The Ohio Provider Supplement Plan redefines healthcare by focusing on affordability, predictability, and support for both families and medical professionals. Explore the key advantages our system offers.

1. Core Idea: Redirect Patient-Based Funding → Provider Supplement Funding

Right now, Medicaid and similar programs:

• Pay high rates to hospitals

• Are bureaucratic

• Inflate prices

• Force doctors to hire extra staff just to deal with paperwork

• Cause insurance companies to raise premiums

This system flips the model:

Instead of giving money to patients → the state gives a supplement directly to providers driving down costs drastically!

To receive the supplement, providers must:

1. Charge dramatically lower rates

2. Publish transparent pricing

3. Agree to no government interference in medical decisions (contracted)

4. Accept all insurance companies at the reduced rate (contracted)

This creates a race to the bottom in pricing — but without cutting doctor income, because the supplement fills the gap.

1. The Problem

Ohio families are crushed by:

• High premiums

• High hospital bills

• High deductibles

• Medicaid bureaucracy

• Doctor shortages

• Government interference

Ohio spends $34 billion on Medicaid — but patients still struggle. (Conservative numbers-these numbers

are projected even higher for next year)

2. The Solution

Redirect 55% of Medicaid funds ($18.7 billion) into a Provider Supplement Pool that:

• Pays doctors and hospitals directly

• Requires much lower prices

• Keeps the government OUT of medical decisions

• Makes care affordable for every Ohioan

This is not socialized medicine. This is free‑market medicine with a state‑funded supplement.

3. What Patients Pay (projected)

OPS Target Medical Prices

• Primary Care Visit: $35

• Specialist Visit: $75

• MRI: $250

• CT Scan: $150

• Outpatient Surgery: $2,000

• Basic Labs: $15–$25

• ER Visit: $95–$200

 

Current Ohio Insurance Premiums

• Individual: $600–$900/month

• Family of Four: $1,800–$2,000/month

• High‑Deductible Individual: $350–$500/month

• High‑Deductible Family: $1,000–$1,400/month

 

OPS Projected Insurance Premiums- (Prices shown do not include Marketplace or employer discounts!) 

Regular Insurance (Marketplace / Employer)

• Individual: $300–$400/month

• Family of Four: $850–$1,150/month

• High‑Deductible Individual: $150–$220/month

• High‑Deductible Family: $450–$650/month

Medicaid

• $0/month (unchanged)

• Lower out‑of‑pocket costs

• Simplified access

• No Estate Recovery needed

 

 

The Deductible Problem — And How OPS Fixes It

Why Deductibles Are Out of Control

Across Ohio, families face deductibles that have climbed to impossible levels:

• Individual deductibles: $3,000–$6,000

• Family deductibles: $6,000–$12,000

• High‑deductible plans: even higher

These huge deductibles exist for one reason: medical prices are inflated far beyond what families can afford.

When an MRI costs $1,300… When a CT scan costs $600–$1,200… When outpatient surgeries cost $8,000–$22,000…

Insurers raise deductibles to protect themselves from unpredictable, inflated costs.

Families end up paying thousands before insurance even starts.

How OPS Fixes Deductibles

OPS lowers deductibles by lowering medical prices statewide.

OPS Target Prices

• Primary care: $35

• Specialist care: $75

• MRI: $250

• CT scan: $150

• Outpatient surgery: $2,000

When medical prices fall 60–80%, deductibles must fall with them.

OPS forces insurers to:

• use the statewide OPS price list

• file premiums and deductibles based on OPS prices

• meet federal Medical Loss Ratio (MLR) rules

• pass savings through to families instead of keeping them

Insurers cannot legally keep the savings or maintain inflated deductibles.

New Deductibles Under OPS

Projected OPS Deductibles

• Individual: $750–$1,200

• Family: $1,500–$2,400

• High‑deductible individual: $1,200–$1,800

• High‑deductible family: $2,400–$3,600

Reduction

OPS lowers deductibles by 60–70% statewide.

Families finally get insurance that works before they hit a $6,000 wall.

