Gabriel Mann

Jaime Miracle, Deputy Director
Senate Medicaid Committee
Testimony in Opposition to HB 96
May 15, 2025

Chair Romanchuk, Vice Chair Huffman, Ranking Member Liston, and members of the Senate Medicaid Committee, thank you for accepting my testimony in opposition to House Bill 96, the proposed state budget. My name is Jaime Miracle, and I am the deputy director for Abortion Forward, formerly Pro-Choice Ohio. Before I begin, I want to thank my Policy Fellow Milena Wood for her assistance with drafting this testimony I’m presenting today.

We have many concerns about the Medicaid portions of the state budget, including limits to doula coverage, the defunding of Medicaid mental health providers who are gender affirming, elimination of continuous coverage for children from birth through age three, banning DEI programming in the Medicaid program, and the trigger language that will kick over 700,000 Ohioans off their health insurance by eliminating the expansion group coverage.

A budget document is a moral document – showing the direction that the state’s elected officials want to go for the next two years. As currently pending, the only signal that this budget is sending to Ohioans is that this legislature unfortunately continues to push cruel and harmful policies on the residents of our great state.

DOULA MEDICAID COVERAGE LIMITS

I’ll will start with the limits to the newly created Medicaid coverage for doula services. This program was implemented less than a year ago, and it is unfathomable to me why this legislature would be acting so quickly to gut this critical program. Doulas are an essential resource by virtue of the emotional and physical support they provide during pregnancy, labor, and the postpartum period, helping to improve the overall birth experience and birth outcomes for both mom and the baby. Non-white women in particular are more vulnerable to poorer health outcomes, especially during the birthing process, and these disparities in care often manifest in higher cesarean rates among non-white women.1 Black women contend with higher rates of cesarean deliveries and the effects of provider biases on treatment protocols than white women.2 A 2018 report found that “black women are losing their infants” on account of aforementioned factors like provider bias higher cesarean rates “ at a greater rate than any other racial/ethnic group in the nation.”3 They continue, “considering that the black preterm birth rate and the black rate of cesarean sections for delivery exceed those of other groups, addressing these factors could decrease the gap between black and white infant mortality rates.” One such method to decrease that gap easily are doulas. Research shows that having a doula can lead to better birth outcomes, such as fewer cesarean sections and less anxiety for the birthing person.4 This is especially true for Black and non-white women.  

For vulnerable populations, having access to a doula can mean the difference between a healthy, stress-free birth and a traumatic birthing experience. This budget limits the funding to $500,000 per year, allowing only 416 births per year to have a doula covered by Medicaid, a wholly inadequate number considering approximately 60,000 births each year are paid for by Medicaid. In other words, only 0.6% of all births will be able to have this life-saving care. Attempting to make Ohio the best place to raise a family must also include making it a place where those who want to start a family have the resources and support necessary to do so. We urge the Senate to allow this program to reach its full potential and not limit it before it has even had a chance. Eliminate the restrictions on Medicaid coverage for doulas and ensure that everyone who is covered by Medicaid has access to these critical, life-saving services.

DEFUNDING MEDICAID MENTAL HEALTH PROVIDERS

Ohio, like the rest of the country, is in the midst of a mental health crisis. Getting access to mental health care can be a real struggle, especially for those who rely on Medicaid for their health insurance coverage. The provision in this bill that would force mental health providers to choose between being able to be a Medicaid provider and being able to serve every patient who comes through the door with the dignity and respect that they deserve is cruel and will cause harm to people across this state. No matter how many bills you introduce or policies you try to push, transgender people exist, have always existed, and will continue to exist long after you are out of office. This legislation is poised to cause great harm to Ohio’s transgender community. Please listen to the stories of transgender Ohioans who have come before this committee to share their stories. Limiting access to healthcare that affirms the basic dignity of humanity and identity will lead to more Ohioans attempting suicide. This provision, plus the provision mirroring the Trump executive order defining only two sexes, and the defunding of youth homelessness programs that affirm a person’s gender identity show just how little regard the Ohio legislature has for residents of our state. We urge you to strike this and the other dangerous and cruel anti-Trans provisions out of this budget document.

