March 25, 2026 · Health Committee · 17,212 words · 11 speakers · 60 segments
Good morning. I would like to call this meeting of the House Health Committee to order. I apologize. I was in another committee earlier and just got out. Will the clerk please call the roll? Chair Schmidt. Here. Vice Chair Dieter is excused. Ranking Member Simani. Here. Representative Baker. Here. Representative Barhorse. Present. Representative Brownlee. Here. Representative Craig. Representative Grimm. Here. Representative Gross checked in. Representative King checked in. Representative Miller. Here. Representative Stewart. Representative White. We have a quorum. Will members please take a moment to review the minutes of the March 18th meeting available on your iPad? Are there any corrections or additions? They stand approved as read. A reminder that we do have a hard stop today at 12 o'clock, and please limit your testimony to five minutes. You will hear a, when you start to go over, we'll give you an extra 30 seconds and then stop it. If you are taking any pictures, would you please fill out the form? And I will now call up House Bill 750 for its first hearing. Will Representative Romer and White please come forward for the testimony?
Thank you. Thank you, Chair, esteemed members of the Health Committee. Just to let you know, this might be the first time I've ever testified in Health Committee in eight years, which tells you how strongly I feel about this bill. This is House Bill 750, and I'll probably leave my testimony just a little bit, to talk about PACE, the Program for All-Inclusive Care of the Elderly. And just to share something personally, the Chair and I had discussions two General Assemblies ago about PACE. What we had done is we were able to include PACE, and I'll talk about what specifically it is. But the chair was so excited, she said, we've got to get this into Claremont County. Guess what, chair? This gets it into Claremont County, potentially. So, Program for All-Inclusive Care of the Elderly. What it is, essentially, is it allows adults to stay in their homes, and these are folks that are all eligible. They're 95% or more Medicaid eligible, but they're all nursing home eligible. These are folks that would be in nursing homes, but we know that something like 97% of people want to age in their own home. They don't want to be in a nursing home. So what this does is this allows, you know, grandma to be in her home. The PACE van comes, picks her up, brings her in to PACE for the day. So it's kind of like adult daycare, but it's a lot more than that. What it does is it has coordination of care. So they'll coordinate her medications. She gets to play bingo. She gets a great lunch. You know, maybe the ophthalmologist comes in that day to check eyes or whatever it happens to be. It's a wonderful program. But I was not initially supportive because I had two concerns. I said, one, the PACE organizations are not going to want to take the most vulnerable. They'll want to skim the cream off the top, take the people that aren't very expensive. Not true at all. It's exactly the opposite. The folks that are participating in PACE across the state of Ohio are actually more medically vulnerable and more expensive. The other thing I was concerned about is the cost, you know, being a CPA. I said, well, is this going to cost a whole lot of money? And the numbers going back when the chair and I worked on this two GAs ago now were the state put in about million in round numbers to stand up these PACE programs and saves about million a year I mean that a payback of like 21 months You never see paybacks like that So people are getting better care, the families are happier, the patients are much happier, they have better health outcomes, and the state saves money. So just a little bit of background. The state has realized millions of dollars in savings as these individuals have avoided more costly stays in nursing homes. We have it, and I want to make sure I get the exact counties that we currently have, and I've participated in multiple PACE grand openings. We have PACE centers in Cuyahoga, Franklin, Hamilton, Summit, Lorraine, Trumbull, Mahoning, and Ashtabula, and I was at grand openings for several of those, had an opportunity to meet with the care providers and the patients. It's a wonderful experience. But what we want to do is we want to open this up to everybody in the state of Ohio. And my esteemed co-sponsor on this is going to go through the specifics of this bill. But we kept it really simple. There's only a few basic points. And with that, Representative White.
Well, thank you, Rep. Romer. And I'm truly happy to be a part of this bill. Some of you know I have. My father recently passed away in November, but at 99 1⁄2. And my mother is 90, and she's in a care place now. But the reality is people are trying to stay in their homes as long as they possibly can. And it's financially prohibitive for many. But yet, instead of being put in a place where they don't want to go yet, they're not ready to go, PACE provides a perfect bridge. And I'm truly excited to be on this bill, so thank you. The PACE program has been a highly effective model for our older adults who need nursing home levels of care, but they still have the ability to remain in their homes, right? And part of being in your home can be very isolating. So the good things about this is it's doing both. It's the best of both worlds, really. You're getting out. You're interacting with others, plus you're being able to stay in your own home. So there's a couple of updates that are going to help us better serve people. Here's what the bill does. It requires the Department of Aging to issue a request for proposals from any entity interested in becoming a PACE organization in any currently unserved county, including Montgomery and Claremont, by December 31st of this year. It requires the payment rates for new PACE organizations to be the same as the rate for current or not raising costs or increasing things, prescribes requirements for entity eligibility, and the Department of Aging review and approval of these proposals. So you've got to meet the criteria. And then it allows the Ohio Department of Aging approved entity to apply for the U.S. Centers for Medicare and Medicaid CMS services approval to become a PACE program, and CMS-approved entities have to provide PACE services within two years of getting that approval. Ultimately, the expansion of PACE is going to give Ohioans more options, as we've talked about, to age in the comfort of their own homes. And we believe this helps the physical, the mental, as well as helps our family members, right, because a lot of us are in that sandwich generation where we are helping care for people on both ends of the age spectrum. A clinical review conducted by Warren Alpert Medical School of Brown University and Harvard Medical School shows utilization of PACE leads to lower hospitalization rates, fewer readmissions, and shorter hospital stays, meaning you can live in your own community approximately four more years longer. Above all, it's expanding, saving money, and helping all of our underserved and rural communities.
So we welcome any questions Thank you for this opportunity Thank you Ernie Representative Barhorst and then Gross And anyone on this side Okay Barhorst and then Representative Gross
Through the chair, thank you, Reps White and Romer, for your bill and their testimony. A question. You mentioned there was a two-year window to start services. What is like a realistic start? I assume the two years is just to give them plenty of time, but what would be realistic and what have you seen at your grand openings?
Through the chair to represent Barhorst, two years would be the exact maximum. What we've seen with a lot of these, and PACE centers, they differ. You have McGregor PACE in Cuyahoga County that's been operating for a long time. They then expanded into Rocky Knoll. Rocky Knoll was a care facility that existed, so they were able to retrofit and utilize that. They were able to do that approximately within a year. The Trumbull County facility I went to totally had to be redone. So that was more than a year but less than two years. The reason Representative White and I worked on this, we said it should be within two years, because two years ought to be enough to get the approval, to retrofit, because it is a very expansive process. But then to be able to hire all the staff, you've got to be up and running within two years, hopefully less.
Thank you. So are these facilities that are serving counties now, are they all like current facilities doing other services where are aging, or are they sometimes standalone, or is it a combination? What does it look like around the state of Ohio that's already happening?
Through the chair, it's both. As an example, I referenced Trumbull County. That was a totally new facility. They utilized another building that had not been used, so it also led to economic development in that community.