Why This Matters

Lower deductibles mean:

• families can afford to use their insurance

• providers see fewer unpaid bills

• rural hospitals stabilize

• insurers stop shifting risk onto households

• healthcare becomes predictable again

OPS makes deductibles reasonable, affordable, and aligned with real medical prices.

 

 WHY THIS SYSTEM WORKS

1. Prices drop because providers compete for supplement money.

2. Doctors earn more because supplement fills the gap.

3. Insurance premiums drop because care is much cheaper.

4. Patients pay less out-of-pocket.

5. Government saves money long-term.

6. Medical freedom is preserved.

7. This is the closest thing to a free-market health-care revolution without destroying hospitals or Doctors!

 

New insurance premium estimates (with 55% redirect)

 

 

I. STRESS‑TEST ANALYSIS OF THE 55% REDIRECT MODEL

1. Rural vs. Urban Providers

Rural Clinics

Strengths

• Guaranteed supplement payments stabilize small practices.

• Lower prices attract uninsured rural residents.

• Doctors earn more even with lower volume.

Risks

• Lower patient volume means supplement weighting may be needed.

• Rural hospitals may need “rural multipliers” (e.g., +10–15% supplement).

Outcome Rural care becomes more stable, more profitable, and more accessible.

Urban Clinics & Hospitals

Strengths

• High patient volume → extremely strong revenue under lower prices + supplements.

• Can cut 30–40% of administrative staff tied to Medicaid billing.

• Lower prices reduce ER overload.

Risks

• Large systems may resist transparent pricing.

• Need strong incentives (bonus supplements for early adopters).

Outcome Urban systems become leaner, more efficient, and more competitive.

2. Small Clinics vs. Large Hospital Systems

Small Clinics

• Win the most: less paperwork, more autonomy, higher income.

• Become the backbone of affordable care.

• Can operate profitably even in low‑income areas.

Large Hospitals

• Must restructure billing departments.

• But with $18.7B (now even more) supplement pool, they remain profitable.

• Lower prices increase patient volume and reduce bad debt.

Outcome Hospitals become more patient‑friendly, more transparent, and more financially stable.

3. Patient Mix Stress Test

Low‑income / Medicaid‑eligible

• Still covered.

• Care becomes dramatically cheaper and easier to access.

• Less bureaucracy.

Middle class

• Biggest winners: premiums drop, out‑of‑pocket drops, access improves.

Uninsured

• Can pay cash at low rates (e.g., $35 visit, $250 MRI).

• Or buy new low‑cost plans ($140 individual, $400 family).

Seniors

• Medicare stays the same, but supplemental costs drop.

Outcome All patient groups benefit — especially middle‑class families and rural residents.

4. Insurance Company Behavior

With prices dropping 60–80%: (projected)

• Insurers must reduce premiums.

• They lose incentive to deny care.

• They gain incentive to enroll more people.

• They become partners instead of gatekeepers.

Outcome Insurance becomes cheaper, simpler, and less adversarial.

5. Economic Stability Stress Test

Provider Income Stability (projected)

With supplements:

• Primary care doctor: ≈$625,000/year

• Specialist: ≈$1.23M/year

• Surgeon: ≈$3.06M/year

• Radiologist: ≈$3.65M/year

Doctors earn more, not less.

Hospital Stability

• Guaranteed supplement payments stabilize revenue.

• Lower prices increase patient volume.

• Less administrative overhead increases profit margins.

State Budget Stability

• Long‑term savings: $5–7 billion/year

• Less fraud, less waste, fewer administrative costs.

Outcome The system is financially stable, doctor‑friendly, and patient‑friendly.

 

 

Safeguard #1 — The Medical Freedom Clause

“No state agency may interfere with medical decision‑making for any provider receiving supplement funds.”

That means no mandates. No forced protocols. No political interference. No bureaucratic control.

Safeguard #2 — The Ownership Protection Clause

“Supplement payments shall not grant the State of Ohio any authority, ownership, or managerial control over private medical practices, hospitals, or health‑care entities.”

Funding does not equal ownership. Funding does not equal control. Funding does not equal permission to interfere.