ELIMINATION OF CONTINUOUS MEDICAID ENROLLMENT FOR CHIDREN THROUGH AGE 3

The elimination of the program that ensures continuous Medicaid coverage for children from birth through age three would have grave consequences for families in our state. You cannot claim to care about young children and then deny them the chance to have a healthy start in life. This program is critical.

Navigating frequent income checks and eligibility reviews can often leave these young children with gaps in coverage. These gaps mean they miss important well-child visits, care for chronic illnesses like asthma, or critical vaccinations. This program also relieves the stress on the parents by ensuring continuity of healthcare coverage that might otherwise be lapsed due to circumstances like a small temporary increase in household income or a missed piece of mail. Research has shown that stable healthcare access in early childhood leads to better long-term health outcomes. Providing this coverage puts that child on the path to a healthy life for their lifespan, not just the four years they are ensured Medicaid coverage. We urge this committee to allow this program to continue and ensure that our youngest Ohioans have access to the healthcare they need to grow into healthy teens and adults.

MEDICAID EXPANSION “TRIGGER” LANGUAGE

In Ohio, the Medicaid expansion provides health insurance coverage to approximately 770,000 people. This group includes people who have incomes that are too high to qualify for traditional Medicaid, but too low to qualify for coverage on the health insurance exchange. The elimination of the Medicaid expansion does not only impact the individuals and families who will lose critical health care coverage but will also have devastating impacts on hospitals across the state, especially in rural counties in Ohio.

According to the March of Dimes, 2.2% of all babies born to women in Ohio live in rural counties, while only 0.2% of maternity care providers practice in rural counties. Thirteen counties in our state are considered maternity care deserts, meaning there are no hospitals or birth centers offering obstetric care in those counties. Immediate termination of the Medicaid expansion as outlined in the “trigger” language of this budget bill would cause all of these rates to rise and our hospitals systems to struggle to care for patients in their community. Please eliminate the hard “trigger” language currently in H.B. 96. Replace the “shall” to “may” to allow the state to fully examine the impacts of changing federal support, and weigh that with the loss of coverage and impacts on our healthcare system.

MEDICAID DIVERSITY, EQUITY, AND INCLUSION BAN

The House proposal also includes language that bans the Department of Medicaid from using “Diversity, Equity, and Inclusion” in its work. The lack of definitions around what this prohibition could mean leaves the department without clear guidance on what they can and cannot do, increasing the likelihood of over-enforcement to ensure compliance. Removing the ability for the department to look at disease trends by race or how certain health outcomes look different in different populations across our state will make the work of medical professionals more difficult and cause our already high levels of racial disparities in health to continue to skyrocket.

The desire for colorblind practices often stems from the idea that discrimination simply won’t exist if we do not acknowledge our differences. In practice, however, colorblind approaches to medicine often yield poor outcomes for the relationship between medical professionals and their patients, and patient health outcomes in general. Trying to appear more unprejudiced by acting as if we don’t notice race, despite automatically seeing race, makes white practitioners appear more uncomfortable, anxious, and less friendly when working with patients of a different race than their own5.

Colorblind approaches to healthcare do not promote equity, genuine understanding, or cultural competency. Black women are almost four times more likely to die while giving birth than white women. Black infants are two to three times more likely to die within their first year of life than white newborns in the U.S.6 Not only that, but many of these deaths and other health complications that disproportionately affect Black and other women of color would be preventable if we were dedicating the proper attention needed to the unique needs of these groups. In other words, a colorblind approach that would be required by this budget language will literally cost us the lives and health of individuals are around the state.

Withholding potentially life-saving information, strategies, and approaches to medicine for the sake of avoiding the imaginary “horrors” of DEI is bad practice and unjust. We need the presence of positive forces like diversity, equity, and inclusion to give us the foundations for true relational equality. This budget language actively keeps us from accomplishing that goal.

In conclusion, we urge the committee to:

Allow the Medicaid doula coverage program to continue to operate without unnecessary and harmful limitations.

Remove the harmful and cruel language that limits what Medicaid mental health providers can discuss with their patients by defunding providers who “promote or affirm social gender transition.”

