Amy Acton wants to spend millions forgiving Ohioans’ medical debt. Vivek Ramaswamy has promised a swift crackdown on Medicaid fraud and said he’d seek help from the Trump Administration to do so.
The contrast captures the divide between how the Ohio governor candidates say they’ll address health care costs – at least so far – which a recent poll from KFF, a health care policy research organization, shows is tied with high gas prices as the top economic concern for voters.
Further research helps illustrate why the topic is so top of mind.
A 2023 Ohio Medicaid Assessment Survey found that one in five Ohioans had trouble paying off a medical bill within the last year, while the Health Policy Institute of Ohio found that one in 10 Ohioans have avoided seeing a doctor because of the cost. Healthcare costs continue to rise while Ohio’s median income remains below the national average. Medical debt is a greater problem for adults age 35-64 – the cutoff falling right before Medicare eligibility – and for Black people in particular.
Brian O’Rourke, an analyst for the Health Policy Institute of Ohio, said the problem is only getting worse.
“It’s not super surprising that we’ve ended up here just because of how much health care costs have grown year over year in the U.S.,” O’Rourke said. “There’s almost this inevitability that it’s going to crowd out more and more Americans.”
Acton and Ramaswamy are running in the November election to replace Republican Gov. Mike DeWine, who can’t run again because of term limits.
Here’s more about what each candidate is saying they’ll do about health care.
Acton pitches plan to spend millions retiring medical debt
An interaction Acton says she had with a woman from Clermont County has become a regular feature in her campaign stump speech.
As the story goes, Acton met the woman early in her campaign. The woman described how despite her careful financial planning that involved saving up to buy a house after getting married, she racked up a crushing $300,000 medical bill after giving birth to premature twins.
“Every one of us is one health care emergency away from losing everything that we’ve worked for for our entire lives,” Acton said in a video posted to her campaign’s social media accounts. “When I am governor, we are ending medical debt.”
Acton repeated the story at a recent campaign event in Cincinnati. Afterward, she shared further details of her proposal in a interview with Signal Statewide. Rather than “ending medical debt” completely, Acton said that if she’s elected governor, her administration will make a one-time payment eliminating medical debt for Ohioans who qualify based on income.
The cutoff would be those who make at or below 400% of the federal poverty level – $128,600 for a family of four – or whose debt exceeds 5% of their household income.
Asked how she would pay for the program, Acton said the details will become clearer once she takes office and gets a better grasp on the details of the state’s finances.
But she referenced how in 2024, Illinois Gov. JB Pritzker, a Democrat, spent $10 million to forgive up to $1 billion in debt. The income criteria for that program was identical to what Acton is proposing.
“We’ll prioritize doing this. If Illinois did it with $10 million and got $1 billion in relief… in the scope of a state budget, that’s something you can easily find,” Acton said.
In the Illinois program, residents couldn’t apply to have their debts forgiven. Rather, the state hired a nonprofit organization called Undue Medical Debt to work with hospitals to identify qualifying patients.
Other Democratic-led states, including Michigan and New Jersey have had similar programs working with Undue Medical Debt. Some Democratic-led cities in Ohio, like Toledo, Akron and Cleveland, did too, using their shares of federal pandemic recovery money.
Generally, hospitals bundle debt they deem uncollectable and sell it to outside collection agencies. In debt relief programs, Undue Medical Debt instead purchases those debts and forgives them, sparing patients the credit damage and aggressive debt collection tactics.
Read related: What Ohioans can do if they face a medical debt lawsuit
A major criticism of debt forgiveness policies is that they don’t prevent others from getting in debt in the future and don’t address underlying issues.
“It can be really impactful for people who have been sitting with medical debt and having all those negative impacts,” said O’Rourke, the analyst for the Health Policy Institute of Ohio. “But the other side of the coin is these are not long-term solutions to the underlying issue.”
Asked about the critique, Acton called her plan a starting point.
“We know that is a large and complicated issue,” she said. “But what I think people need is immediate relief.”
Acton’s platform contains several other proposals meant to address healthcare costs.
One is creating “Ohio Rx,” an online store – whose branding recalls a new federal government website – that Acton said would use the state’s negotiating power through its Medicaid program to reduce prescription drug costs.
Acton also has said she would fight Medicaid fraud, and push for more pricing transparency – both of which are issues that Republicans have campaigned on.
Ramaswamy’s plan to cut taxes and fight fraud
Ramaswamy hasn’t commented directly on dealing with medical debt, and his campaign didn’t provide a response to a question about the issue for this article.