Safeguard #3 — The Patient Rights Clause

“All medical decisions shall remain between the patient and the provider, without state involvement,

  except in cases of fraud or criminal activity.”

Safeguard #4 — The Sunset Review Clause

Every five years, the supplement program must be reviewed publicly to ensure:

• No government overreach

• No creeping bureaucracy

• No hidden regulations

• No erosion of medical freedom

If any overreach is detected, the program automatically reverts to a lower level until corrected.

Safeguard #5 — The Taxpayer Protection Clause

“Any Medicaid funds not required for essential care shall be returned to the people of Ohio through tax relief, credits, or debt reduction.”

Because this system is paid for by the people’s tax dollars, and the people deserve to benefit from the savings.

These safeguards ensure that the government funds care but never runs care.

They ensure that doctors remain free. They ensure that hospitals remain independent. They ensure that patients remain in control of their own medical decisions.

And they ensure that Ohio families finally get relief — not just in health‑care costs, but in taxes and financial pressure.

The 55% Provider Supplement Plan doesn’t just fix health care.

It shrinks Medicaid, cuts waste, lowers costs, protects medical freedom, and gives money back to the people of Ohio.

It is a plan rooted in common sense, stewardship, and compassion.

A plan that honors the taxpayer. A plan that protects the poor. A plan that strengthens doctors. A plan that frees patients. A plan that keeps government in its proper place.

And it is a plan that can make Ohio a national leader in affordable, free‑market health care.

Guardrails That Protect Patients, Providers, and the State

Clear standards that keep the OPS Plan fair, affordable, and trustworthy.

The OPS Plan is designed to strengthen healthcare — not to create loopholes or opportunities for misuse. These guardrails ensure that every provider, hospital, and health system participates responsibly, keeps prices fair, and maintains transparency. They protect families, stabilize hospitals, and give the state confidence that the plan will operate with integrity.

Below is the full set of guardrails built into the OPS Plan.

 

Providers and health systems agree to lower their rates by a defined percentage to qualify for supplement payments. This ensures:

• fair pricing

• lower patient costs

• reduced insurance premiums

• statewide affordability

2. Mandatory Public Price Transparency

All participating providers must publish their prices for common services, including:

• office visits

• imaging (MRI, CT, X‑ray, ultrasound)

• labs

• outpatient procedures

• behavioral health visits

This prevents hidden fees and protects families from surprise bills.

3. Standardized Pricing for High‑Cost Services

Key services (like imaging and outpatient surgery) follow state‑approved price ranges, such as:

• MRI: $300

• CT: $300

• Outpatient surgery: $2,000 target

This keeps costs predictable and prevents price inflation.

4. Weekly Supplement Payments Tied to Compliance (not interference)

Providers receive weekly supplements only if they meet all guardrail requirements, including:

• price transparency

• rate reductions

• reporting accuracy

• patient access standards

This ensures accountability.

These could easily be stream-lined using a software program that is much more efficient than what we have now!

5. No Balance Billing Allowed

Providers cannot charge patients more than the published rate. This protects families from unexpected costs and keeps care affordable.

6. Required Access Standards

Participating providers must maintain:

• reasonable appointment availability

• fair scheduling practices

• no discriminatory access

• timely follow‑up care

This ensures patients receive the care they need without barriers.

7. Anti‑Consolidation Safeguards

Large health systems cannot use the OPS Plan to:

• buy out independent clinics

• eliminate competition

• raise prices

• restrict patient choice

This protects independent practices and rural providers.

8. Annual Audits for Accuracy & Fairness

The state conducts simple, non‑intrusive audits to ensure:

• correct pricing

• accurate reporting

• compliance with guardrails

• fair use of supplement funds

This keeps the system honest and transparent.

9. Penalties for Overcharging or Misuse

If a provider violates guardrails, the state may:

• pause supplement payments

• require corrective action

• remove the provider from the program

This protects the integrity of the plan. 

10. Patient Protection Guarantee

The OPS Plan includes a built‑in guarantee:

Patients will never pay more than the published rate. This gives families confidence and eliminates fear of surprise bills.