Continue to require the Department of Medicaid to apply for a federal waiver to expand continuous Medicaid coverage through age three.

Remove the language requiring the state to immediately terminate coverage for 770,000 Ohioans that rely on the Medicaid expansion for their health coverage.

Remove the language banning the Department of Medicaid from using Diversity, Equity and Inclusion in their work.

Thank you for your time and attention. I’m happy to answer any questions that the committee members might have.

The SAVE Act—one of the most explicit anti-democracy pieces of legislation we’ve seen yet—has reached Ohio. Both the state and federal versions of the bill will actively take away or severely limit people’s ability to participate in our democracy by infringing upon an essential right: voting! 

Here’s what you need to know, but if you’re just ready to take action, scroll down to the bottom to find a tool to easily email your Ohio state lawmakers. 

Both the state and federal bills require proof of U.S. citizenship for voting and define similar documents as acceptable proof of citizenship, including U.S. passports, birth certificates, naturalization certificates, and driver’s licenses that indicate citizenship status (most of which do not).  

If you don’t have one of these documents or have changed your name since one of these documents was issued, you will be unable to vote. 

• If you don’t have a passport or birth certificate that matches your current legal name, you will not be considered eligible to vote. If you have a birth certificate but you got married and changed your name, then your birth certificate no longer has your correct name on it. 
• Roughly 146 million Americans don’t have a valid passport. When you consider that 153 million Americans voted in the last election, it becomes very clear just how many people this requirement will effect, especially working-class and lower-income populations who are more likely to not have, and not be able to afford, a valid passport.  
• Beyond just not having a valid passport, 84% of women who get married change their surname. This means roughly 69 million American women do not have a birth certificate that matches their legal name, disqualifying their birth certificates from being considered valid documentation while trying to vote. Even more concerningly, marriage certificates are not stated to be a valid form of proof, leaving millions of people without a viable alternative.  

Should these pieces of legislation pass, it is likely that people will only be able to register to vote or update their registration at the BMV or county Board of Elections.  

With no voter registration drives, no voter registration forms at local events, and no online voter registration procedures, the voices of a significant portion of the population that currently relies on these services will be silenced in our elections.  

What does this mean in practice for Ohio?  

The Ohio SAVE Act will put a ban on all ballot drop boxes, requiring voters to hand-deliver ballots directly to election officials during office hours, potentially creating accessibility challenges for those with work, school, or childcare commitments. 

Ohio’s SAVE Act would require IDs to match voter information exactly. If not, you could be made to vote provisionally. “A provisional ballot is a ballot cast by a voter whose eligibility to vote cannot be proven at the polls on Election Day. If, after the election, administrators determine that the voter who cast the provisional ballot was eligible to vote, the ballot will be counted as a regular ballot.”  

You could be forced to vote provisionally if:  

• Your middle initial is listed on your voter registration but not on your license 
• You moved in the past 8 years but didn’t update your license 
• You use a nickname, for example your voter registration says Michael, but your license says Mike 
• You have ever changed your name for any reason at any time 
• BMV data is wrong or not updated  
• You don’t have a driver license or state ID  

If you vote provisionally and fail to provide proper documentation afterwards, your voter registration will be cancelled. Registrations could be cancelled before we even find out it’s too late to send in proper documentation! 

Who does this effect nationwide? 

• Anyone could be flagged at any time! 
• If you have a change in voter status of any kind, you will have to go in-person to update that information to be eligible to vote. Even small changes, like moving within a state you currently live in or a change in party affiliation, are considered a change in voter status. For every change, an in-person visit to an election office would be required regardless of how far you live from one of those locations.  
• Anyone who has ever used an online voter registration service, sent in a voter registration application through the mail, used an automatic voter registration (AVR) service, or registered through a voter registration drive would have to completely change how they register to vote going forward and may have their prior voter registrations wiped.  
• As said by The Center for American Progress, these changes “would make civic participation much more difficult for tens of millions of citizens every election cycle and would outright disenfranchise millions more. The policies of the SAVE Act would also be in addition to state voter ID laws that require voters to show identification at the polls.” 

