Hospital Prices & Cost Variation

RAND Hospital Price Transparency Study https://www.rand.org 

NASHP Hospital Cost Tool https://nashp.org/hospital-cost-tool/ (nashp.org in Bing)

The Century Foundation – Lowering Hospital Prices https://tcf.org/content/report/how-states-can-lower-hospital-prices/ (tcf.org in Bing)

JAMA Network Open – State Spending Benchmarks https://jamanetwork.com/journals/jamanetworkopen (jamanetwork.com in Bing)

MedPAC Reports to Congress https://www.medpac.gov

Rural Hospital Stability

KFF – Rural Hospital Financial Challenges https://www.kff.org/health-costs/report/10-things-to-know-about-rural-hospitals/ (kff.org in Bing)

American Hospital Association – Rural Health Reports https://www.aha.org/ruralhealth (aha.org in Bing)

Chartis Rural Hospital Vulnerability Index https://www.chartis.com/rural-health (chartis.com in Bing)

Drug Plan Costs & Administrative Burden

CMS Medicare Part D Drug Spending Dashboard https://www.cms.gov/data-research (cms.gov in Bing)

HHS Inspector General – Prior Authorization Burden https://oig.hhs.gov

GAO – Pharmacy Benefit Manager Reports https://www.gao.gov

Insurance Premium Trends

CMS ACA Marketplace Landscape Files https://www.cms.gov

KFF Marketplace Premium Tracker https://www.kff.org/health-reform/state-indicator/marketplace-average-benchmark-premiums/ (kff.org in Bing)

USHealthCosts.com Premium Analysis https://ushealthcosts.com

Milliman Health Cost Index https://www.milliman.com

Health Affairs – Employer Insurance Cost Studies https://www.healthaffairs.org

Administrative Waste & Savings Potential

Health Affairs – Administrative Waste Analysis https://www.healthaffairs.org

NEJM – Administrative Simplification Studies https://www.nejm.org

Commonwealth Fund – Administrative Burden Reports https://www.commonwealthfund.org

Independent Imaging Center Pricing

USHealthCosts MRI Pricing Study https://ushealthcosts.com

MedPAC – Site‑Neutral Payment Reports https://www.medpac.gov

FAIR Health – Procedure Cost Lookup https://www.fairhealth.org

Medicaid Simplification & Coverage

KFF Medicaid Coverage Gap Report https://www.kff.org

MACPAC – Medicaid Access Reports https://www.macpac.gov

CMS Medicaid Enrollment & Cost Data https://www.medicaid.gov

 

Independent Data Showing Why Families Benefit Under the OPS Plan

Families deserve healthcare that is affordable, predictable, and easy to use. The sources below come from respected national research organizations and show why families face high costs today — and why the OPS Plan’s approach is grounded in real, verifiable data. These references highlight the challenges families experience with premiums, medical prices, drug costs, rural access, and administrative complexity.

 

1. Why Families Pay So Much Today

Premiums, deductibles, and out‑of‑pocket costs

KFF – Employer Family Premiums (Average $23,968/year) https://www.kff.org/report-section/ehbs-2023-section-1/ (kff.org in Bing)

KFF – Deductible Growth for Families https://www.kff.org/report-section/ehbs-2023-section-7/ (kff.org in Bing)

Commonwealth Fund – Families Skipping Care Due to Cost https://www.commonwealthfund.org/publications (commonwealthfund.org in Bing)

Urban Institute – Family Out‑of‑Pocket Burden https://www.urban.org/research/publication (urban.org in Bing)

Health Affairs – Why Family Premiums Rise Faster Than Wages https://www.healthaffairs.org

2. Why Insurance Premiums Keep Rising

The cost drivers that hit families hardest

Brookings – Hospital Prices Drive Premium Growth https://www.brookings.edu/articles/hospital-prices-and-premiums/ (brookings.edu in Bing)

Peterson-KFF Health System Tracker – Premium Inflation https://www.healthsystemtracker.org

American Academy of Actuaries – Premium Drivers https://www.actuary.org/content/health-insurance-premium-drivers (actuary.org in Bing)

CBO – Employer Premium Growth Analysis https://www.cbo.gov/publication (cbo.gov in Bing)

