With a set of initiatives unanimously approved last week, City Council is looking to join the state in combating Cincinnati’s human trafficking problem. The initiatives would evaluate local courts’ practices in human trafficking and prostitution cases and study the need for more surveillance cameras and streetlights at West McMicken Avenue, a notorious prostitution hotspot. Councilwoman Yvette Simpson, who spearheaded the initiatives, says the West McMicken Avenue study will serve as a pilot program that could eventually branch out to other prostitution hotspots in Cincinnati, including Lower Price Hill and Camp Washington. Medicare data released yesterday revealed charges and payments can vary by thousands of dollars depending on the hospital, including in Cincinnati. Health care advocates and experts attribute the price disparity to the lack of transparency in the health care system, which allows hospitals to set prices without worrying about typical market checks. CityBeat previously covered the lack of health care price transparency in Ohio here. Duke Energy is the No. 1 utility company polluter in the nation, according to new rankings from Pear Energy. The rankings looked at carbon dioxide emissions, which directly contribute to global warming. Pear Energy is a solar and wind energy company that competes with utility companies like Duke Energy, but the methodology behind the rankings was fairly transparent and based on U.S. Environmental Protection Agency data. Commentary: “Republicans Continue Voter Suppression Tactics.” City Council approved form-based code yesterday, which Vice Mayor Roxanne Qualls has been working on for years. In a statement, Qualls’ office called form-based code an “innovative alternative to conventional zoning” that will spur development. “Cincinnati now joins hundreds of cities that are using form-based code to build and reinforce walkable places that create value, preserve character and are the bedrock of Cincinnati neighborhoods’ competitive advantage,” Qualls said in the statement. State Sen. Peggy Lehner is looking to amend the Ohio budget bill to add a $100 million voucher program that would cover preschool for three- and four-year-olds. The details of the program are so far unclear, but Lehner said she might put most of the funding on the second year of the biennium budget to give the state time to prepare proper preschool programs. If the amendment proceeded, it would join recent efforts in Cincinnati to open up early education programs to low- and middle-income families. CityBeat covered the local efforts and many benefits of quality preschool here. Gov. John Kasich says he would back a ballot initiative for a mostly federally funded Medicaid expansion, which the Health Policy Institute of Ohio says would insure nearly half a million Ohioans and save the state hundreds of thousands of dollars in the next decade. CityBeat covered the Medicaid expansion in further detail here. Policy Matters Ohio released a lengthy report yesterday detailing how the state could move towards clean energy and electric cars and calling for more state incentives for clean energy. The report praises Cincinnati in particular for using municipal policies to build local clean energy and keep energy jobs in the city. The last tenant at Tower Place Mall is moving out. Scientists are working on a microchip that could be implanted into the brain to restore memories. They also found proof that seafloor bacteria ate radioactive supernova dust.

The Centers for Medicare and Medicaid Services (CMS) unveiled price data today for more than 3,000 U.S. hospitals, revealing large price variations between hospitals around the nation, including in Cincinnati. For treating chest pain, charges from three Cincinnati hospitals varied by thousands of dollars: Bethesda North charged on average $17,696, Christ Hospital charged $12,000 and University Hospital charged $10,130. But the initial charge seems to have little relation to what Medicare ultimately paid out. In the three cases for chest pain, Medicare on average paid $3,242 to Bethesda North, $3,657 to Christ Hospital and $5,463 to University Hospital. In other words, University Hospital charged about 57 percent of what Bethesda North charged, but University Hospital was ultimately paid 68 percent more. The price variation wasn’t exclusive to chest pain, either. For major joint replacement or reattachment of a lower extremity without major complications, Bethesda North charged $61,947 and was paid $12,712 on average, Jewish Hospital charged $38,465 and was paid $14,069 on average and University Hospital charged $46,463 and was paid $20,116 on average. In fact, all of the 100 metrics tracked by CMS had at least some degree of variation in charges and payments. Whether it was chest pain, joint replacement, diabetes or cardiovascular complications, prices always varied between hospitals — sometimes greatly, other times by a little. The data from fiscal year 2011 shows how much hospitals initially charged Medicare for the 100 most frequently billed discharges and how much Medicare ultimately paid out. The difference between charges and payments is usually large because Medicare negotiates prices down. CMS says the price discrepancy is happening at hospitals all around the nation: “As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.” Still, some health care advocacy groups say Ohio is doing worse than other states. A study from Catalyst for Payment Reform and the Health Care Incentives Improvement Institute gave Ohio and six other states a “D” for health care price transparency, based on the states’ laws and regulations. That was actually better than 29 other states, which flat-out flunked with an “F.” Only New Hampshire and Massachusetts received an “A,” the highest grade possible. Even then, the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute cautioned in the study that their grades were given on a curve, which means all states would likely fare worse if the organizations measured them based on ideals instead of comparatively. Many health care experts and advocacy groups claim the price variation is caused by a lack of transparency in the health care system, which gives hospitals free reign to charge without typical market checks (“Healthy Discussion,” issue of April 10).