Rocky Knoll is a large retirement community. There they retrofitted a portion of it. And McGregor Pace, which has expanded, they've been doing it for a long time. So there's kind of three areas along that continuum. You know, somebody that's already doing it expanded significantly. Another area where they were offering services, but basically nursing home services, where they expanded, and then a totally new facility. Thank you. Representative Gross. Thank you, Chair Schmidt. Thank you, representatives. We know that the Ohio PACE programs leverage NPs to enhance access and reduce hospitalization, support the model's goal of community-based care. NPs bring geriatric expertise that aligns well with the PACE's holistic team approach. And my research shows that there's a great cost savings by utilizing this role model in the PACE program. What data do you have, if any, that will show reduced health care costs by utilizing the nurse practitioner model? Through the chair, relative to that specific piece, we don't. I can give you overall numbers of paybacks in the 20-month range. I can give you savings to the state of Ohio from the original PACE expansion of about $30 million a year. included in that continuum, it's better outcomes, coordinated care, nurse practitioners, all of those types of things. So we don't have any, unless the representative is aware, we don't have any breakdown of there's $2 million savings because of this million because of that But the overall savings is astronomical when you looking at better care better outcomes and as Representative White said people living in their homes four years longer Thank you very much. Representative Baker. Thank you, Chair. Thank you guys for bringing this. I don't have a question as much as just a statement that I had no idea that this wasn't available in all states. I know that in Hamilton County it's been a successful program, and I can't believe we're just now realizing what we've learned in these communities and expanding it to everyone regardless of where they live and bringing really a collaborative team-based model, looking at how to deliver care in a cost-effective and the way that patients want it. So I just wanted to thank you for opening our eyes to that and super excited about this bill. Thanks. And Chair, if I could make just one quick comment through the chair. We really appreciate hearing that. What was done originally is those areas of population concentration, where it's a whole lot easier to take the van out, drive for half an hour, and have everybody picked up and at the center. If you're in more rural areas, it was not necessarily as economical initially, but what we found is the PACE model really works, and folks in more rural counties should have the exact same opportunity for outstanding care. Just rather than live in Summit or Hamilton or Franklin or Cuyahoga, the folks in other counties really need it. So if you're in western Ohio or southern Ohio, you ought to have the same opportunities for great care. Thank you. I do have one comment. We did open in Cincinnati in August of last year a pay center. I believe it's doing well because I keep tabs, but it is a beautiful facility. It really gives people the ability to have a setting to go to, to communicate, to have friends with, as well as being at home. It's a beautiful model. and I only hope that my county wants to try it. Thank you. Thank you. Same hope here. Any other questions? Any other questions? Thank you so much. Thank you. Thank you very much. All right. That concludes the first hearing on House Bill 750. We will now call on House Bill 401 for its first hearing. Will Representative Rader and Baker, oh, it rhymes, Rader and Baker, please step forward. Thank you. Very good. Thank you, Madam Chair, and thank you, Vice Chair, for being here and Ranking Member Simani. I really appreciate the time and for bringing this bill forward. It's an important topic. I first learned about myositis, actually, when I was in the hospital about a year ago. I was experiencing some weakness in my lower extremities, and I was tested for this disease. I didn't know anything about it. I ended up having something else called Gambaree, so GBS, a mild case. Also very serious, also sort of rare. But from learning that, I actually ran into some constituents who've had this disease. And if not caught early, myositis can lead to permanent muscle loss, permanent damage. And that's why we're bringing this bill forward. We think it's really important that we designate May as Myositis Awareness Month. What myositis is, is an autoimmune disorder where your immune system literally attacks your muscles, will eat them away. And if it's not caught, and there's a juvenile version of this as well, very few, only a few juveniles have it, it's something that usually happens older in life. If it's not caught early enough, again, it can lead to permanent disability, permanent muscle damage. And because it's a fairly rare disease, Fewer than 100,000 people in the country suffer from this. Not many people know about it. There's even some health care professionals. I was really lucky to have an excellent team at the Cleveland Clinic who tested for all these things. But I keep thinking back on that. If I hadn't been tested for these things like Gamberay, which is very rare, and myositis, I might have not been on the right path today, and it might have led to more damage in the long term. And that happens to a lot of adults. A lot of adults are caught. This is caught very late on in the process. So, again, just a really important thing. A few constituents of mine in my district have this. Ran into one gentleman who, they caught this about 10 years down the road, and he has to use some mobility devices now to get around because of it, unfortunately. And it's just sad to think that if they had caught this early enough, he could have got immune suppressors, and he could have just been a normal, healthy 50-something adult right now. So that's why I'm bringing this forward. Again, I appreciate your time, and I'll turn it over to my co-sponsor here, Rachel Baker. Thank you. Thank you. Thank you, Chair and Committee, for hearing our bill. I was excited Rep Rader asked me to join him on this, and I'm glad to hear your beginning part because the fact that it's rare in pediatrics tells me why I didn't know how to pronounce it. I have spent years as a pediatric nurse and hadn't heard of this, so I was practicing myositis this morning, so I said it correctly, but it shows us that we need an awareness day, right? So this bill seeks to designate an official Awareness Day in Ohio, increased awareness around providers, around the public, and public awareness really empowers patients to seek care sooner and advocate for themselves. Importantly, this bill doesn't impose any mandates, no significant costs. Instead, it's really just using the power of visibility and education, tools that are effective and fiscally responsible by naming and recognizing this condition and people who are diagnosed with it. Ohio has a strong tradition of supporting individuals with complex medical conditions, and passing this bill continues this tradition. So thank you for hearing it today, and we're happy to take any questions. Thank you, and by way of passage, I had no idea what this was either. Representative Gross. Thank you, Chair Schmidt. Thank you, sponsors, for bringing this forward. It's mostly a comment. My father passed away from inclusion body myositis, which is non-curable. And he was playing tennis at 80, and his get-up-and-go got up and went. And it was a physician's assistant at Johns Hopkins who did a large muscle biopsy and found inclusion body myositis. I think it's important what you're doing here, and I thank you so much for bringing this forward. The side effects and the complications of myositis aren't well known, and the study continues. So to bring it forward could help others and maybe bring research interest into this area. So I just wanted to say thank you very much. Through the chair, thank you, Representative Gross, and I'm so sorry to hear about your father. Representative Brownlee, did you have something? Through the chair, thank you. Just a brief question. You may or may not have this information, but, I mean, this is the first time I'm hearing of this, too. I think I'm going to have nightmares about it tonight. Beyond patient awareness, would love to get your thoughts, if you have any, on how to increase, like Rep. Gross was just saying, increase provider awareness about this to make sure that they're prepared and are testing people for this disease? You know I not a medical provider I not a physician I know there are certain tests that we do on the regular and certain tests that we don and we look for different types of symptoms I think it just right now important that the community on whole knows about this And I think we have a pretty important position here as legislators and as a body to make that awareness kind of widespread So I'll leave it to the professionals to understand better where to include those tests and to not. But happy to continue the discussion as this business moves forward. I look forward to hearing that. Are there any – Representative White. Well, for this disease being rare, there's two of us sitting in this row who have had personal family experience with my, it brought me back 30 years to sitting in Children's Hospital Cincinnati getting a diagnosis for one of my children of a dermatomyositis. And four in a million kids get it. And fortunately, praise God, she had a couple years of intensive things. She's probably an inch or two shorter than she would have been. But, you know, she has outgrown that over the year, you know, within a few years. But many kids don't and many adults don't. And then I've had several family or friends who have come down with just a rare autoimmune reaction that results in healthy muscles or skin or whatever the myositis is related to. So I really appreciate it because I'm not even sure, you know, if her pediatrician had not run a test, the right blood tests, to determine is there ANAs and different activity, and then they do a muscle biopsy and whatever procedures they do. But I truly appreciate that the health care community, perhaps this will help more health professionals, you know, take note as well. So I appreciate the effort to bring it forward, and I wish you well as well. Thank you. Any other questions? Thank you for educating us, and we look forward to moving the bill forward in the future. This concludes the first hearing on House Bill 401. Now call on Representative Sweeney and