Instead, Ramaswamy has described taking steps to help Ohioans have more money to deal with everyday expenses, including medical costs. He’s touted his proposal to eliminate the state income tax – which provides the state with a quarter of its revenue – and to significantly roll back property tax rates as one way to do this. Both tax-cutting proposals are a cornerstone of his campaign for governor.
In a December interview with Sound of Ideas, a Cleveland public radio show, Ramaswamy said the country needs “thoughtful health care reform,” and said many potential solutions come from the federal level. He referenced health savings accounts, tax-free accounts for health care costs that work similarly to a 401k retirement plan.
“I think the ultimate solution comes from putting money in the pockets of Ohioans, and to make sure that we also have a competitive health care system as well,” Ramaswamy said.
Ramaswamy also has announced anti-fraud initiatives earlier this week targeting the state’s massive Medicaid program that he said will help reduce medical costs by reducing wasteful spending in the overall medical system. He said he would ask the Trump Administration for permission to allow Ohio to keep an enhanced share of any fraud recovery. He said he would ask to keep up to two-thirds of any fraud savings — a larger proportion than the roughly one-third share the state currently contributes to Medicaid funding.
“When you have criminals, fraudsters, thieves claiming money for themselves, it diverts money away from those for whom these programs were intended,” Ramawamy said at a campaign event on Tuesday.
At the event, Ramaswamy referenced returning money the state recovers from fraudsters to Ohioans via “copay assistance, through bringing down premiums, through expanding the value of your health savings accounts.” He didn’t elaborate.
Acton’s campaign has noted Republicans have run the state Medicaid for program for years, and that Ramaswamy’s running mate, Ohio Senate President Rob McColley, played a key role crafting a state budget bill that eliminated a legislative Medicaid oversight committee.
In turn, Ramaswamy’s campaign has attacked Acton’s medical debt program as a “bailout” that doesn’t address the underlying issues of health care costs. It described Acton’s plan as carrying a $15.1 billion price tag – although that figure far exceeds what Acton said she is proposing, and doesn’t reflect how debt relief programs involve buying debts for pennies on the dollar.
The Ramaswamy campaign reached this number by calculating the total amount of medical debt Ohioans might have, multiplying 810,000 – an estimate of how many Ohioans have medical debt – by $18,660, a figure that appears in a 2021 article by a left-leaning think tank that estimates the average amount of medical debt Americans have.
Acton has described forgiving a fraction of medical debt and used the Illinois program, which saw the state spend $10 million, as her model to do so.
Generally, Republicans in other states have been less willing to buy medical debt outright, like what Acton is proposing. Instead, they’ve pursued market-based solutions to try to get hospitals to lower their costs, or to help patients have more money to cover their bills.
Right-leaning proposals include promoting health-care price transparency measures that require hospitals to provide patients with an estimate of their medical bills.
Indiana, a Republican-controlled state, recently approved a slate of antitrust and transparency legislation that Georgetown University researchers called some of the most significant cost-containment measures of any state to date. They include price caps for large nonprofit hospitals and target mergers and other anti-competitive industry practices.
Republicans also pushed in the recent One Big Beautiful Bill Act to expand the number of insurance plans that qualify for health savings accounts.
President Donald Trump’s “Trump RX” website offers a set list of prescription drugs that are dramatically discounted for people who pay cash, bypassing their insurance provider. Acton’s “Ohio RX” plan describes a similar idea.
As a cost-cutting measure, the One Big Beautiful Bill Act also implements deep cuts to Medicaid while pushing for states to reduce waste and fraud. The changes are estimated to cut federal funding for Ohio’s Medicaid program by $33 billion over the next 10 years and result in 340,000 people losing Medicaid coverage.
Where do the parties agree?
Acton and Ramaswamy don’t have any overlap in their medical debt plans, although debt relief programs like what Acton is proposing have drawn some Republican support in states like Vermont and Pennsylvania.
But some bipartisan proposals have emerged.
An Ohio bill introduced by Democratic state Rep. Michele Grim and Republican Rep. Jean Schmidt would seek to rein in medical debt lending and collection efforts. House Bill 257 would ban providers from garnishing wages – a term that refers to seizing a percentage of someone’s paycheck – to cover unpaid medical bills.
It also would reduce from 8% to 3% the legal interest rate that runs on collection judgments. Language that would bar health care providers from reporting unpaid debts to credit agencies has been removed from the bill.
Elected officials in both parties also have agreed in principle that hospitals need to do a better job making their patients aware of financial aid plans – which they’re required to provide to keep their nonprofit status.
A Republican member of Congress also recently criticized the trend of health care providers consolidating into the hands of fewer and fewer owners, according to Health Care Dive, an industry publication, a possible area of consensus between the two parties.