Today is primary election day in Ohio, but there are no ballot items in Cincinnati. Some Hamilton County precincts outside the city have ballot issues, which are listed here. Polls will be open between 6:30 a.m. and 7:30 p.m. An amendment snuck into the budget bill approved by the Republican-controlled Ohio House would force universities to decide between providing the proper documentation for voting to out-of-state students or getting extra money from out-of-state tuition rates, prompting concerns from Democrats that Republicans are attempting to limit voting opportunities once again. Republicans spent a bulk of the lead-up to the 2012 election approving measures that limit voting, including a later-repealed set of laws that greatly reduced early voting hours. About 82 percent of all Leadership in Energy and Environmental Design (LEED) certified buildings in Ohio are in Cincinnati, and the reason is likely local tax incentives, which allow Cincinnatians to eliminate property taxes for up to 15 years by retrofitting businesses and homes in an environmentally friendly manner. CityBeat covered Cincinnati’s successes in solar energy here and FirstEnergy’s campaign to weaken Ohio’s energy efficiency standards here. If legislators fail to take up the Medicaid expansion, the issue could appear on the ballot on November 2014. Supporters of the expansion, including Gov. John Kasich, say the expansion will help insure hundreds of thousands of Ohioans and save the state money in the next decade, but Republican legislators say they’re concerned the federal funds backing the expansion will eventually dry up. CityBeat covered the Ohio House budget bill, which effectively rejected the expansion for the time being, here. The Ohio Department of Transportation says 2,230 bridges in the state need repairs, but there’s not enough funding to make it happen. Ohio banks are warning of possible cyberattacks that could happen today. The Ohio Bankers League and the Ohio Credit Union League said the attacks would impact online services but not the security of customers’ bank accounts. The Cincinnati/Northern Kentucky International Airport has the second highest airfares in the nation, according to statistics released by the U.S. Department of Transportation’s Bureau of Transportation Statistics. Cincinnati-based Procter & Gamble was ranked No. 7 in a ranking for top 50 most diverse companies by DiverseInc. Sometimes human brains make people do bad things, such as enjoying high-calorie foods even when the foods aren’t delicious.