Click. Click is... Could you step forward for a second? Do you want to go forward without Representative Click? He said he was open to that, if you guys are. I hate, okay, I know you have a busy schedule, so if you can handle it for the both of them, we're going to give you that grace. Thank you. Well, thank you, Chair Schmidt, Ranking Member Simani, and members of the House Health Committee. Thank you for the opportunity to testify on House Bill 363, which would designate the last week in February as Eating Disorder Awareness Week. This legislation passed previously in the House by a broad bipartisan effort to 93 to 1 in 2022. Eating Disorder Awareness Week is nationally recognized campaign supported by major leading mental health institutions to raise awareness and connect individuals and families affected by eating disorders with critical resources, support, and care. Our legislation would bring Ohio into alignment with existing federal designations and several other states that already formalize this week, the last week of February, as Eating Disorder Awareness Week. Eating disorders such as anorexia, bulimia, binge eating, avoidant restrictive food intake disorder are serious but treatable mental illnesses that affect all people of different backgrounds, regardless of age, gender, race, body, shape, or weight. approximately 9% of the U.S. population will experience a clinically significant eating disorder in their lifetime, including over 1 million Ohioans. Despite the prevalence, eating disorders are often misunderstood stigmatized underdiagnosed and sometimes even promoted They also carry the second highest mortality rate of any mental health condition second only to opioid addiction underscoring the urgent need for greater public awareness and access to treatment Really appreciate you guys taking the time today, and I do just want to share that this bill came to me from a former aide and a family member who suffered severely from an eating disorder, and I just wanted to share that it means so much to her. if we could just get this into law and show that we do, that these are real disorders. They're not something to glorify and to give people to that. And I appreciate to thank most of you. I've previously voted for this. I'm happy to answer any questions. And I do want to be very, acknowledge Representative Click, who has been with me over the past few years trying to get this done, and he's been a great joint sponsor. And thank you to the chair for having us have a hearing today. Are there any questions? Representative Baker. Thank you, Chair. Thank you for bringing this here. Super important. I think most people have someone in their life they can think of that us acknowledging this is important. There is another whole area around eating disorders that I've been talking with people about doing some legislation around, so I'd love your thoughts on it, and I'm like plugging this idea for the committee. But currently in Ohio, diet pills and diet supplements are not age restricted. So our teenage daughters who are 13, 14 can buy these over the counter and take them without their parents knowing. Do you have thoughts on that and what are your thoughts relating how this could help with that? Thank you. Yes. To the chair and to the representative, I am familiar with that piece of legislation and think, you know, awareness is an important piece. but awareness doesn't mean much if we're not actually having legislation that can be coupled with that in action steps, and I think that is a perfect example of, I think, first, it's acknowledging that these are real serious disorders, and if we really believe that these are such problems, that we should really look at the access. If you have to go, and if you can't buy cold medicine as an 18, you know, under 18, you know, I'll tell you that, you know, especially as ever prevalent with social media, we see the mental health rise of our youth, regardless of, you know, economic. I mean, it is a problem in the most affluent school districts, most economically disadvantaged of specifically young women. And I think it gets at when you feel this pressure on social media, by celebrities, to look a certain way, it comes at and you have easy access to diet pills. I mean, in high school, I was taking diet pills when I had absolutely no need to be taking diet pills. And I have not actually suffered from an eating disorder. But it just shows that my parents were completely unaware of that. And I think that it is very important that if we already look at the access to other harmful substances, that these are actually more harmful than ones that we already kind of age limit. So I hope that the committee looks at not just awareness, but how we actually are trying to educate youth and whether or not they should have access to supplements that can make these issues worse. Quick follow-up. Thank you. Thank you. And not to take away from awareness. Yes, because that's an important first step, and while it impacts males too, the huge disproportionate is in females. So thank you for bringing this on Women History Month and thank you Chair for bringing it for our committee today Representative Simani Thank you Thank you through the Chair I agree the predominant problem of eating disorders is in women but I do think there needs to be awareness and education for young men also. So I'm wondering if that's going to be included in this, because you talked mostly about women. To the Chair, to the Representative, by no means do I mean to indicate that this was only a female. It is predominantly, specifically when you look at the increase in mental health issues within children, of young women specifically, I think we've seen some of the highest rises, and I think it's part of contributing to the pressures on social media and society's standards for women to look a certain way. But I think it shows a lot that, you know, when I put this co-sponsor request out, Representative Click, like, reach out to me and asked if he could be a part of this, And he has his own reasonings because it's not discriminatory. And I think each one of us, whether we know it or not, has somebody in our lives. No one is immune for the pressures to look a certain way, especially, I think, with the addition of, you know, the new GLP-1s and, you know, a lot of people losing weight rapidly. And if you don't have access to that, like what, you know, are we really actually studying what this has on this pressure to be thinner, thinner or, you know, the opposite? I mean, I think it's recognizing that this is a mental health disorder and not just a physical one. And, again, I think demonstrative of the fact that Representative Click has been working with me, it's not just a female issue by any means. Thank you. I want to personally thank you for bringing this to our attention. Nobody's immune to this, and I don't want to get too personal because I don't want them to know I'm really talking about them, but I am. But an individual later in life, lost her husband, has no children, wasn't heavy at all, suddenly decided that they needed to lose weight. And I watched this individual continue to shrink and shrink and shrink, has a very restrictive diet, and it is clearly an eating disorder. But it's so insidious because if you try to talk to them about it, they don't believe it. They don't see what they look like in the mirror. And getting a discussion like this out there, perhaps we can reverse the poor decisions they're making for themselves, probably due to loneliness, want some control in their life, and this is the only way they can get control. Yeah, we see it a lot of times in young kids, but there's also the more mature population where this can happen, too. So I want to thank both you and Representative Click for bringing this to our attention. Let's get it across the finish line. Thank you. I really appreciate that. There are no more questions. This is the final on House Bill 363. I said that incorrectly. I will now call up House Bill 561 for its third hearing. Members, there is also written testimony on your iPad. We have a number of people on the list. Representative Barhorst. Representative Barhorst. Thank you. I'm going to call forward Dan Dodd. Are you here? Thank you. Chair, Vice Chair, and Ranking Member, thank you for the opportunity to testify today as an opponent to House Bill 561. I'm Dan Dodd. I'm executive director of the Ohio Alliance of Independent Schools, a member organization of 45 independent charter non-public schools throughout Ohio. Our organization is opposed to House Bill 561 because it mischaracterizes what private schools may do to set their vaccination policies under ORC sections 33.67 and 33.671 and equates them with public schools. The statutes clearly do not make them the same. The proposals contained within HB 561 would require private schools to explain to parents options they may not have under the school's policies and expose the school to liability or punishment for not offering alternatives that are not legally required to offer. 