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Who's responsible?

These are the officials and agencies making decisions affecting people's health care:

In Ohio

Gov. Bob Taft: Officials who run the state's Medicaid program answer to him. To balance the budget, he ordered cuts this year that ultimately eliminated benefits to middle-income families with severely ill children. Taft acknowledges that the cuts have hurt Ohioans, but he says the state is out of money. "We face very difficult choices. We're talking about a $9 billion Medicaid program that is growing three or four times the rate of our revenue, and it's simply not sustainable."
Phone: (614) 466-3555
E-mail: governor.taft@das.state.oh.us

Ohio Department of Job and Family Services: It's the main state agency responsible for paying billions in tax dollars each year to hospitals, doctors, nursing homes and other providers of health care for Ohio's 1.7 million disabled and poor residents. Barb Edwards, the agency's Medicaid director, says officials can only afford to help those who need it most. "Lawmakers say, 'The Medicaid program is growing too much, and you've got to bring costs down,' " she says. "Then, in the same breath, they say, 'Why haven't we done more to help kids with autism?' or, 'Why can't we help more elderly people?' "
Phone: (800) 324-8680
E-mail: medicaid@odjfs.state.oh.us

Bureau for Children with Medical Handicaps: This small agency within the Department of Health covers expensive specialists, medical equipment and co-pays for families with children suffering from cystic fibrosis, cerebral palsy and other severe illnesses. Faced with losing more than half its state funding, the bureau this year reduced coverage to 5,000 middle-income families. "I think people realize that we're in tough times, and we have made really hard decisions," says Dr. James Bryant, the bureau director. "For some middle-class families, it's very serious."
Phone: (614) 466-1549
E-mail: BCMH@gw.odh.state.oh.us

Ohio General Assembly: State lawmakers write the laws that shape the state's health-care system. In recent years, they've been reluctant to make changes. One bill up for debate in the Senate would make state officials offer high-risk insurance to adults and children who have serious illnesses and nowhere else to turn. "It's something we should definitely debate," says the bill's sponsor, Sen. Lynn Wachtmann, R-Napoleon.
Wachtmann's Phone: (614) 466-8150
E-mail: SD01@mailr.sen.state.oh.us

County welfare agencies: County departments of Job and Family Services handle applications for families trying to get Medicaid. But county officials say there is often nothing they can do if a family makes too much money to qualify. David Erbaugh, a supervisor at the Preble County Job and Family Services agency, says income rules are in place because the government can't afford to pay for care for everyone. "If you're middle class, we are not the place to come," he says. "There is not a lot we can do unless you lose your income or have more kids."
In Hamilton County: (513) 946-1000
In Butler County: (513) 887-4000
In Warren County: (513) 695-1420
In Clermont County: (513) 732-7111 *

In Kentucky

Gov. Ernie Fletcher: Officials who run the state's Medicaid program answer to him. He faces a grim task: Estimates show a $1.3 billion Medicaid deficit over the next two years. Former Gov. Paul E. Patton proposed $250 million in cuts to Medicaid in January. The changes, which took effect this year, included restrictions on prescription drugs, nursing homes and in-home care.
Phone: (502) 564-2611
E-mail: governor@mail.state.ky.us

The Cabinet for Health Services: It's the main state agency responsible for paying billions in tax dollars each year to hospitals, doctors, nursing homes and other services for Kentucky's 600,000 poor, disabled and elderly. To cut costs, agency officials say they had to limit nursing home and in-home care to only the sickest and poorest people. "We wanted to ensure you were a medically fragile person to be there," says Ben Sweger, the agency's director of long-term care and disability services.
Medicaid question line: (800) 635-2570

County welfare agencies: Every county has a state office for community based services that handles the applications for families trying to get Medicaid. Like Ohio, there is little officials can do if families make too much money to qualify.
In Boone County: (859) 371-6900
In Campbell County: (859) 292-6700
In Kenton County: (859) 292-6600


Insurers: Private insurance companies cover millions of Americans through employer, family and group health plans. Many of those plans limit a person's maximum lifetime benefits to $1 million. Insurance industry advocates say more plans are offering higher limits, but no one will say exactly how many.

David Linney, health insurance expert with the Great Lakes Hemophilia Foundation, says the best solution for a family who runs out of insurance is to get a new job with more coverage. "If your employer has the same insurance plan with no change in the lifetime limit, then you have a problem," Linney says. "Nationally, no one has really owned up to this."
Phone: (202) 778-3200
E-mail: cac@aahp.org

Pharmaceutical companies: Rapidly increasing drug prices are helping drive the national explosion in health-care costs. Drugs made from genetic material are particularly expensive. Baxter Healthcare Corp., a major drug maker, says prices for new drugs are often high because they are costly to invent and manufacture. But the payoffs can be huge, the company says. It cites Advate, a hemophilia-fighting drug that costs more than $6,000 an ounce. "The kids today using this on a regular basis can have a normal life," says Dr. Bruce Ewenstein, Baxter's global medical director.

The Pharmaceutical Research and Manufacturers Association takes comments through its Web site at: www.phrma.org/whoweare/contact.cfm

Back to Extreme Choices
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Listen to these mothers' advice for other families:
Barb Steele
Debbie Martin
Melissa Hahn

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Enquirer photographer Michael Keating tells the story of these families through his own words and photos.

The Hahn Family
Melissa and Randy Hahn are dealing with a daughter that has extensive brain damage, epilepsy and a seizure condition.

Your Choice
These situations are hypothetical, yet drawn from real experiences. What would you choose?

You are a physician, free to accept or refuse anyone as a patient. Do you treat someone who has a low-paying job that does not proved health insurance coverage?
You make the choice.

How much care should your critically ill newborn receive?

How do you pay when your insurance runs out?

You're a legislator. Where do you spend the money?

Did You Know?
Ohio hasn't increased its payments to doctors seeing Medicaid patients in three years, but nursing homes get automatic increases every year. It's state law. Nursing home costs increased 31 percent in five years to $2.2 billion, making it the health care program's single biggest expense in 2001.