If people’s ability to register to vote is impeded by unnecessary and discriminatory requirements, our democracy cannot call itself legitimate. Exercising our right to vote is one of the most fundamental rights we have. The SAVE Act directly takes that away from us. 

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This month, Abortion Forward joined hundreds of Ohio college students, faculty, staff, and concerned citizens in testifying against Senate Bill 1. Our testimony was submitted by our Deputy Director Jaime Miracle, but was written by Policy Fellow Milena Wood. Milena also recorded a video for social media discussing the harm that comes from abolishing DEI activities.

Please share Milena’s video on Instagram, read the testimony below, and call Gov. Mike DeWine at 614-466-3555 to demand he veto Senate Bill 1 when it reaches his desk!

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Jaime Miracle, Deputy Director
Testimony in Opposition to Senate Bill 1
March 11, 2025

Ohio Senate Bill 1, introduced in the 136th General Assembly, proposes significant restrictions on diversity, equity, and inclusion (DEI) activities at state higher education institutions. The bill contains language that prohibit diversity, equity, and inclusion training courses, require closure of existing DEI offices, ban DEI language in job descriptions, prohibit contracting with consultants who promote admissions or hiring based on demographic characteristics, and restrict DEI-related institutional scholarships. Despite effectively banning the presence of DEI, the legislation also conflictingly mandates that institutions affirm intellectual diversity, maintain neutrality on “controversial beliefs,” prohibit political litmus tests in hiring and admissions, and abolish diversity statements in applications. Importantly, the General Assembly would be permitted to withhold or reduce funding to institutions that fail to comply with these provisions.

Senate Bill 1 also requires the development of an American Civic Liberty course for Ohio institutions of higher education with the express goal of providing students an understanding of some of the core documents America was built on. Included in the mandatory reading for such a course is Letter from Birmingham Jail by Martin Luther King, Jr. It is considered by many to be not only one of the core documents of the Civil Rights Movement but also an example of rhetorical appeals used to their best ability. It’s a document already read by most high school students and in some college level courses, and for good reason: it does, indeed, give a good account of the social, political, and cultural climate Dr. King and the rest of America found itself in at the height of the Civil Rights Movement. If we’re going to mandate the reading of this text for all Ohio students, it’s important that we understand the essential value of the text first.

Dr. King makes a legal argument against segregation on the basis of it being the outcome of an unjust law. The law doesn’t need to be perfect in order for it to be just. However, if laws are unjust, then they should be challenged out of respect for the broader legal system. He defines unjust laws as ones that lack impartiality and limit who gets a voice. Just laws equally uplift everyone, while unjust laws exclude and prevent a genuine sense of positive peace from being established. Only when we have positive peace—not just the absence of negative forces but the presence of positive ones, like justice—and the absence of unjust laws can we then foster a genuine sense of relational equality between all groups of people.

In understanding how King defines an unjust law, it’s disconcerting to see how this bill mandates the reading of this text yet simultaneously contains language that will itself produce an unjust law. The rhetoric employed by this bill finds Letter from Birmingham Jail important enough to American democracy to be read by all students, yet apparently not virtuous enough to actually adhere itself to the worldview it prescribes. It leaves one to wonder if the minds behind this bill ever read the text to begin with.

Expulsion of DEI principles in higher education will actively harm individuals. The principles of diversity, equity, and inclusion exist to expand the pool of qualified candidates and make room for conversations that benefit people from all walks of life to create a level playing field. Most importantly, it serves to solidify the importance of recognizing and celebrating the differences between us that contribute to our intellectually diverse social fabric. An education system without DEI does not equally uplift all individuals, it closes the doors to opportunity for some and reduces the substantive quality of education as a whole for everyone else.

Our systems of education shouldn’t need DEI offices. Our universities, under optimal circumstances, would be perfect institutions that have the capacity to provide genuine support and true opportunity for all of its students, faculty, and staff. We operate under the assumption that ‘all men are created equal’ applies in all cases. However, the discrepancies that exist between various groups, all rooted in systemic inequalities, show time and time again that all men, while created equal, are not treated equal under the current system. We shouldn’t need DEI but without its presence, the system cannot equally support and uplift all individuals. Our systems of education are unjust because they exist within unjust contexts. We need the presence of DEI as a force of restorative justice where ideals of equality haven’t been met to correct for the deficiencies in our broader cultural landscape.