33.13.67 A1 and A2, and I won't read you the revised code section because I'm sure you don't want to listen to me read it, But both of them refer to a board of education. A2 reads, a board of education shall not adopt rules under A1 of this section that are inconsistent with Division B and C of 3313.671. Charter non-public schools are not governed by boards of education. There is no other instance in the entirety of the revised code where charter non-public schools are governed by language pertaining to boards of education. Moving on to 3313.671. The underlying language notes an elementary or high school for which the director of education and workforce prescribes minimum standards pursuant to Division D of Section 3301.07 of the revised code. The underlying language in A1 of 3313.671 does not refer to boards of education. It refers to schools for which the director prescribes minimum standards, which means it is applicable to charter non-public schools. The result is charter nonpublic schools are tasked with assuring students are immunized. Going into Division B of 33.13.671, charter nonpublic schools are also absolved from the responsibility of obtaining immunization records from families and disenrolling noncompliant students who opt out for the reasons listed within statute. That's important because what the statute does is it imposes on the school the requirement to collect these records. The requirement is not required if the family says they don't want to do it. None of that speaks to what the policy of the charter nonpublic school is. So what does all of it mean? To summarize it is the following. Charter nonpublic schools are required to ensure students are immunized. They are not covered by the prohibition of adopting rules that are inconsistent with BNC of 3313.671. reading the two sections together as intended, non-public schools are legally permitted to adopt rules or policies that do not recognize a refusal to have a child immunized for the reasons listed in B and C. Charter non-public schools put a great deal of thought into their vaccination policies. They rely on science, governing board directives, religious teachings when applicable, and community input. The policies are clear to families at the time of enrollment. Unlike public schools, private schools are a choice, not a right. A family can choose to not enroll in a school based on their policy and pursue another option The school is not obligated to enroll someone who refuses to abide by this or other policies The provisions of House Bill 561 require preschools, including those operated by non-public schools, to honor all vaccination refusals. This not only contradicts existing statute regarding K-12 non-public schools, but also destroys the ability of private schools to set a policy for their community that their community wants and expects, even if that policy is based on science or religious teaching. Private schools, although they do have a right to exist, are not mandated under the Ohio Constitution. A thorough and efficient system of common schools throughout the state is mandated under our Constitution. If the General Assembly wants to mandate this policy on those constitutionally guaranteed schools, you're certainly within your purview to do so. However, taking this option away from private schools is in direct opposition to the concept of school choice. Thank you for the opportunity to testify today. I'd be happy to answer any questions. Representative Gross. Thank you, Representative Barhorst. Thank you, sir, for being here. In Ohio, religious liberty is protected by both the U.S. Constitution and the Ohio Constitution. Additionally, I would like to ask you if your schools accept vouchers. Chair to the representative, about half do and half do not. Follow up? Okay, so you do take state funds that come through the parents that decide to come, And then we have religious liberty both in the U.S. Constitution, the Ohio Constitution. How then will you justify going against religious liberty with a policy, whether based in science, according to you, or not? How then will you be able to justify going against religious liberty, which is fiercely protected? And actually, Ohio is recognized as the fifth state in the nation by religious liberty organizations. How will you justify that? Chair, to the representative, I would note a couple of things with regard to the acceptance of taxpayer dollars. While half of our schools participate in EdChoice, and that's a substantial increase over the past couple of years, All of our schools do also accept auxiliary services funding and administrative cost reimbursement. I would note that whether it's EdChoice or ACR or auxiliary services, if we turn away that money tomorrow, we still have to follow all the same rules. So the money does not follow the rules, not in this or anything else. As a condition of our charter, we are required to follow those revised code sections regardless of the acceptance of taxpayer dollars. With regard to religious liberty, I do have a list of the schools on our letterhead. Several of them are religious. Not all of them are, but several are. They have a religious liberty that's at stake as well. They are organized under religious auspices and set policies that are consistent with their religious beliefs. Again, if the family doesn't like it, they can go. They are made aware of it at the time of enrollment. They are very well aware of what their responsibilities are. that's why we call it school choice because you choose a school based on what it fits for your family and your personal beliefs if they want to if somebody wants to organize a school where every student has to claim an exemption have at it. They have the right to do so. But in this instance, our private schools are setting policies that their communities expect and that parents at the time of enrollment are well aware of. And if they want to take their voucher money and head somewhere else, they have the absolute right to do so. Follow-up? Any other questions for the witness? Dr. Simani. Thank you. Through the Chair, thank you for testifying. Currently in Ohio, we do have the ability for parents to say they want a religious exemption. This legislation is mostly about schools being required to tell parents that there is an exemption available. So I'm assuming that there are kids that have religious exemptions in these schools. Chair and ranking member, it would depend on the individual school. So I would say probably over half of our schools, if I had to guess, do not have an exemption policy. They are not required to have one under law currently. What this bill does, if you go down into 6711, I think it's Section F, which is new, that would require schools to not only disclose these exemptions, but also accept certain types of paperwork and whatnot. The schools right now are not required to accept those. So essentially what that is doing is creating a backdoor and requiring schools to accept those when they are not required to under Division A or divisions A or B under 33, 13.67. Follow-up? Follow-up. Thank you. Are you concerned that this legislation would potentially increase the risk then of infections in your schools with the students? Is there any concerns in that regard as far as public health? Chair and ranking member, I am not here to advocate or debate the efficacy of vaccines and whether or not families should opt into those. I'm here to oppose the infringement on our operational autonomy, to let private school communities make those choices for themselves as to whether or not a mandatory vaccine policy is the best fit for the school. That's what I'm most concerned about because we aren't required to do it now. We haven't been required to do it really since the existence of the statute. and to come in and say now we have to notify parents of the right to an exemption that they don't actually have, that we have to put it on a website and then expose ourselves to either monetary sanctions or charter revocation. Again, if we notify them about exemptions that they may not have under the school's policy, that's incredibly problematic from an operational perspective. Representative Miller. Thank you, Acting Chair. And to the witness, thank you for coming in today. I want to go back to Rep Gross's question and maybe follow up on that. Do you believe that a belief in science should be held above protecting religious beliefs of our citizens? Chair and Representative what I believe is that private schools should be the best fit for their parents and their community And if the parents are advised of what the expectations are at the time of enrollment parents can make an informed decision as to whether or not if the policy of that school is the best fit for their family. Again, as I mentioned before, we have religious schools that are members of our organization. We have religious schools that are members of our organization who have a mandatory vaccine policy. So in that instance, what you would be saying is the religious leadership of that school has made a determination based not only on what is best for the community, but on religious principles as to whether or not a mandatory vaccine policy is the best fit for their religious community. And then you have somebody come in and say, I don't agree with you, and you're going to listen and follow what I say, contradicting the expectations of the community. That is what I'm more concerned about from a First Amendment perspective. Sorry, forgot my cue. Follow-up? All right. Representative King?
Thank you, Chair, and thank you for being with us. And I'm just going to kind of backtrack a little bit. I'm not sure which member asked about the funding portion, but are you willing to give up state funding?
whether it's the Autism Peterson Grant or vouchers in order to, I guess, hold fast to your policy to deny exemptions? Chair and Representative, that would be the decision of each school community. What I would caution, and you don't have to take my advice at all about this, When you start attaching requirements to taxpayer funding to private schools, whether that be through a voucher or administrative cost reimbursement or auxiliary services that have absolutely nothing to do with the receipt of those funds and the purposes for which they are used, you are setting a very bad precedent with regard to not only the autonomy of private schools to exist in the state, but whether or not they want to continue to be a viable option for families who cannot otherwise afford private education. Because whether it's this or something else, and we've had a lot of instances in the past that are proposed, and fortunately have not made it through the legislative process, Looking at private schools as being a tool of the government to impose certain types of beliefs and actions on private communities is not conducive to the entire concept of school choice. And giving parents the ability to choose the community that is the best fit for their children. Thank you.
You do acknowledge that the Ohio Revised Code in statute gives exemptions, and perhaps even there are physicians that will recommend an alternative vaccination schedule based on the child's health?
Chair and Representative, when I reference mandatory vaccinations, I think in those schools that have them, I believe all of them have some type of policy for when those are medically not appropriate or with if a physician, a qualified physician recommends something else. Those are different scenarios than somebody just coming in and saying, I don't want to do it because I don't want to do it. That's where we have more of a problem. I think if it were an issue of medical necessity or if somebody, you know, has already had chicken pox or whatever it is and does not require a vaccine, that is completely different than somebody just opting out for the sake of opting out. Because, again, they don't have to actually list their religion as being the reason why they're doing so. They can say conscientiously, I don't want to do it. So that's where it creates more of a problem for us than an instance where a medical doctor, a qualified medical physician, has said that this is not appropriate for the child.
Paula?
