Physician voices are needed to speak out against concerning legislation aimed at weakening long-standing public health protections that help prevent disease outbreaks in our community. 

Ohio is one of 14 states that allows vaccine exemptions due to religious or conscientious reasons, along with medical exemptions that exist nationwide. House Bill 561, which was introduced in the fall and is now being considered by the House Health Committee, takes additional and extremely concerning steps. 

The legislation would: 

• Remove a requirement that the Hepatitis B vaccine be administered to children attending childcare or preschools, putting our children at risk for lifelong liver disease, liver cancer, and chronic infections. 
• Bar public schools from keeping out unvaccinated students if outbreaks of any disease occur, putting all students at risk of contracting vaccine-preventable diseases, including those who are medically vulnerable and at a higher risk of serious complications. 
• Prohibit schools from requiring additional documentation for students to be considered exempt from vaccine requirements, causing inaccurate records and complicating the ability for schools and health department officials to respond quickly when there is a disease outbreak to protect others.  

These proposed changes would increase preventable disease risk across our state, where we are already are experiencing worrying outbreaks in majority unvaccinated or under-vaccinated individuals. It would be easier than ever for parents to decide against vaccinating their children based on myths and misinformation and without consulting with their trusted physician.  

That’s why we joined a coalition of other public health advocates urging members of the House Health Committee to vote against this harmful measure, stating that we all “respect parental choice and support transparency. However, opting out of vaccination should be a deliberate, informed decision and not the path of least resistance.” 

House Bill 561 had its first hearing in the House Health Committee on February 4 and a second this week, on Wednesday, March 18.  

Call to Action 

You can help speak out against this harmful legislation by contacting members of the House Health Committee. Please call and email members right away and share your expertise to urge them to vote against House Bill 561. 

Thank you, 

Bill Cotton, MD, FAAP 

Co-Chair, CMA Public Policy Committee 

State Policy Updates

The Ohio General Assembly was busy at the end of 2025! Both houses introduced legislation affecting physicians, health care organizations, and patients, and also moved legislation that had been previously introduced. The most noteworthy updates include the following: 

HB 508 (Enact the Better Access to Health Care Act): This legislation received two hearings in the House Medicaid Committee in November, including proponent and opponent testimony. The Ohio State Medical Association (OSMA) testified in opposition to the bill, which grants an advanced practice registered nurse (APRN) who is a certified nurse practitioner, clinical nurse specialist, or certified nurse-midwife the option to practice without a Standard Care Arrangement and collaborating practitioner if the APRN has practiced in a clinical setting for 5,000 hours; and also permits an APRN’s collaborating practitioner to be not only a physician, but also an APRN who is not practicing with another collaborator.  

HB 567: This was introduced in the House and referred to the House Health Committee. This bill is aimed at restructuring the governance and operational standards of the nursing profession in Ohio. Among other things, the bill seeks to expand clinical autonomy for advanced practice registered nurses, introduces a tiered regulatory framework for midwifery, and clarifies the Board of Nursing’s authority to discipline licensees for disqualifying offenses. 

HB 589: This bill was introduced in the House and referred to the House Insurance Committee. It requires health insurance companies to give to providers material amendments to their contract at least 90 days prior to the effective date of such amendment(s). 

HB 629 (Enact the Pharmacist Prescribing Authority Act): This was introduced in the House. In accordance with a protocol that meets requirements described in the bill, the legislation would permit a pharmacist to provide treatment and related services to individuals age 13 or older for any of the following health conditions by ordering or performing laboratory or diagnostic tests or screenings; evaluating or interpreting the results of the tests or screenings; prescribing drugs and drug therapy related devices, excluding any controlled substance: (1) Influenza; (2) Pharyngitis caused by the bacteria known as "group A Streptococcus"; (3) COVID; (4) Bronchitis; (5) Sinusitis; (6) Lice; (7) Skin conditions, including ringworm and athlete's foot; (8) Urinary tract infections; (9) HIV prevention, including pre-exposure and postexposure prophylaxis; (10) Any other minor or generally self-limiting condition specified in the protocol. 

Federal Policy Updates 

On January 20, the U.S. House of Representatives released the text of the Consolidated Appropriations Act, 2026, which includes the FY26 Labor, Health and Human Services, and Related Agencies appropriations bill. This bill represents a bipartisan negotiation between Congress and provides funding for the remainder of FY26. The bill is part of a larger "minibus" package designed to prevent a government shutdown. It provides $116.6 billion to the U. S. Department of Health and Human Services, notably rejecting many of the deeper cuts and department restructurings initially proposed by the Administration. 

