Medical costs are a concern for many people in Ohio, but efforts are under way to alleviate some of the financial burdens associated with health care.

An estimated one in ten adults in the U.S. have medical debt, including nearly three million who owe more than $10,000.

Steven Wagner, executive director of the Universal Healthcare Action Network of Ohio, explained medical debt often happens because a treatment is not expected or cannot be avoided.

"So it's not this issue of people not saving well or being irresponsible with their finances," Wagner emphasized. "A significant portion of all communities don't have the ability to pay a $1,000 bill if it's a big surprise bill."

The Hospital Care Assurance Program helps pay bills for Ohioans who earn less than the federal poverty limit. And those who earn more can apply for hospital financial assistance programs required under the Affordable Care Act.

Wagner encouraged patients to ask for copies of financial-assistance policies as soon as a bill arrives, or prior to care when possible. October is Health Literacy Month and the Universal Health Care Action Network of Ohio offers assistance with applying for and understanding hospital assistance policies.

Wagner noted hospitals have some flexibility about how generous the assistance is they can provide.

"Hospitals in Ohio have gone all the way up to 400% of the federal poverty limit in terms of who they'll provide assistance to," Wagner observed. "Hospitals sometimes are also doing that for both insured and uninsured people."

Michele Grim, a Toledo city councilwoman, is proposing a measure to use American Rescue Plan Act dollars to help relieve up to $200 million in medical debt for eligible residents.

Grim has heard stories from constituents who have avoided care because they cannot afford their medical bills.

"Medical debt prevents people from putting food on the table, it prevents people from paying the rent, paying their mortgage, paying their utilities," Grim pointed out. "It also exacerbates evictions. So to relieve medical debt, that's really gonna help the people in our community recover economically."

Grim anticipates a vote on the measure Nov. 9, which is modeled after a similar initiative passed in Illinois' Cook County.

About three in four voters recently polled ranked health care costs as a greater concern than the cost of housing, child care and college.

After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.