So you don't believe in personal medical freedom, the right for an individual to choose what goes into their own body?
Chair and Representative, again, as I mentioned before, I'm not here to debate whether or not vaccines are good or bad. What I am here to oppose is telling communities that make up private schools who have thought about this carefully and have had policies for years, if not decades, that they have to completely upend that precedent because an individual who is already aware of what the policy is at the time of enrollment decides that they don't want to do it anymore or they just don't want to do it. I would urge that family or those individuals to exercise their choice, their freedom of choice, their medical freedom of choice to go to a school that is more consistent with their beliefs than trying to impose it on a community that has decided, as a private school community, that they don't want to follow that path. Thank you.
If there are no more questions, I will now call on Kate King. Oh, I'm sorry, Dana Howard. I apologize, Kate. I was out of the room. I didn't see.
Thank you. Thank you, Chair Schmidt, Vice Chair Dieter, and Ranking Member Simani and members of the Health Committee. Thank you for allowing me to testify today. My name is Dana Howard. I'm a bioethicist and a member of Defend Public Health Ohio. And today I come primarily before you as a concerned mom of an elementary school student in Columbus City Schools. I'm strongly opposed to HB 561. I have to say that this is the first time that I'm testifying in person at the Statehouse, and I decided to come today because I'm tired of sitting by, not doing anything, and reading in the dispatch about new bills that jeopardize the health of our children and our communities and chips away at reasonable public health measures that would protect our kids if there were an outbreak. And in the written testimony, I say some things that are worrying parts, but today here I want to focus on the way this bill limits the abilities of schools and child care centers to keep children safe were there to be a known outbreak. The bill, as written, states that if there is an outbreak like chickenpox or measles, a school may deny admission to a student who has contracted the disease. But, and now I'm quoting, a school shall not deny admission to an uninfected pupil, including a pupil who is otherwise exempted from the immunization requirements. And I think that this is a dangerous measure that comes exactly at the wrong time As a mom I take myself to be responsible not only for the health and well of my own child but also to do my part to make sure that others around me and my child are safe, especially those who are the most vulnerable, like kids that are immune-compromised or babies that aren't yet fully vaccinated. I think we should all take our responsibilities to keeping our community safe, And I hope that parents who choose to not vaccinate their children take that responsibility seriously as well. But these parents may not even know yet that their child is infected. And sending their child to school can endanger other children who have not been and cannot be vaccinated. According to the CDC, if you have measles, up to 90% of the people close to you who are not immune will become infected. An infected person can spread measles to others even before knowing that they have the disease. And you can spread measles to others four days before and four days after a rash appears. And as we know, there's been a series of outbreaks in Ohio in 2025, including six cases in Columbus last month. The bill would limit the ability of schools and daycare centers to minimize exposure exactly at the time when we need to have measures, available to keep all of Ohio's children safe, especially the kids who are not vaccinated. I will close by saying that this bill is to be called the Parental Choice Act, but it puts the choices of some parents over the choices of others. So we love going to the Arnold Invitational each year, and we had friends that just moved to Columbus, Ohio, and we've been talking it up, and they have an eight-month-old, and the child is not yet vaccinated with measles, and because of the recent outbreaks, they were worried about going and about bringing their child. And so their choices are constrained when we have more outbreaks, as are the choices of parents who have children with medical conditions and cannot vaccinate their kids. OIO already has laws in place to give parents the right to refuse to vaccinate their child for medical or conscientious-based reasons. and as the sponsors of the bill articulate, this bill does not actually broaden those exemptions. All the language does, at least the part that I'm focusing on, is putting more restrictions on what schools and daycare centers can do in the face of an outbreak in order to keep our children and the general public safe. So I ask you to consider my testimony and vote no on this harmful bill, and thanks again for giving me the opportunity to speak today.
Thank you for your testimony, Representative Gross. You had a question?
Thank you, Chair Schmidt. Thank you for being here today. Since you pointed out that you are a bioethicist, we have had zero reported measles deaths in Ohio from 1990 through the present day. Yet we do have 105 reported MMR deaths from children who have been vaccinated for the MMR. how do you justify bioethics, and do you believe that the deaths of those 105, even though we've had no deaths from the disease, how do you justify that bioethically? Is that for the good of the cause that those 105 children are dead?
Thank you, Representative and Chair, for the question. I'm here today to testify just about sort of schools being able to enact measures when there is a known outbreak, And I really do think that it up to parents to make an informed decision with their health care providers about what to do to safeguard the safety and well of their children A follow
So when you go to those sports events, do you know everyone around you who's vaccinated or not vaccinated? And do you justify the 105 reported Ohio children who have died from the MMR and no deaths from the exposure to the measles itself? Do you believe that those deaths are justified even though there have been no deaths from measles since 1990 in Ohio?
Thank you for the question, Representative and Chair. I mean, I feel like when it comes to decisions about what is for the well-being of your child, parents have to make informed decisions that is best for their kid. and they have to make decisions about what is best for their kid when they go to the Arnold International, and that's what parents are doing. So there's going to be risks and benefits, and I take parents seriously when they're making these decisions. I don't want to take the decision away from parents, but I do think that it's important to the parents when they're making these decisions about whether or not to vaccinate their kid, there are going to be certain public health measures that schools and daycare centres should be responsible to have the opportunity to do to make sure that especially those kids that haven't been vaccinated are safe from exposure to the disease because those kids that haven't been vaccinated are going to be the ones that are most likely to get measles. Thank you.
Thank you. Representative Miller.
Thank you, Chair. And, Dana, I'd like to thank you for coming in and sharing your testimony. And you did a very nice job. if this is your very first time. So thank you for coming in. I hope this isn't repetitive with Representative Gross. I really appreciate your question, but just wanted to maybe piggyback off of some of her questioning. So do you believe it is ethical to ask a parent to possibly sacrifice the health or life of their child in order to possibly protect the life or health of another child or group of children?
So, I mean, coming from a bioethics perspective, I really do think that parental discretion is really important, and different parents are going to make that decision differently. As a parent, that is a decision that I have to make as well. And yeah, I thought that the amount, the risk of a negative side effect when it comes to vaccination was worth it both to protect my child against diseases, but also I think it's worth it as a member of society to protect against other kids who can't get the vaccination. So I personally made that decision, but I don't want to take it away from other people and their responsibility. I think that what we need to do is we need to have reasonable measures that when there is an outbreak, schools and daycare centers can manage and protect the children that are under their supervision. Okay.
So thank you very much, Chair. So am I hearing you correctly that you would feel that if your child were to die with the maybe an adverse reaction to a vaccine, that it would be worth it? Is that what I'm hearing you say as you're sharing that?
I'm I'm just making. So this is my personal decision. like I made a decision to vaccinate my kids and I weighed the risks the very minimal risks that I see of vaccination against the risks of actually getting an infectious disease And you know we haven had we been lucky to not yet have deaths of measles but one in five kids that get measles have to be hospitalized, and there's a lot of other health complications, lifelong health complications that come with measles outbreaks. So these are just decisions that every parent in Ohio has to make, and I take those seriously. And I just think that when there's an outbreak, We really need to have all of the public health measures in place to protect the children, especially those children who haven't been vaccinated. Thank you.
Thank you. Representative Somani.
Thank you. Thank you through the chair. And thank you so much for your testimony. So as a bioethicist and as somebody who obviously believes in public health, do you know, and, you know, this idea of deaths through vaccines keeps being brought up, but when we think about vaccine-preventable deaths, do you know over the years? Because I think one of the misconceptions is that measles is not scary, measles is not frightening, because we have not seen it in 50 years, 60 years. And now we're seeing deaths that are preventable. I just want to ask, like, why would we expose people in the community, people that are vulnerable, to things that are preventable?