• National Institutes of Health (NIH): Received approximately $48.7 billion. Key allocations include $7.4 billion for cancer research, $3.9 billion for Alzheimer’s, and $2.3 billion for diabetes. The bill specifically protects the NIH from a proposed 15% cap on indirect cost rates. 
• CDC: Funded at roughly $9.2 billion (near-level funding). It includes modest $10 million increases for both Public Health Infrastructure ($360 million total) and Data Modernization ($185 million total). 
• Mental Health & Substance Abuse: 
  • $5.5 billion total for mental health services. 
  • $1.6 billion for State Opioid Response Grants. 
  • $535 million for the 988 Suicide & Crisis Lifeline (a $15 million increase). 
• Preparedness: $3.7 billion for the Administration for Strategic Preparedness and Response (ASPR), the line item that funds the Hospital Preparedness Program. This appropriation includes $240 million, or level funding, for formula grants. 
• Community Health Centers: $1.86 billion in discretionary funding, plus extensions of mandatory funding. 
• Rural Health: $418 million, specifically targeting rural hospitals at risk of closure and increasing rural residency spots. 
• Maternal Health: $1.2 billion for the Maternal and Child Health Bureau, including a new $15 million "Food is Medicine" pilot for maternal produce prescriptions. 
• Ryan White HIV/AIDS: Maintained at $2.6 billion, including level funding for the "Ending the HIV Epidemic" initiative. 

Policy changes encompassed in the bill include: 

• Language that requires hospitals to ensure each off-campus outpatient department (OPD) has a unique National Provider Identifier distinct from the main hospital. Noncompliance will render the OPD ineligible for Medicare payment starting in 2028. 
• Extension of pandemic-era Medicare telehealth waivers through 2027. 

The bill does not include an extension of the enhanced subsidies for buying Affordable Care Act (ACA) marketplace insurance. The status quo means ACA enrollees will continue to face premium payments that have been projected to more than double the 2025 out-of-pocket premium, on average. 

State & Federal Budgets: What Physicians Need to Know Right Now

There has been considerable activity coming from both the state and federal governments within the past few weeks. Each level has passed a budget and is considering legislation that could directly impact providers and patients. Below is a reference to key changes and ways in which you can get involved. 

Find key updates below and click here to skip ahead to the federal budget update, including the status of funding for the Hospital Preparedness Program (HPP), which is crucial for emergency preparedness in Ohio.

State Budget

Ohio Gov. Mike DeWine signed the state’s biennial operating budget into law on June 30, 2025. Click here to read about key provisions, as well as the Governor’s vetoes. The House is expected to return on July 21 to override some of the Governor’s vetoes. 

State Miscellaneous

House Bill 281 was introduced into the Ohio House on May 20, 2025. This bill would allow the enforcement of federal immigration laws in Ohio hospitals. Click here to learn more about the potential impacts from this legislation.

There are a number of other bills pending in the state legislature that will impact physicians and patients. See the our June 13 State Policy Advocacy Alert to learn more about those bills. There are no current updates to those bills, but we will monitor the legislation to provide the latest updates when applicable.

TAKE ACTION: After passing the state budget, the Ohio legislature (mostly) adjourned for the summer. Now is a great time to meet with your legislator in your district to discuss current or potential bills or issues of importance to you. Click here to identify your legislator and legislators representing locations where your patients are served. 

Federal Budget

The U.S. Congress passed the federal reconciliation budget on July 3, 2025. The reconciliation bill addresses mandatory spending for programs such as Medicaid. Click here to learn more about how the federal budget bill impacts physicians and patients, particularly those on Medicaid.

The federal appropriations budget, which controls discretionary spending for programs such as the Hospital Preparedness Program (HPP), is currently working its way through the House and Senate Appropriations Committees. The Trump Administration proposed eliminating funding to the HPP. 

There is positive news—with support from the Association of State and Territorial Health Officials (ASTHO), the current versions of the appropriations budgets include funding for Health Care Readiness and Recovery, which includes the HPP. Action from our members and partners is still needed to join a number of organizations, including our affiliate COTS, to continue to push to keep and increase funding for the HPP. 

For more details on the importance of HPP funding for our safety in Ohio: 

• Read our HPP Advocacy Alert here.
• Read the Columbus Dispatch article on the proposed cuts here.
• Watch the 10TV story on the proposed cuts here.

TAKE ACTION: To advocate for stable funding for the HPP, you can contact Rep. David Joyce (District 14) and Rep. Marcy Kaptur (District 09) who are both representatives from Ohio and on the House Appropriations Committee. 

If you have questions about COTS, contact Sherri Kovach, COTS President, at skovach@cotshealth.org.