City Council wants to do more research before it proceeds with freestanding public restrooms in downtown and Over-the-Rhine. The vote has been delayed. Critics say the restrooms are too expensive at $130,000, but supporters, particularly Councilman Chris Seelbach, insist the restrooms will not be that expensive. A majority of City Council argues the restrooms are necessary because increasing populations and growth in downtown have made 24-hour facilities necessary. A new report found Ohio’s budget would benefit from a Medicaid expansion. The expansion would mostly save money by letting the federal government pick up a much larger share of the cost for Ohio’s population, particularly prison inmates. A previous study found Medicaid expansions were correlated with better health results, including decreased mortality rates, in some states. Another study from the Arkansas Department of Human Services found the state would save $378 million by 2025 with the Medicaid expansion. Most of the savings from the Arkansas study would come from uncompensated care — costs that are placed on health institutions and state and local governments when uninsured patients that can’t and don’t pay use medical services. The Dayton Daily News has a wonderful example of how not to do journalism. In an article on the supposed “climate debate,” the newspaper ignored the near-unanimous scientific consensus on global warming and decided to give credence to people who deny all scientific reasoning. To be clear, there is no climate debate. There’s the overwhelming majority of scientists, climatologists and data on one side, and there’s the pro-oil, pro-coal lobby and stubborn, irrational conservatives who will deny anything that hurts their interests on the other side. The Ohio Board of Education approved policies for seclusion rooms. The non-binding policy requires parents to be notified if their children are placed in a seclusion room, and the Ohio Department of Education can also request data, even though it won’t be made public. More stringent policies may come in the spring. Seclusion rooms are supposed to be used to hold out-of-control kids, but an investigation from The Columbus Dispatch and StateImpact Ohio found the rooms were being abused by teachers and school staff for their convenience.  If the city wants to buy Tower Place, the mall will have to be cleared out, according to City Manager Milton Dohoney. Last week, the remaining businesses at Tower Place were evicted, and Dohoney said the city did not sign off on the eviction orders. Apparently, the city really didn’t agree to or enforce eviction orders, but the city’s buyout requires evictions. Dohoney said the eviction notices should signify the deal to buy Tower Place is moving forward. Dohoney appointed Captain Paul Humphries to the assistant chief position for the Cincinnati Police Department. Humphries has been on the force for 26 years, and he currently serves as the chief of staff to Chief James Craig. Cincinnati’s Neighborhood Enhancement Program (NEP) is targeting Mt. Airy and Carthage. Starting March 1, police, businesses and civic groups will begin putting together accelerated revitalization and reinvestment plans for the communities. NEP emphasizes building code enforcement, crime, neighborhood cleanup and beautification. Good news, everyone. Cincinnati is no longer the bedbug capital. Bob Castellini, owner of the Reds, was named the region’s master entrepreneur by Northern Kentucky University. The Ohio Department of Transportation released a website that has real-time traffic information. Some people really suck at political slogans. Oh, science. Apparently, particle physics could improve Netflix’s suggestions.

Gov. John Kasich is refusing to work with Obamacare. In a letter to the U.S. Department of Health and Human Services, the governor today declined to have the state government run its health insurance exchange. With the move, the federal government will be put in charge of managing Ohio’s exchange. Exchanges are subsidized, heavily regulated insurance markets that will go into effect in 2014 as part of Obamacare. They are supposed to bring down costs by offering more transparent, open competition through a fair, regulated marketplace. As part of Obamacare, states have to decide by Dec. 14 whether they’ll manage the exchanges or let the federal government do it. Conservatives were quick to praise Kasich's decision. Americans for Prosperity applauded the choice in a statement. The Buckeye Institute put up a blog post calling the move “the right decision for Ohio.” The Coalition Opposed to Additional Taxes and Spending (COAST) called the move the right choice. At first, the choice seems like a contradiction for conservatives. After all, they’re the group that normally rails against a big federal government. Why let the federal government take over a new, major part of the health-care system? Rob Nichols, Kasich’s spokesperson, justified the decision in a statement: “Ohio would have no flexibility to shape an exchange to our needs and its costs will be so high that it just doesn’t make sense for the state to operate a health exchange under Obamacare.” In other words, even if the state managed the exchanges, it would still have to answer to the federal government. In his letter, Kasich also stated Ohio will not give up its right to regulate the insurance market. So the federal government will have the final say on exchanges, but Kasich wants to keep the rest of the market under state regulatory control. The state will also keep control over deciding Medicaid and Children’s Health Insurance Plan (CHIP) eligibility. Ohio is not alone in declining to supervise exchanges. Other states have signed off on letting the federal government manage them, including Florida and Texas. Still, Republicans may want to proceed cautiously. Recent polling has shown that support for repealing Obamacare has massively dropped. That shift could reflect reality catching up to public opinion. Republicans tend to rail against Obamacare by saying it’s too expensive, but a Congressional Budget Office report found repealing Obamacare would increase the deficit by $109 billion between 2013 and 2022.