Milliman – Family Plan Cost Trends https://www.milliman.com/en/insights

3. Why Medical Prices Are So High

Families pay more because hospitals charge more

Health Care Cost Institute – Price Variation Report https://healthcostinstitute.org

FAIR Health – National Procedure Cost Benchmarks https://www.fairhealth.org

Blue Cross Blue Shield – Cost Variation Study https://www.bcbs.com/the-health-of-america (bcbs.com in Bing)

AMA – Site‑of‑Service Price Differences https://www.ama-assn.org

Medicare Payment Advisory Commission – Hospital vs. Independent Pricing https://www.medpac.gov

4. Why Rural Families Are Hit Hardest

Closures, long travel times, and unstable access

UNC Rural Health Research Program – Rural Hospital Closures https://www.ruralhealthresearch.org

National Rural Health Association – Family Access Challenges https://www.ruralhealth.us

CDC – Rural Health Disparities https://www.cdc.gov/ruralhealth (cdc.gov in Bing)

USDA – Rural Community Health Access https://www.ers.usda.gov/topics/rural-economy-population/rural-health/ (ers.usda.gov in Bing)

Chartis – Rural Hospital Financial Distress Index https://www.chartis.com/rural-health (chartis.com in Bing)

5. Why Drug Costs Strain Families

High prices, PBM practices, and skipped medications

GoodRx – Family Prescription Cost Trends https://www.goodrx.com/research

IQVIA – Drug Spending Trends https://www.iqvia.com/insights/the-iqvia-institute (iqvia.com in Bing)

AARP – Prescription Price Inflation Reports https://www.aarp.org/health/drugs-supplements/info-2023/drug-price-report.html (aarp.org in Bing)

GAO – PBM Practices Affect Family Drug Costs https://www.gao.gov

HHS – Drug Affordability Challenges https://www.hhs.gov/about/news/index.html (hhs.gov in Bing)

6. Why Families Struggle With Medicaid Complexity

Denials, paperwork, and administrative barriers

MACPAC – Medicaid Access Barriers https://www.macpac.gov/publication (macpac.gov in Bing)

KFF – Medicaid Renewal & Churn Problems https://www.kff.org/medicaid/

CMS – Medicaid Enrollment & Eligibility Data https://www.medicaid.gov

Urban Institute – Medicaid Administrative Burden https://www.urban.org/research/publication (urban.org in Bing)

Commonwealth Fund – Medicaid Family Experience Reports https://www.commonwealthfund.org

7. Why Administrative Waste Hurts Families

Families pay more because the system is inefficient

JAMA – Administrative Complexity in U.S. Healthcare https://jamanetwork.com/journals/jama

NEJM Catalyst – Administrative Waste Estimates https://catalyst.nejm.org

Health Affairs – Billing Complexity Burden https://www.healthaffairs.org

Commonwealth Fund – Family Impact of Administrative Waste https://www.commonwealthfund.org

Annals of Internal Medicine – Physician Time Spent on Paperwork https://www.acpjournals.org/journal/

Federal oversight agencies confirm that large portions of Medicaid dollars never reach medical providers. CMS reports that states routinely use financing schemes — including provider taxes and intergovernmental transfers — that divert Medicaid funds before they ever become provider payments, calling these practices “misused Medicaid dollars” and noting that more than half of state‑directed payments are financed by these mechanisms rather than real provider reimbursement . KFF further documents that most “improper payments” in Medicaid are caused by administrative and paperwork errors, with 77.2% of improper payments tied to documentation failures rather than care delivered, meaning billions are lost to administrative friction rather than reaching providers . Combined with managed‑care overhead, state financing loops, and rising administrative costs, the evidence shows that a substantial share — often well below half — of Medicaid spending actually reaches frontline medical providers.

CMS: “CMS Moves to Rein In Misused Medicaid Dollars”

Confirms states divert Medicaid funds using provider taxes and transfers; more than half of directed payments are financed this way.

1. MACPAC (via CMS citation): Over half of directed payments financed by taxes/transfers

Shows that a large portion of Medicaid “payments” never become provider pay.

3. KFF: Medicaid Payment Error Rate Measurement (PERM)

Shows 77.2% of improper payments are administrative/documentation errors — not care delivered.

4. CMS Fraud War Room Report

Shows massive improper payments and administrative waste — $203M stopped in 88 days.

