positive difference in people’s lives. While overall, access and care appear to have improved for Ohio women, there are still issues like maternal health, maternal care deserts, pregnancy-related death, and mental health.

In our new release of Status of Women, we see the Ohio health insurance coverage rate is 95%.

The process of researching, compiling, and providing visualization to the data that comprises Status of Women was a collaborative process across our organization. As the Policy Director, when we began conversations about this project over the summer, I began to think about the data that would be most important to move our policy priorities forward. Status of Women spans demographic, health and economic data, and this data, comparable across every county in Ohio, can tell us where progress has been made and where we still have work to do. While my colleague (and new President and CEO), Emily Campbell, examines how the 2023 Status of Women trends in Ohio, I am focused on where health policy change has made a clear difference, either in a positive or negative direction.

Health insurance coverage has seen a huge increase in Ohio

I have been working in the world of policy long enough to remember when health insurance coverage rates were low: unacceptably, “how-are-we-allowing-this-to-be-the-status-quo” low. Uninsurance rates in 2011 for Ohioans aged 0-64, living under 200 percent of the federal poverty threshold was 25 percent. A quarter of people living under 200 percent of the federal poverty threshold did not have health insurance.Looking at the statewide health coverage rates for women, men and children, we have come a long, long way. Ohio’s uninsured rate is lower than the uninsured rate for the U.S. overall and Ohio health insurance coverage rate is 95%. This will shift, however, as the Medicaid waiver ends.

Thirteen counties in Ohio are maternity care deserts, another four counties have low access

A critical component of the health status for many women is the quality of and access to maternity care. We looked at a resource from the March of Dimes that looks at maternity care deserts and learned that nearly 20% of Ohio counties offer little or no access to maternity health care.Thirteen counties in Ohio are classified as maternity care deserts, meaning there is no access within the county to a hospital with obstetric care or a maternity care provider (OB/GYN or advanced practice nurse midwife), and an additional four counties have low access to maternity care, meaning that there are less than 2 hospitals or birthing centers in the county and less than 60 OB providers per 10,000 births. Access to health coverage is also a factor in determining maternity care deserts, but as we looked at above, Ohioans have access to health insurance. March of Dimes produces this data for every county in the nation, so access to health coverage looks drastically different in states that have not expanded Medicaid.

In Ohio there are 13 counties that have no OB care providers for the women who live there.

What is still shocking in Ohio is that there are 13 counties in the state that have no OB care providers for the women who live there. Of course, many people travel to other counties for care, and for some that may even be easier (they live near the county line). But for many women residing in these counties, it is a significant challenge to access OB care, especially for the routine visits that are so frequent during pregnancy. Ohio continues to struggle with high rates of maternal and infant deaths, and moving toward more equal and equitable access to care can make a difference.

Maternal mortality

In the coming weeks, we will be releasing a fact sheet for the whole state of Ohio. This fact sheet includes similar, and additional data, because some data is available at a state level that is not available by county. One data point that will be included on the state fact sheet is the state’s rate of maternal mortality. There were 23.8 maternal deaths per 100,000 live births between 2018 and 2021 in Ohio. Ohio is in about the middle of the pack, nationally. Community Solutions has been working for the last several years to improve the collection, analysis and reporting process around maternal deaths. The state releases detailed data on maternal deaths about every 2 years, but the most recent detailed analysis covers only through 2018 and county level data is not included, so we were not able to include this information across the 88 counties.

Mental health

We were able to include data on mental health treatment. It includes treatment covered through Medicaid and local mental health and addiction recovery services (often known as ADAMHS (Alcohol, Drug Addiction, and Mental Health Services) Boards in Ohio). While this does not include mental health services paid for through private insurance or Medicare, it is a good snapshot and will be one to keep an eye on over time, as we know there are significant needs for behavioral health care and a shortage within the workforce for these services. The state and stakeholders are exploring many available options to grow the behavioral health workforce.

Conclusion

We will spend a lot more time looking at Status of Women data. As we look more closely across the categories and how different counties are impacted, this will inform the next stages of our policy advocacy as it relates to women’s and children’s health.

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