Abortion Forward is particularly concerned with the impact this will have on the education of our future medical professionals. The absence of DEI principles will have detrimental consequences in healthcare, especially in light of the long history of medical racism, systemic inequalities, and disregard for the wellbeing of minority groups that much of modern medicine is based upon. When we consider the racist foundations of much of modern medicine—especially gynecology, which finds its roots in the unethical experimentation and the systematic dehumanization of Black women—a medical education that refuses to acknowledge race and gender in an effort to be neutral or ‘colorblind’ is bad for all parties involved. Oversimplified colorblind treatment refuses to acknowledge that historically and presently, people’s bodies and differences do still matter.

There are concerns from sponsors of this bill that DEI practices don’t foster positive racial relations and don’t actually bring about equality or fairness, but there is evidence to support the contrary. The desire for colorblind practices often stems from the idea that by not acknowledging differences, discrimination will not have the opportunity to emerge. In practice, however, colorblind approaches to medicine often yield poor outcomes for both the relationship between medical professionals and their patients as well as general health outcomes. Research has found that non-Black physicians who consider themselves non-prejudiced and color-blind “often harbor strong unconscious racial biases toward minority patients, and are more likely to negatively evaluate Black patients” and these evaluations “can negatively impact treatment decisions, treatment adherence [and] undermine patients’ role in the medical interaction…and lead physicians to have a lower positive emotional tone in visits.” In other words, colorblind approaches to patient-practitioner relationships have the opposite of their desired effect.

Trying to appear more unprejudiced by acting as if we don’t notice race, despite automatically seeing race, makes White practitioners appear more uncomfortable, anxious, and less friendly when working with patients of a different race than them. Not only this, but colorblind interactions with White providers are shown to be cognitively taxing for minorities because “those whites appeared more prejudiced…more offensive, and devaluing the importance of racial issues.” All of this contributes to worse interactions and relationships between medical providers and their patients, and it also undermines trust in medical providers making minority patients less likely to listen to their advice. Colorblind approaches make it impossible for individuals to see where their own biases come into play and even more impossible to see when race is an important component to be considered.

Colorblind approaches to healthcare don’t promote equity, genuine understanding, or cultural competency. When we consider the egregious discrepancies in health outcomes for Black women, ignoring the background conditions that inform these poorer health outcomes is just plain bad medical practice. One study shows that Black women are almost four times more likely to die while giving birth than White women, and Black infants are two to three times more likely to die within their first year of life than White newborns in the U.S. Not only this, but many of these deaths and other health complications that disproportionately affect Black and minority women are preventable. The study also shows that most of these disparities are rooted in modifiable factors like maternal health behaviors, physical and social environments, and inadequate healthcare access or quality.

These disparities persist even when we take ‘risk taking behaviors’ out of the equation. Another study shows that “even when risky behaviors are controlled, the black-white [infant mortality rate] disparity continues to exist.” Even with factors like obesity or alcohol and drug use considered or held constant, Black women still continue to have a higher infant mortality rate than White women. The report offers that “it’s not race so much as racism and the experience of being a black woman or a person of color in this society” that contributes to this disparity in infant mortality rates between White and Black women. The patterns of risk for Black and minority women are rooted in systemic and structural inequalities; it is not the individuals but the frameworks they are made to live and participate in that perpetuate these inequalities.

These facts culminate in one simple truth: the poorer reproductive health outcomes of Black and minority groups can and should be addressed by conscious efforts to understand the background conditions that inform why they have dramatically different health outcomes in the first place, as well as the steps we can take to address them. The singular force we have to accomplish that goal, to push the culture of medical practice in the right direction, is the structure of DEI. Considering how far we’re yet to go in truly addressing health disparities, stopping the programming, messaging, and research that is guiding us to equity is a step backwards. A colorblind approach that would be taught in the absence of DEI structures will literally cost us the lives and health of individuals around the state. Ensuring that our medical schools help students focus on diversity, equity, and inclusion frameworks, rather than be blind to them, make our healthcare professionals better healthcare professionals. We need to use the building blocks of DEI for the continued betterment of the system, not destroy the foundations we have fought so hard to lay.