These guardrails ensure the OPS Plan remains fair, affordable, transparent, and trustworthy

 delivering the strongest healthcare future Ohio has ever seen.

 

 

Why the OPS Plan Is Not Socialized Medicine

A simpler system does not mean a government‑run system.

It’s important for families, providers, and policymakers to understand one thing clearly: The OPS Plan is not socialized medicine. It does not replace private healthcare, does not replace private insurance, and does not put the government in charge of medical decisions!

Instead, the OPS Plan simply removes waste, lowers prices, and supports providers through a predictable supplement — while keeping healthcare fully in the hands of private doctors, private clinics, private hospitals, and private insurers.

Below is a clear explanation-

1. Doctors and Hospitals Stay Private

Under socialized medicine, the government owns or controls the healthcare system. Under the OPS Plan, every doctor, clinic, and hospital remains fully private. Nothing changes about ownership or control.

2. Medical Decisions Stay in the Exam Room

Socialized systems often involve government‑controlled treatment rules. The OPS Plan does the opposite — it removes interference from insurance companies and restores clinical autonomy to physicians.

3. Insurance Still Exists

Socialized medicine replaces private insurance with government coverage. The OPS Plan keeps private insurance but makes it dramatically more affordable by lowering prices and reducing administrative waste.

4. Patients Keep Full Freedom of Choice

Socialized systems often restrict where patients can go. The OPS Plan expands choice, because lower prices and simpler access make more providers available to more people.

5. The State Does Not Control Healthcare Delivery

The OPS Plan does not create a government‑run system. It simply provides supplement payments to stabilize providers — similar to how states already support rural hospitals, EMS, and behavioral health programs.

This is support, not control.

6. Providers Agree to Guardrails — Not Government Control

The OPS Plan includes guardrails like:

• publishing prices

• lowering rates

• maintaining access

• preventing overcharging

These are standards, not government management. Providers remain fully independent.

7. The OPS Plan Reduces Bureaucracy — It Doesn’t Expand It

Socialized systems often add layers of government administration. The OPS Plan removes layers, simplifies Medicaid, reduces denials, and cuts paperwork.

It is less government, not more.

8. The OPS Plan Strengthens the Free Market

By lowering prices and increasing transparency, the OPS Plan actually makes the market more competitive, not less.

Patients can compare prices. Providers compete fairly. Costs stay predictable.

That is the opposite of socialized medicine.

9. The State’s Role Is Financial Stability — Not Medical Control

The supplement is simply a financial stabilizer, similar to:

• agricultural support

• rural broadband support

• EMS support

• hospital stabilization funds

It does not change how medicine is practiced.

10. The OPS Plan Protects Families Without Taking Over Healthcare

Families get:

• lower costs

• simpler access

• fewer denials

• fewer surprises

• more predictable care

But they keep full freedom, full choice, and full access to private healthcare!

The OPS Plan is not socialized medicine — it is a smarter, simpler, more affordable version of the system we already have, built to strengthen providers and protect families.

 

 

THE INCENTIVE‑BALANCED MODEL (Built on the 55% Plan) let's drive down costs even more!

Core idea! Doctors earn a strong wage! — but agree to earn slightly less in exchange for major benefits.

This model keeps the 55% redirect (because it’s the sweet spot) but adjusts supplement payments downward 15% while adding high‑value incentives that doctors actually want.

This creates:

• Lower supplement spending

• Lower total Medicaid spending

• Lower premiums

• Lower patient costs

• Higher doctor satisfaction

• More long-term savings for Ohio

Let’s break it down.

1. Why surgeons and specialists earn more in the 55% model

Under the 55% plan: (projected)

• Surgeons earn ≈ $3.06M/year

• Radiologists earn ≈ $3.65M/year

• Specialists earn ≈ $1.23M/year

These numbers are realistic because:

• They reflect actual cash‑pay market efficiency

• They remove administrative waste

• They eliminate Medicaid billing overhead

• They pay doctors for volume, not bureaucracy

But we can trim these numbers slightly without losing doctors.

Why?

Because doctors value freedom, simplicity, and predictability just as much as raw income.

