Critics of the amendment called it meaningless because federal law trumps state laws. Then came the U.S. Supreme Court ruling, upholding the federal law. That was a setback for the Tea Party and other conservative foes of the law. But now, some Republican state legislators say they have found a new way Ohio could successfully fight the new federal mandate. Click the play button to hear details, as well as reaction from supporters of the Affordable Care Act.

Big Data – according to Charlie Lougheed –is all about the three V’s: volume, velocity, and variety.

“So if you think about an organization like Google, they have massive amounts of volume coming at them. If you think about a large bank, there are a lot of transactions coming through, that’s velocity, it’s coming at you very quickly. If you think about a healthcare org. there’s a huge degree of variety in the data.”

Lougheed is president of Explorys, a Cleveland start-up that has created a Google-type tool for the medical industry to help make sense of the tsunami of data sloshing around.

From a volume standpoint today we’ve curated 85 billion clinical, financial, and operational data facts, and those are the data facts that make-up the process of care.

Every time you see your family doctor, or take a drug, or enter the hospital you generate potentially useful data that, taken together, could lead to better treatment for you, and a way for hospital administrators to streamline care.

Lougheed says Explorys uses anonymous patient information in the aggregate to do basic research to “more or less have a conversation with your data, because that’s what’s always been missing within large sets of healthcare data, it’s taken a long time to ask a basic question.”

Explorys got its start three years ago from an idea hatched by a Cleveland Clinic physician who mined the hospital’s database to uncover trends and insights for his practice. The company incubated in a suite at the Clinic’s business development arm before landing last November in the spacious digs of the former MOCA galleries and hiring 85 employees.

Cleveland Clinic Innovations director Chris Coburn says Explorys is a response to enormous changes happening in the healthcare industry.

What we’re heading in to is an era where information management is going to dominate healthcare – the groups, the companies, the hospitals that best manage data are going to come out on top.

Explorys CEO Steve McHale says the value of big data comes from the Affordable Care Act’s shift from piece-meal payments, or ‘fee-for-service’ patient care, to a lump-sum, outcome-based system.

McHale says today’s hospital leaders are facing a steep learning curve.

“They need to now prepare for new payment models and new care models, the fee for service model will become a thing of the past. Now the key is, how do you transform yourself into that new model without going under.”

And like the airlines, banking, and other industries, he says healthcare is undergoing rapid consolidation.

There’s not going to be all these little mom and pop systems and hospitals. It’s going to come down to mega-systems we think.

McHale predicts about a-third of hospitals will be gone, or absorbed in mergers over the next seven years.

Right now Explorys counts 13 hospital chains in its network, including the Cleveland Clinic, University Hospitals, MetroHealth, Akron General, Summa and Catholic Health Partners.

The network tracks 31 million patients and 120 hospitals, and 85 billion data points.

McHale says analytic tools like Explorys could give providers an edge in the new era of slimmer profit margins, and higher risk.

Big data-driven healthcare is his prescription for hospitals hoping to survive this coming revolution.

Attorney General Mike DeWine says investigators noticed a problem with the kits from Pickaway Diversified Industries when several kits from obviously-unrelated cases tested positive for the same DNA.

“We then started tracing it back and found that we have contamination from the company that actually assembles these rape kits,” DeWine says.

Tammy Alvoid is executive director at the non-profit. She’s most concerned with having to potentially reimburse hospitals.

“It financially could have a very serious impact on our business,” Alvoid says.

DeWine says the A.G.’s office will do its best to handle payments to hospitals. He declined to blame the problem on the non-profit employing developmentally disabled people. He called it an issue of “poor supervision.”

But the two are at odds over the governor’s proposal to expand Medicaid to an extra 275,000 low-income Ohio adults. Click the play button above to hear why Kasich stands behind his decision, and why some Republicans are so upset.

The drug wholesaler Cardinal Health says it plans to acquire AssuraMed for $2.07 billion. Cardinal manufactures and distributes pharmaceuticals and medical equipment, but mostly to doctors and other providers.

The acquisition of AssuraMed could be Cardinal’s in-road to home-based medical care. AssuraMed reported about $1 billion in sales last year, and a statement from Cardinal says it plans to use its supply chain knowledge to make the business more efficient.

Cardinal says the deal will be financed mostly with debt and is expected to be finalized in the spring. News of the announcement increased Cardinal shares by nearly two percent this morning.

Margaret Graham assesses 40 year old Michelle Mingle who has come to Ohio State’s Total Health and Wellness center with a racing heartbeat.

“Based on the fact that you’ve had these heart palpitations over the past month and that has occurred several times, we’re going to go ahead and do an EKG,” says Graham.