Considering all of the above, colorblind approaches to medicine cannot adequately address the various concerns and disparities that exist amongst minority women. Different groups of people face certain patterns of risk, some being higher than others. A colorblind approach misses the critical differences in outcomes amongst distinct groups by assuming that minorities fundamentally face the same obstacles as their White counterparts in an attempt to appear unprejudiced. The intent to appear unprejudiced means nothing if those actions actively produce inequality.

Promoting genuine equality and making healthcare better and safer for everyone starts with the education our healthcare providers receive. Withholding potentially life-saving strategies, information, and approaches to medicine for the sake of avoiding the imagined horrors of DEI is bad practice and unjust. Ohio’s students deserve to have a well-founded, robust education to provide them with the groundwork to thrive in their respective fields. We need the presence of positive forces like diversity, equity, and inclusion to give us the foundations for true relational equality, and this bill actively keeps us from accomplishing that goal.

We need to be consistent: if what Dr. King said in Letter from Birmingham Jail is so important to understanding American democracy, adhering to the principles of justice he outlines for our democracy is essential. Appealing to his authority as leader of the Civil Rights Movement yet woefully disregarding the key tenets of this work is contradictory. Senate Bill 1 will not promote a well-rounded higher education system for Ohioans: it dismantles the already limited protected environments for underrepresented or vulnerable students and will certainly devalue the education of our future medical professionals.

In 2008, I was asked to apply for a job with Planned Parenthood. An odd political mutt, I didn’t have any experience with women’s health care, so I was a little confused. It turned out that the Ohio affiliate had been given a grant from the national Planned Parenthood Action Fund to hire staff into key swing states Florida, Missouri, and Ohio that would build out digital programs in their advocacy operations, just in time for the presidential election.

This was Cecile Richard’s vision for how reproductive health care advocates should shape the national political discussion on abortion.

It also wasn’t my first time working in a program that she built. In 2004, the America Votes umbrella coalition began coordinating political work by organized labor, reproductive rights groups, environmental activists, education advocates, and many more. Cecile was a co-founder of that program, which is still coordinating political activities that Abortion Forward contributes to in 2025. It was clear in ’04 that, as a Texas daughter, she was familiar with the crap that came with the Bush administration and she knew the urgency with which we needed to fight back.

In the decade and a half that Cecile was the head of Planned Parenthood, many, MANY challenges to abortion rights popped up. She was very familiar with our fight in Ohio, visiting the state many times during the legislative battle over the six-week abortion ban. And her famous four-hour testimony before Congress in 2015 required her to face off against Ohio’s disgraceful Jim Jordan.

Over the last decade, I’ve met many people within Ohio’s reproductive rights community who got their start at Planned Parenthood, thanks in no small part to the structure that she helped build and maintain. Even at independent clinics and abortion funds around the state, you’ll find that the organization is a gateway for young activists, health care workers, and volunteers.

We were all saddened to learn of Cecile’s passing on January 20, but we’re grateful for the dedication she gave to the movement. Like many others, we’ll be carrying on in her memory, encouraged by her words:

“It’s not hard to imagine future generations one day asking: ‘When there was so much at stake for our country, what did you do?’ The only acceptable answer is: ‘Everything we could.’”

— Gabriel Mann

Like everyone else, the Abortion Forward team is horrified that Elon Musk is a part of Trump’s fascist regime. Here are all the links for places that you can find us that aren’t twitter:

New account on Bluesky
https://bsky.app/profile/abortionforward.bsky.social

https://www.tiktok.com/@abortionforward

https://www.reddit.com/user/AbortionForward

https://www.instagram.com/abortionforward

https://www.threads.net/@abortionforward

https://www.youtube.com/@abortionforward

https://www.facebook.com/AbortionForward