5. BenefitsUSA: Medicaid Administrative Cost Shift

Explains how rising administrative cost burdens reduce provider-facing dollars.

 

Medicaid members deserve healthcare that is simple, predictable, and free from unnecessary administrative barriers. The sources below come from respected national organizations and show why Medicaid is often difficult to navigate today — and why the OPS Plan’s approach is grounded in real, verifiable data that improves access, reduces denials, and stabilizes care for low‑income families.

 

1. Medicaid Administrative Burden & Denials

HHS – Medicaid Prior Authorization Review https://www.hhs.gov/about/news/index.html (hhs.gov in Bing)

CMS – Medicaid Improper Payment Reports https://www.cms.gov/newsroom

GAO – Medicaid Eligibility & Administrative Burden https://www.gao.gov

Urban Institute – Medicaid Churn & Coverage Loss https://www.urban.org/research/publication (urban.org in Bing)

Commonwealth Fund – Medicaid Administrative Complexity https://www.commonwealthfund.org

 

2. Medicaid Access Problems

KFF – Medicaid Access to Care Survey https://www.kff.org/medicaid/

MACPAC – Access Barriers for Medicaid Patients https://www.macpac.gov/publication (macpac.gov in Bing)

National Academy for State Health Policy – Medicaid Access Issues https://nashp.org

Health Affairs – Medicaid Provider Participation Trends https://www.healthaffairs.org

AAMC – Medicaid Patient Access Challenges https://www.aamc.org

 

3. Medicaid Cost Pressures

CBO – Medicaid Spending Growth Analysis https://www.cbo.gov/publication (cbo.gov in Bing)

Brookings – Medicaid Cost Drivers https://www.brookings.edu

Peterson-KFF Health System Tracker – Medicaid Spending Trends https://www.healthsystemtracker.org

Milliman – Medicaid Actuarial Cost Trends https://www.milliman.com

HHS ASPE – Medicaid Cost & Utilization Reports https://aspe.hhs.gov

 

4. Medicaid & Rural Health

CDC – Rural Medicaid Health Disparities https://www.cdc.gov/ruralhealth (cdc.gov in Bing)

Chartis – Rural Hospital Medicaid Dependence https://www.chartis.com/rural-health (chartis.com in Bing)

National Rural Health Association – Medicaid’s Role in Rural Care https://www.ruralhealth.us

USDA – Rural Health Access & Medicaid Reliance https://www.ers.usda.gov/topics/rural-economy-population/rural-health/ (ers.usda.gov in Bing)

UNC Rural Health Research Program – Medicaid & Rural Closures https://www.ruralhealthresearch.org

 

5. Medicaid Drug Access

IQVIA – Medicaid Drug Spending Trends https://www.iqvia.com/insights/the-iqvia-institute (iqvia.com in Bing)

AARP – Medicaid Drug Affordability Reports https://www.aarp.org/health/drugs-supplements (aarp.org in Bing)

GAO – Medicaid Pharmacy Benefit Oversight https://www.gao.gov

CMS – Medicaid Drug Rebate Program Data https://www.medicaid.gov/medicaid/prescription-drugs/ (medicaid.gov in Bing)

HHS OIG – Medicaid Drug Access Audits https://oig.hhs.gov

 

Why OPSP Isn’t a “crazy Idea” — It’s a Structured Solution

When new ideas appear in healthcare, the first reaction is often skepticism — especially from people who work inside the system every day. That’s normal. Healthcare professionals are trained to trust established structures, and anything unfamiliar can feel risky.

But OPSP isn’t a wild concept. It’s a carefully built, economically grounded model created to solve a real problem: the rising cost of care for families, providers, and hospitals across Ohio.

Here’s why OPSP is not “crazy” — it’s necessary:

• It uses existing funding, not new taxes or new government programs

• It reduces premiums by redesigning the flow of money, not by cutting care

• It strengthens rural hospitals, which are currently at risk

• It protects medical freedom, keeping decisions between patients and providers

• It has a committee of professionals forming to oversee and refine the model

• It has already been evaluated by AI modeling, scoring 9/10 for feasibility

Every major healthcare reform began with someone willing to ask, “What if we did this differently?” OPSP is simply the next step in that tradition — a practical, structured, and hopeful solution for Ohio.

This isn’t a dream. It’s a plan. And it’s moving forward.