Graham is not a doctor – she’s a nurse practitioner. That’s a nurse trained to diagnose patients who can prescribe certain drugs.

In fact there is no doctor at the clinic which is run by OSU’s college of nursing. It opened last month at University Hospital East.

“I think that as we get more and more people in the health care system, on the health care rolls we have to use the best provider for the situation and make sure that all providers are able to practice to their full scope,” says Graham.

In addition to primary care nurse practitioners, the clinic includes a pharmacist, dietician, and a social worker, and soon a psychiatric mental health nurse practitioner. A physician is available by phone or e-mail if necessary.

Mingle’s visit helps put her mind at ease.

“Kind of maybe a little worried about heart disease, but she’s made me feel more comfortable that maybe it’s not,” says Mingle.

Without this clinic, Mingle might have gone to the emergency room – which is much more expensive. Keeping patients like Mingle out of the ER is one of the goals of the nurse practitioner run facility.

Director Kristie Flamm says the east side location is convenient to bus transportation and close to low-income patients who will soon be covered under the Affordable Care Act.

“In the long-run this should really save health care dollars if we can prevent heart attacks, if we can prevent strokes, if we can identify diabetes early in patients and get them treated for their diabetes and prevent the long-term complications,” says Flamm.

The clinic recently received a $1.5 million federal grant.

A recent study indicated that Ohioans are 29% more likely to visit the ER than the national average.

It’s estimated misuse of the E.R. amounts to nearly a billion dollars of wasted health care dollars in Ohio every year. A billion dollars for visits that could be avoided and handled in a primary care setting.

In addition to the cost savings, more nurse practitioner-run clinics could help the healthcare system overcome a shortage of primary care doctors.

Miami University last fall set up a Nurse Practitioner clinic on the Oxford campus for its more than 3,000 employees.

Miami economics professor Melissa Thomasson says before the clinic opened employees frequently went to the E.R., if they had the flu or an ear infection because there are not enough primary care providers in the area.

“We did have a pretty high number of people who went to the E.R. for such things and again the copay to the employee is $100 but when that hits our health plan it’s billed out to like $1200,” says Thomasson.

Doctors seem to welcome the shift to nurse practitioners.

Tim Maglione speaks for the Ohio State Medical Association which represents 20,000 physicians.

“It’s something that the physician communities support and embrace as a kind of a team-based approach to care. A multi-disciplinary team based approach to care is where we’re moving today in health care,” says Maglione.

Maglione adds that having a physician to consult with will be important in complex cases though to maintain quality of care.

Ohio Hospital Association’s Jonathan Archey says the group supports parts of the federal health care law.

“When you can allocate resources more effectively you can provide the care more efficiently and the idea is to make it better for the patients and also better for the cost curve as well,” says Archey.

We could see more of these clinics Under the Affordable Care Act. The federal government will spend nearly $2 billion to add more than 12,000 primary care physicians, nurse practitioners and physician assistants in the next 3 years.

And there could be more restrictions in the future.

An estimated 55 million abortions have occurred since the landmark Roe versus Wade ruling in 1973.

But since that time, Ohio’s legislature has taken steps to lower the number performed in Ohio. State lawmakers have restricted the practice, requiring a short waiting period for women seeking abortions, mandating parental consent for women under the age of 18 before they could have an abortion, and banning abortions past the point that a fetus is considered viable.

Mike Gonadakis with Ohio Right to Life says it’s paying off.

We are at an all time low in the number of abortions in our state’s history. We dropped 12 percent from the previous year.

But Gonadakis is quick to point out that his group will be pushing Ohio’s newly seated general assembly to take up legislation that would restrict abortion even more.

“Take federal (Temporary Assistance for Needy Families) dollars that each state gets on an annual basis to help Catholic Social Services, Lutheran Social Services, and other facilities that are in Appalachian Ohio where pregnant women may not have health care and prenatal care and make sure they have those options and they are well known. That’s a piece of legislation that we are going to fight for hard and put a lot of effort behind there.

“We currently work with Attorney General Mike DeWine on his foster care advisory board, and we hope to introduce legislation to the general assembly in the next 30 to 45 days, opportunities to tweak our foster care laws to help children in the system get adopted out in a more efficient manner and provide a safety net for them as well.

“And then adoption. My wife and I just recently finalized our second adoption of our son here in Ohio. We’ve personally identified ways to make the system better, and I know there are groups out there like the Dave Thomas Foundation who want to find ways to make adoption more affordable and more available.”

Gonadakis says his group will also, once again, back a proposal that failed to make it through the legislative process in the last general assembly that would have taken federal dollars away from Planned Parenthood and given the money to local community health centers, instead.