2. The Incentive‑Balanced Model: Doctors agree to 15% lower supplements in exchange for major benefits (this could be 12-15%)

Doctors accept approx. 15% less which lowers supplement payments in exchange for:

Incentive 1 — Zero Prior Authorizations

No insurance company can require prior auth for:

• Imaging

• Labs

• Surgeries

• Referrals

• Medications

Doctors LOVE this. It saves them hours per day.

Incentive 2 — Zero Medicaid Paperwork

No:

• Billing codes

• Pre‑approvals

• Claim denials

• Audits

• Documentation burdens

Doctors get paid weekly from the supplement pool.

This alone is worth hundreds of thousands in saved staff time.

Incentive 3 — Guaranteed Weekly Payments

Doctors get paid:

• Every Friday

• Automatically

• Without claims

• Without delays

This is better than any insurance contract in America.

Incentive 4 — Liability Protection Boost

The state provides:

• Lower malpractice premiums

• Legal defense support for frivolous lawsuits

• A “safe harbor” for guideline‑compliant care

Doctors will typically accept slightly lower income for this.

Incentive 5 — Freedom From Government Control

Protected by:

• Medical Freedom Clause

• Ownership Protection Clause

• Patient Rights Clause

• Sunset Review Clause

Doctors keep full autonomy.

Incentive 6 — Tax Credits for Participating Providers

Doctors receive:

• A state tax credit

• Reduced business taxes

• Reduced payroll taxes for staff

This offsets the reduced supplement.

3. New Doctor Income with incentive plan. (15% lower supplements) Still attractive rates (projected)

Primary Care

111×20×5×50=555,000

New PCP income: ≈ $555,000/year

Specialist

219×20×5×50=1,095,000

New specialist income: ≈ $1.1M/year

Surgeon

5,506×10×50=2,753,000

New surgeon income: ≈ $2.75M/year

Radiologist

658×20×5×50=3,290,000

New radiologist income: ≈ $3.29M/year

5. How much does Ohio save with this incentive model?

Original 55% supplement pool:

$18.7B

15% reduction:

18.7B×0.15=2.8B saved

New supplement pool:

18.7B−2.8B=15.9B

Ohio saves $2.8 billion per year more — without hurting doctors, hospitals, or patients.

6. What happens to the savings?

You can use the $2.8B saved to:

• Reduce the Medicaid budget

• Lower state taxes

• Provide family tax credits

• Reduce small‑business taxes

• Improve rural hospitals

• Reduce state debt

• Fund parental rights protections

• Support foster care and adoption programs

This is real relief for Ohio families.

Where the Savings Go

Reduce the overall Medicaid budget

Ohio no longer needs the full $34B Medicaid budget because:

• Prices drop 60–80%

• Care becomes cheaper

• Fewer people rely on Medicaid

• Administrative waste disappears

The state can safely reduce Medicaid to $26–28B, saving $6–8B annually. (projected)

7. Why doctors will still want to join this model

✔ Why doctors would still join (summary)

Doctors accept slightly lower income because they gain:

• Zero prior authorizations

• Zero Medicaid paperwork

• Guaranteed weekly payments

• Lower malpractice premiums

• Tax credits

• Full medical autonomy protected by law

• No government ownership or control

These incentives are worth far more than the income reduction.

They also get:

• Higher income than today

• Less paperwork

• More freedom

• No insurance games

• No billing nightmares

Doctors typically will accept slightly lower supplements for these benefits.

BOTTOM LINE

• Doctors still make excellent money

• Surgeons make slightly less

• The state saves billions

• Medicaid shrinks

• Families get relief

• Medical freedom is protected

• The system becomes sustainable

• Reduces supplement spending by 15%

• Saves Ohio $2.8B/year immediately

• Allows long‑term Medicaid reduction of $6–8B/year

• Returns money to taxpayers

• Protects those in the lowest income brackets

• Prevents government ownership or control

• Makes health care affordable for everyone

Medicaid Savings Breakdown

Original 55% Plan

• Supplement pool: $18.7B

Incentive‑Balanced Plan (15% reduction)

• New supplement pool:

18.7B−(18.7B×0.15) =15.9B

Annual Medicaid Savings

18.7B−15.9B=2.8B

Ohio saves $2.8 billion every year.

