Pink Rose Society

Healthcare in Ohio

Healthcare is the sharpest personal-stakes contrast on Ohio's 2026 ballot — a race between a physician and a candidate who called Medicaid a "mistake," set against looming federal cuts that would remove hundreds of thousands of Ohioans from coverage.

Medicaid — coverage on the line

Ohio expanded Medicaid in 2014 under Republican Gov. John Kasich, and it now covers roughly 2.8–3 million people at a 90% federal match. Two forces now threaten that coverage:

  • A state work requirement. Ohio submitted a Section 1115 waiver to the federal government in early 2025 that would require expansion adults to work 20 hours a week or lose eligibility, with a projected start of January 2026. (It was still under federal review, not confirmed approved, as of late 2025.)
  • Federal cuts. The 2025 federal budget law ("One Big Beautiful Bill Act") mandates Medicaid work requirements nationally from 2027. The Center for Community Solutions estimates it would cut Ohio Medicaid spending by about $5.13 billion in year one and remove roughly 337,000 Ohioans from coverage, rising to a ten-year reduction near $53 billion.

The health record the numbers show

  • Infant mortality: 7.2 deaths per 1,000 births — 48th among the states (plus DC and Puerto Rico) — with Black infants dying at roughly 1.9 times the state rate.
  • Maternity deserts: about 18% of Ohio counties have no obstetric care, concentrated in Southeast Ohio; since 2020, 21 hospitals have closed or cut maternity services. Rural access shrinks precisely where Medicaid cuts would bite hardest.

Transparency and the opioid money

Ohio's opioid-settlement dollars flow mostly through the private OneOhio Recovery Foundation. In 2023 the Ohio Supreme Court ruled it was the "functional equivalent of a public office" and subject to public-records law — after which the Ohio General Assembly used the state budget to exempt OneOhio from open-records and open-meetings rules, a transparency reversal worth watching as billions in Public Health as a Political Stake (Ohio) money are spent.

Why it matters in 2026

  • Governor. Amy Acton — a physician and former state health director who led Ohio's early COVID response — runs on protecting and streamlining Medicaid and cutting drug costs. Vivek Ramaswamy is on record calling Medicare and Medicaid "mistakes" and now backs work requirements and fraud recovery. The Medicaid Director and Health Director are gubernatorial appointments, so the winner controls how the work requirement and coverage retention are run (Ohio 2026 Governor Race).
  • Legislature. The Ohio General Assembly sets Medicaid eligibility and must decide how to absorb the ~$809M/year state-share loss from the federal law — and whether to preserve expansion.
  • U.S. Senate. Husted vs. Brown votes directly on the federal Medicaid match and ACA subsidies driving Ohio's cuts.

Sources