Gonadakis should find support in the legislature for many of his ideas since Republicans outnumber Democrats two to one.

Kellie Copeland with the NARAL Pro Choice Ohio worries about that. She says state legislators passed more restrictions on abortion in the last session than anytime during the past ten years.

We are concerned that the anti-choice super majorities in the legislature which were created by gerrymandering are going to, once again, move to outlaw abortion in Ohio and to defund family planning services. So we are going to work with pro-choice Ohioans across the state to lobby their legislators and I think even more importantly Governor Kasich to ask them to stay out of women’s personal private medical decisions.

Copeland says the fact is that young women of child bearing age are starting to realize what’s at stake politically when it comes to abortion rights.

“The younger generation has grown up with the expectation that they will make their own health care decisions without having to consult their local politicians. And as they have watched anti choice forces get more and more involved in their personal lives, they have pushed back very sharply.

“I think that was evidenced in the last election. If you look at how younger people and women in particular voted, they voted for pro choice candidates. And they are saying enough is enough.

There’s no word yet on whether the Ohio legislature will take up the controversial heartbeat abortion bill that was squashed by the Republican led Ohio senate last time around. Former Senate President Tom Niehaus said he had questions about that bill’s constitutionality.

But backers of that plan say it was indeed constitutional and they are lobbying for lawmakers to bring it back and pass it during the next two years.

But state officials are not convinced about the costs involved.

State officials haven’t yet decided whether to expand Medicaid under the Affordable Care Act. But budget director Tim Keen is concerned about the so-called “woodwork effect”, where people who are eligible for Medicaid but haven’t signed up do so in droves – and their costs won’t be covered by the new health care law.

“These will be borne in the traditional sharing method where the state has to pay about a third of those costs.”

Reporter: “So the state has to absorb those costs…“

Keen: “We do.”

Kasler: “…and will maybe have to shift funding from other areas?”

Keen: “Well, clearly, again, this – the answer’s yes. We will have to absorb these costs. And that means there’s that much less money that is available for us to apply to other areas, including some of the tax cuts that the Governor wants to put into this budget.”

But Cathy Levine with Ohio Consumers for Health Coverage says she calls it the “welcome mat effect” and says it’s going to happen anyway – but that if the state expands Medicaid, that will bring in new revenues to help with the costs.

“What the study demonstrates is that the money coming in for the newly eligible will generate new revenues from provider taxes, sales taxes, incomes taxes – so much revenue will come into the state that it will help the state pay for the woodwork effect.

“If I were the state budget and were worried about the woodwork effect, I would support the Medicaid expansion as the best way to pay for the woodwork effect that will happen whether or not we do the Medicaid expansion.”

The study estimates that Medicaid expansion in Ohio would pay for itself by 2022, but the federal government’s share will eventually drop and the state would basically break even.

Several groups have come out in favor of Medicaid expansion, including the Ohio State Medical Association and the Columbus Chamber of Commerce.

Kasich says the mandate will ease the heavy financial burden on families with an autistic child.

But lobbiest Roger Geiger says the mandate will be a burden for Ohio companies, especially small businesses.

The coverage mandate begins next year.

Click the play button above to hear Bill’s full report.

With just two weeks until Election Day Mandel unveiled his plan at an orthopedic private practice in Westlake. Point one of the plan is to repeal the Affordable Care Act, which has been a centerpiece of his campaign.

“Some people call it Obamacare, some people call it the Affordable health care act. I call it what I believe it is: the federal government takeover of healthcare,” Mandel said.

Several of the rest of Mandel’s ten points are principles that Republicans in general have applied to health care, such as tort reform, allowing patients cross state lines to buy insurance, encouraging medical savings accounts, and giving Medicaid block grants to states. Others you don’t hear so often, such as giving a tax deduction for health insurance to those who must buy it on their own. Mandel says that would help people get coverage for pre-existing conditions – although he doesn’t say how.

“The way to provide coverage for pre-existing is not to have the federal government take over the health care system. It’s to change the tax code to make it more friendly to small businesses and to people who are self employed, and more friendly to workers who may want to move from job to job.”

Democratic incumbent Senator Sherrod Brown’s campaign calls the plan “slogans over substance.”

Spokesperson Sadie Weiner said it would do little to expand access to health care, and repealing the Affordable Care Act would have immediate repercussions.

“Big insurance companies can kick you off your plan if you get sick. Those same big insurance companies can refuse to cover you if you have a pre-existing consition, and millions of young adults would be kicked off their parents plans when they graduate and begin looking for a job if Josh Mandel has his way on this.”

The two candidates will have their final debate of the campaign Thursday night in Cincinnati.