Protect those in the lowest income brackets

The remaining Medicaid funds (≈$15.3B) cover:

• Families with very limited financial resources

• And with small co‑pays ($3–$10)

• And access to the same low prices

This creates dignity, responsibility, and sustainability.

Recap on how OPS Billing Differs from Today’s System

Today, Medicaid works like this:

• A provider treats a Medicaid patient.

• The provider sends a claim to Medicaid.

• Medicaid pays its standard low rate for that service.

• The provider must accept that payment as “payment in full,” even if it is far below the real cost.

This system creates financial stress because Medicaid’s rates are often too low for providers to break even. Nothing else happens — the claim is finished, and the provider absorbs the loss.

How Billing Works Under the OPS Plan

OPS uses some of the same Medicaid money, but it changes how that money is distributed.

Here’s the difference:

✔ 1. Providers still bill Medicaid exactly the same way.

They submit a claim for the service, just like today.

✔ 2. Medicaid still pays its normal rate.

Nothing changes in Medicaid’s rules, fee schedule, or reimbursement process.

✔ 3. OPS adds a supplemental payment on top of Medicaid’s payment.

This supplemental payment comes from the OPS pool — which is funded by existing Medicaid medical service spending, not new taxes or new money.

✔ 4. The provider receives a realistic, sustainable total payment.

Medicaid pays its part. OPS fills the gap. The provider finally breaks even.

Same Money, Different Structure

OPS does not increase Medicaid spending. OPS does not raise taxes. OPS does not change Medicaid rules.

OPS simply redirects a portion of existing Medicaid medical service spending into a supplemental pool that supports providers after Medicaid pays its normal rate.

Think of it this way:

Current System:

Medicaid pays → provider loses money → system destabilizes.

OPS System:

Medicaid pays → OPS supplements → provider stabilizes → system strengthens.

Summary 

OPS does not replace Medicaid billing — it improves it. Providers still bill Medicaid, and Medicaid still pays its standard rate. The difference is that OPS adds a supplemental payment funded from existing Medicaid medical service spending. Because providers receive this stable supplement, they agree to charge lower base prices for services. Medicaid pays its normal rate, OPS fills the gap, and the provider finally breaks even. This lowers medical bills, reduces cost shifting onto private insurance, and strengthens the entire healthcare system — all without increasing Medicaid spending or raising taxes.

How We Will Transition to the OPS Plan

We are not tearing down the current system—we are strengthening it step by step.

1. Design and testing phase: We first build the OPS payment structure using existing Medicaid medical‑service funds, test it with real claims, and make sure providers can break even without increasing total Medicaid spending.

2. Pilot phase: A group of hospitals and clinics begin using OPS. They still bill Medicaid the same way, Medicaid still pays its normal rate, and OPS adds a supplemental payment on top. In return, providers agree to lower their base prices, which reduces medical bills and stabilizes their income.

3. Statewide rollout: After the pilot proves stable and effective, more providers join in waves. Private insurers and employers are brought into the conversation so they can see how OPS reduces cost‑shifting and helps keep premiums under control.

4. Ongoing monitoring: We continuously track provider stability, patient bills, insurance impacts, and Medicaid spending to ensure OPS remains fair, sustainable, and budget‑neutral.

In simple terms: We keep Medicaid billing the same, (hopefully simplified) add a carefully designed OPS supplement funded from existing Medicaid dollars and ask providers to charge less because they are finally supported. Over time, this lowers bills, stabilizes providers, and strengthens the entire healthcare system.

The Vision

Ohio becomes the national leader in affordable, free‑market health care.

Families save. Doctors thrive. Hospitals stabilize. Government steps back. Patients save; everyone wins!

Then we go national!

Note-These projected numbers (new costs and savings etc.) can change after the entire system is built by our committee. These are our best estimates at the time this website was posted. We will try and update any changes as we go. keep in mind that means they could go lower too!

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