So I will say that I'm a Ph.D., but not a doctor that saves lives. I know some of you are, and I know that some of the other people that are witnesses today are. And so I want to defer to you all to make those decisions. And I'm just really here to think about how do we respect parents and their decisions, but at the same time support reasonable efforts in public health crises. And I personally think that vaccines save lives. So it is one of the reasons why I'm up here today.
Follow-up? Thank you, Chair. And this actually might be a better question for the pediatricians in the room, but I was going to ask about the long-term effects of measles because not only is it a miserable disease to have, luckily I was vaccinated as a child and didn't have measles, but I did have chickenpox, and now we have a vaccine for varicella, and we know the long-term effects of chickenpox is shingles, which is also incredibly miserable, but now there's a vaccine for that, I think, when you turn 50 or something. And so just maybe, again, maybe that's a better question for the pediatricians, but, you know, maybe if you can address kind of the long-term effects of measles.
I do think that sometimes we think only about the mortality rates and we don't think about the sort of downstream consequences of having measles or chickenpox. So, yes, all these things are things that we need to be taking into consideration, and I think that parents are taking those things into consideration when they're making their own choice about whether or not to vaccinate. Thank you.
Follow-up? Thank you.
Representative Rockhorst.
Thank you, Chair. Thank you for your time today and your testimony. I just wanted to ask what it looks like in your world as far as the information that you gather and it's presented to you. Is it mainly the CDC? Yes.
Any other organizations. I was looking at some CDC information about measles pre COVID era and post, and it's literally the same number, but we have these vaccine injuries that have risen since then. So I think that's why this bill is out there is so we can mitigate keeping the past policies on measles and vaccinations. So there isn't an outbreak and there hasn't been. And then to stop these poor families that have had these vaccine injuries and they either lost their children or they're still alive, but they've still lost them because they're terminally ill and with no hope. I mean, I do use, I still use, like, federal guidance, and the CDC is still, that's the current information on the websites today. And I defer to, I have certain expertise when it comes to some of the ethical decision-making. That's why I take parental decision-making, informed parental decision-making really seriously. and you know if we're thinking about some of these other questions, you know those questions aren't central to the bill, the bill really is isn't about, it's just about what schools can do in order, like what school responsibilities are and the sort of added regulatory burdens of schools so yeah thank you
Are there any other questions of this witness?
Representative King. Thank you, Chair, and thank you for being here with us today. So I just, I want to touch on the bill. It requires that the school programs provide notice to the exemptions in the same manner as the program provides the notice of the requirements. So my question, I guess if so, if there are statutory exemptions And if the school is only permitting the mandated vaccination requirements with no alternatives, it's very misleading to families, that they don't know that there are legal options. And so it does appear that the schools are intentionally presenting this as a mandatory without alternatives.
Do you feel that that's ethical? So thank you, Representative and Chair. You know, thinking about what the school's responsibilities are versus the public health community versus the government's responsibility, if there are more awareness campaigns that need to happen to make sure that parents have the information about their alternatives, that seems like a worthwhile possibility if that's sort of the measure that you think is necessary. but I don't think that actually it's the school's responsibilities to make sure that all of their rights are equally presented I think that the schools have certain so it's like the school is there primarily to educate children and maybe public health like maybe there has to be more awareness about what parents' rights are. Maybe medical professionals have to make certain things, but that's not what is in this bill.
A follow-up, Chair? Quickly. So would you be opposed, and thank you for sharing your personal thoughts. So would you be opposed to just on the vaccination form, if the schools would put just a little reference to the Ohio Revised Code for numbers, dot two, so it would be a series of six numbers for additional information I mean how simple is that to just add that to a form for parents Would you be opposed to something like that I am not opposed to something like that
And also, I will say, you know, I work less in the sort of, I work in medical decision making more broadly. And it's like, people tend to gloss over informed consent documents. So, I mean, And it is like, I mean, I do think that part if, you know, it's like the things that I think are really like problematic are taking away certain requirements for vaccinations and also not allowing schools to actually manage an outbreak for the safekeeping of their students.
Representative Brownlee, question.
Through the chair, thank you for your testimony. I know you've been asked a lot of questions, so I just want to clarify what you have brought today to the table. It sounds like you don't, I mean, you're an ethicist, for goodness sake. So you are open to, you know, people having choice and learning, being informed. But it seems like the issue that you have very specifically, just to clarify, is that should there be an outbreak that the schools are required to accept the kids who are not vaccinated at that time? So that is the crux of the argument.
That is taking away the choice. And that is what you are discussing today. Thank you, Representative.
And thank you, Chair. Yes, that is the crux of my argument today. And when it comes to sort of decision-making related to vaccines, in some ways I feel like taking parents seriously and taking their decision-making seriously is an important component of public health.
And that's why I also think it's really important for parents to talk to medical health professionals to navigate some of these choices, especially with a lot of misinformation that is out there. Thank you.
and thank you for your testimony. I'd like to remind everyone we have seven more witnesses, so we're going to shorten your testimony to three minutes. So get your little erasers out, tighten it up, because we do want to hear from all of you, but we do have a hard stop at noon. So thank you. Kate King, now it's your turn.
Thank you. Good morning, Chairwoman Schmidt, Vice Chair, Dieter, Ranking Member, Samani, and the House Health Committee. My name is Kate King. I am the Executive Director of the Ohio Association of School Nurses. I have been a nurse for over 40 years and a school nurse for over 25. The Ohio Association of School Nurses has several concerns regarding House Bill 561. As written, this bill will negatively impact evidence-based public health protections that help prevent outbreaks of vaccine-preventable diseases in schools and child care settings. We urge you to oppose this legislation as written. School nurses work tirelessly to monitor the vaccine data of students in school. We do the lion's share of the work, to be honest. Assured data on immunization records in schools are accurate and reach out to parents and families of children who are not fully vaccinated and provide information, support, and referrals to vaccine accessibility in order to assist parents in making an informed choice in the immunization process for their children. And we do know in the school setting that exemption process already exists. Parents trust school nurses to support the health and well of students and immunizations are no exception for that You have my written testimony and in light of the change in testimony I'd like to really talk about limiting temporary exclusion of unvaccinated children during outbreaks. The language of House Bill 561 does not address students who have a vaccine-preventable disease, are in a prodromal phase, and thus cannot be identified as the bill language states in having contracted or are infected, but actually are contagious. The prodromal phase is characterized by mild symptoms that are common to many diseases, a runny nose, a headache, maybe even a low-grade fever that they don't even know about. But in some children, and often, these prodromal symptoms do not appear. Students who are not immunized against a disease during an epidemic or outbreak, but are exposed and allowed to stay in schools, may very well be in that prodromal stage and then spread the disease to others, thus limiting the school's ability to manage that outbreak. We need to be sure that students can, with consultation with the health department of public health experts, make sure that all students are safe, including the other children who are immunized and maybe children in that school if the school does not have herd immunity. We also want to make sure that they have informed choices. School nurses are on the front lines of working with parents who want exemptions. We talk about that exemption form. It's an easy and user-friendly way to do that. I myself have talked to many parents about exemptions, and often it is because they don't know how to get vaccines, they can't afford vaccines, and they don't have access to vaccines. And school nurses do the work of linking them with health care providers, and especially in school-based health centers and in vaccine school clinics. Thank you.
Thank you. For questions of this witness, Dr. Samani.
Thank you. Through the chair. Would you be able to elaborate on how often you find that people ask for the exemption, and then when they realize they can get the vaccine, they go ahead and get it? They're getting the exemption because of the inability to have child care or the inability to provide alternative resources for their kids.
So I cannot give you actual data, but in my long history and expertise, that's over 50% of those parents. Representative King.
Thank you, Chair, and thank you for being with us today. I remember many years ago, my children are now adults, but when I took them to the health department for their vaccinations, I always got a very colorful sheet with the possible side effects, easy to understand reads, so it is informed consent. My question to you is this bill requires that school programs also provide a notice to the exemptions in the same manner that they provide notice of the requirements. Again, full transparency. And it seems like some of the schools are wanting to only present one side of the equation, and it appears that they are intentionally presenting vaccination as mandatory without providing families with legal options. So it feels like they are intentionally presenting this as a mandatory Do you think that ethical I mean is that informed consent I guess do you oppose just letting families know
that there are options, just like there's always risk, informed consent? Do you have a problem with that portion of the bill? Chairwoman Smith, Representative King, I know that across the state, there has been great inconsistency in notifying parents about that through school districts and schools. And I believe that there really is an old-fashioned kind of thought about that in some cases. So I am not opposed to letting parents know that, like as you told the other witness, you know, a little thing about the ORC. I'm not opposed to that. What I want to be able to do is that school nurses and other health care professionals have the opportunity then to talk with those parents. So to say that parents can just exempt without that conversation, I think is not the thing that all of us here are trying to do is give parents information and informed choice. I'm going to tell you a quick story in the spring with measles coming up. I ran a list of all of my students who were exempt. I called every single parent because I'm worried about their children. I was a little nervous. I've been a nurse for a long time. I was a little nervous, but I went ahead and did that after hours so I get parents, and interestingly enough, they were so happy that I reached out and talked to them about it. And over 50% of those parents, now I'm in a middle school, so let's say that, immediately signed up for an in-school vaccine clinic for the MMR for their child. It is that kind of work that we want to do to inform parents about that so that they can make those choices.
Follow-up. So what I'm hearing you say, if I as a parent choose to exempt whether my child may be as fragile health and my physician has recommended to postpone it or delay it, if I choose the exemption, I turn it into the school, what I'm hearing you say is that then I should be required to have a one-on-one meeting with the school nurse
to question my decision as a parent on having my child exempted from the vaccination schedule. Is that correct what I heard you say? Chair of membership, Representative King, that is not what I am saying at all. In fact, with the medical exemption, I didn't call any of those parents. I should have been more clear about that. I would never do that. I appreciate it. Thank you for the clarification. Representative King. Thank you, Chair. Thank you for testifying. I align with a lot of what people are talking about and how important it is for parents to be informed on all sides when we take risks with our kids. I think that the section that you talked about with the prodromal phase, that's the part of the bill that's really got me stuck. Can you talk us through what the protocols look like at schools when someone has, like let's say someone had measles at one of your schools and what you would do in current law and how this bill would change that? Thank you. Sure. So if we had a case of measles at schools, I would immediately notify my local health department and start to have a collaboration with them. If we had one or more cases, then the health department and the school nurse or the school, if they didn't have a school nurse, which we don't have to in every school, unfortunately, but they would work together to determine who was exposed, when were they exposed, if they were at risk not only of contracting measles, but then contracting them, coming to school with no symptoms and spreading them. And it is not done lightly to exclude those children from school who are at risk of contracting that disease. We do this, again, in conjunction with public health experts and then to make sure that happens. And then the school nurse would inform the parent of what is happening and why, and those children would be excluded from school with the sanction of the superintendent. Miller Thank you, Chair. And Kate, I'd like to thank you for being here and testifying today. I have a specific question, a little bit more of kind of checking for measles among maybe the staff of the school. So how often do our school nurses, other school workers, teachers, and other staff have their tears checked? Titers. Titers, thank you. Thank you very much. I want to make sure, thank you for correcting me on that. For measles to confirm they're not part of the 60% of the population who's no longer immune and able to carry and transmit subclinical measles infections? My understanding is that most schools do not check that among staff, although I have been hearing more schools now asking for that from staff, asking for immunization records or titers. I had measles as a child, and mine are written in a baby book, so I have titers, but they do not require that. But now that measles outbreak is coming, I have heard that districts are requiring that more for staff. Yes, please. Thank you, Chair. So how would you manage in this setting, in an operation? So if you're able to test for that, if you had potentially 60% of the staff during that duration of the outbreak gone, how would you manage that in the school setting? Well, as a school nurse, that's outside of my pay grade, Representative Miller and Chair Schmidt. However, we did that, and people can agree or disagree during COVID. We do that during flu outbreaks if 60% or more of your staff are gone. It would be very, I would say most school districts should have a plan for if that happens, and many of them actually do in order to provide education for students. That's what we're really all about. Thank you. Thank you. Representative Brownlee. Through the chair, thank you for your testimony, and thank you for all of your work as a school nurse. I know it's a very, very difficult job, and you taught me a new word, prodromal. Never heard of that one before. So can you, you know, kind of piggybacking on what Rhett Baker asked about protocols, Can you just give a visual as to the delicate balance that a school nurse has to keep to keep the students safe and healthy in a school? Because you're not just dealing with a few kids. You're dealing with, you know, a couple hundred kids, and they all have varying medical needs. And so what is that balance, and why is it so important that choice really is always in, you know, choice and policy, and how schools respond to these outbreaks is very important. So school nurses, especially at the beginning of the year and when students come in new to schools, that is our sole purpose, not our sole purpose, we do emergencies and all, but the biggest work is that immunization status, so that when we have an outbreak, well, if we have an outbreak, hopefully not when, we have an outbreak, we know, like I know how to pull that list up I know where those students are in a classroom One thing COVID taught us was to make sure we have all that at our fingertips We have classrooms where our kids sit who in lunch together You know, if a student comes in that pro-dremel phase and is on the football team and travels on the bus and goes to another gym or stadium, they have the potential for infecting everyone. So again, that is a delicate balance, but that is our work. That is our expertise, and it's what we do. Through the chair, thank you. I mean, are there kids, though, who are, you know where the kids sit, you know who they're eating lunch with. I mean, there are some kids in your school who are very medically fragile, who, if this would impact them, could mean severe long-term either morbidity or even mortality. So in that case, again, in conjunction with the health department, we would notify parents about an infection and allow those students, if they're unimmunized, we would exclude them just like anyone else, but then give them that choice and an opportunity to get their education outside of the school if they should choose to do so. Thank you. Thank you for your testimony. Thank you. We are approaching 30 minutes, so three-minute testimony. Everybody gets one question, no follow-up, because they do want to hear from as many people as possible. We're going to call up Bobbi Shannon now. Welcome, Bobbi. Chair Schmidt, Vice Chair Dieter, Ranking Member Samani, and members of the committee, thank you for the opportunity to testify on House Bill 561. My name is Bobbi Shannon, and I'm the Executive Director of Early Learning for the Y of Central Ohio. I am here on behalf of the Ohio Alliance of YMCAs. The Ohio Alliance of YMCAs is a nonprofit organization that represents OhioWISE. We're in 164 communities around the state and serve 1.9 million Ohioans, both children and adults. Ohio YMCAs are the largest child care provider in Ohio, providing care for over 250,000 children each year. Here in central Ohio, we serve 6,400 youth annually in over 100 programs, and those programs include early learning, Head Start, school age, teens, and summer camp. I'm here today to talk specifically about our child care centers serving our youngest. We start at six weeks old in those early learning centers. Under current law, the state requires children enrolled at child care centers to be vaccinated against a number of diseases with three exemptions. However, as private businesses, child care centers, including the Ys, are not prohibited from adopting a policy that requires all children to be immunized in the center. Child care centers differ from schools in this very important way. As a school is a public entity that is required to provide education, private child care centers do not have those same requirements. YMCAs care for a broad array of families and their children. Many of the children in our care are infants and toddlers and preschoolers, a lot of whom have weakened immune systems. In the case of these types of children, vaccines are not available to them. If these children were in the same center as an unvaccinated child who contracted a disease such as measles and unknowingly exposed that to others, the results could be deadly. Some YMCA childcare centers currently have policies in place requiring all children in the care to be immunized because we care for those kids those medically disadvantaged kids and the kids that are too young to have vaccines yet However, all child care centers do not. Thus, families who choose to decline vaccines can find care at centers that permit it, and families who have those kids who can't be vaccinated yet can choose to have a center that requires vaccinations. House Bill 561 also interferes in the right of private businesses to decide what is best for them. YMCAs, like other private child care centers, should be able to decide what policies best suit the families we serve. Thank you for your time, and I'm happy to answer any questions you should have. Any questions from the committee? Seeing none, thank you for your testimony. Next, we have Zach Rosfeld, physician. Doctor, the floor is yours. Thank you to the acting chair and ranking member, Samani, and members of the House Health Committee. My name is Zach Rosfeld. I'm here in my personal capacity today as somebody certified by the American Board of Pediatrics to provide opponent testimony for this bill. Sponsors of HB 561 have chosen an interesting title with the Choice Act. After all, choice is a great thing. The only choice, however, that this bill makes is to put Ohio's children at greater risk of preventable disease. Vaccines are safe, effective, and save lives, and Ohioans know it. Recent polling data here in Ohio tell us that 87% of parents believe it is important or very important that parents vaccinate their children. Vaccination is not a fringe position. It is a requirement for attending daycare and school. And yet parents in Ohio, unlike most states, do have the right to exempt their children from immunization requirements, citing conscience or religious conviction. Vaccination is the default because it protects children, and such a default needs to be protected itself, not undermined. House Bill 561 requires Ohio schools and child care centers to actively promote opting out. not by choice but by state mandate alongside its notification mandates this bill also removes hepatitis b as a requirement for attending child care and there is no public health rationale for this this committee should not be misled by the bill's framing parental choice in ohio is already protected what is not protected and what this bill actively undermines is the health of children who have no choice and have no voice in the vaccination rates of the communities they live in. HB 561 offers a name that sounds like empowerment, and it delivers increased risk of preventable disease. I urge this committee's opposition to HB 561, and I'm happy to entertain questions. Any questions to this witness? Representative Miller, White, who else? Dr. Simani. Okay. Okay. Thank you, Chair Schmidt. And Zach, thank you very much for coming in and testifying today. Appreciate your work. In your testimony, you bolded, and I'm assuming that is with intention, that vaccines are safe, effective, and save lives and Ohioans know it. So as a physician, have you seen vaccine injuries? Do you believe that they are real as a healthcare provider? Thank you for the question through the chair. And I respect that there's a federal role for being able to petition for vaccine injury and to be compensated fairly right These things do exist I here on conviction because of defaults that I believe in This is a public good to have herd immunity and not have the focus on mortality but we've also heard today about the morbidity of preventable disease. We can be free from measles. We can be free from polio. We can be free from chickenpox. That's the freedom I'm here to talk about, and a default that the vaccination requirement, recognizing there is an individual liberty for exemption exists. Thank you, Dr. Rosfeld, Chair Schmidt. I did want to ask you, could you please elaborate again for the committee your concerns related to hepatitis B? Why is that important in a newborn? and there's a lot of questions about that because if the mother can be tested and she doesn't have it, et cetera, why is hepatitis B important in kids? I think I would like to hear you reiterate more information. Thanks. Thank you for the question through the chair. What you're describing from transmission from mother to child is vertical transmission. My understanding of hepatitis B, that's only about half, right? There's horizontal transmission being in a health care setting. So first and foremost, how the disease is transferred matters, right? It's also true that in health care there's these generations, especially around vaccine-preventable illness, right? The requirements for a newborn vaccine dates, I believe, to 1991, and so I haven't seen hepatitis B in a newborn, right? We need to remember our history. We're not seeing these things for a reason. Dr. Simani? A follow-up to Representative White. So I've been through the period prior to routine hepatitis B vaccination. Can you explain why we went to doing newborns? Instead of selective screening, we did universal screening and treat everybody with hepatitis B. Yeah, and thank you for the question through the chair. I'm reminded, of course, of the Swiss cheese model of health care. We talk about preventable harm and trying to offer these layers of protection so that there's not some through path, right? And what we're talking about in hepatitis B specifically, not just vertical transmission but horizontal, these are these additional layers that actually prevent harm. And why I'm here, why I'm standing up before you is because I'm worried about more holes being poked into the defaults that exist for a reason. Representative King? Representative King? Thank you, Chair. Are you aware that vaccine manufacturers have been granted liability protection because vaccines were deemed to be unavoidably unsafe and very likely that manufacturers likely have to stop production unless they were granted this federal immunity? Yeah, thank you for the question through the chair. It's not a source I'm familiar with. I'd be happy to follow up. Are there any other questions? I do have one, sir. Ohio law right now says that a parent has the choice to not vaccinate their children. Unfortunately, when you go to schools, sometimes they hide it. and so you can't see it. Sometimes your pediatrician will deny you access to taking care of your child unless you are given the vaccinations. Happened to my daughter. If we have the freedom as parents to decide, when does the medical community just give advice or tries to, I hate to use the term, bully a parent into making a decision they may not feel is in the best of their child? I appreciate the question, and I think I'm trying to understand this ranking of what is most important, right? What I can tell you is when I graduated, I raised my hand and took an oath, and the first thing I promised was to do no harm. What this bill proposes, taking away at the default that vaccination is encouraged, will lead to preventable harm. Hearing no more questions, we will call on Elsie Berlin. Thank you. Chairwoman Schmidt, Vice Chair Dieter, Ranking Member Dr. Samani, and members of the House Health Committee, thank you so much for the opportunity to testify today. I'll skip over my kind of professional credentials there in my written testimony. I've been a pediatrician for 23 years. I'm an adolescent medicine specialist at Nationwide Children's Hospital, and I'm here representing the Ohio American Academy of Pediatrics, which represents 2,900 pediatricians in the state of Ohio. What I really wanted to talk about today, and I just want to say that I do trust that legislators and health experts can figure out a system for kind of notification of exemptions and things like that. I don't really, I just trust that that can happen. What I wanted to do today was talk a little bit more about infection transmission and herd immunity, because it's really important to make vaccine policy that's grounded in science. And I really think in Ohio we have the opportunity to respect parental choice, help educators have clear policy, and help us protect the child and adolescent health. So the first concept is the timing of infection. And we already talked about that prodrome. But even before the prodrome, there's this asymptomatic period where young people and all people who get an infection have symptoms and may transmit that infection before they have any symptoms. So just to clarify, people may have an infection, may transmit the infection before they have any signs of having an infection. In the example of measles, the infection is so contagious that 12 to 18 people who are vulnerable can get the infection just from one exposure. The second concept, and the time is going by fast, is community immunity. We used to call this herd immunity. But I want you to imagine your community like a pasture, like a field. And people who are vaccinated are like the fence posts kind of around the field protecting that community. Every vaccinated person is a fence post kind of around that community. In the setting of an outbreak, it is really important to have the highest degree of community immunity in an outbreak. What can happen? So current Ohio policy allows school officials to remove vaccine-exempted students from school during an outbreak. And House Bill 560 removes that really important public health tool. And I'll tell you why this is a problem. First because of their lack of immunity during an outbreak unvaccinated students are at very increased risk of acquiring the infection themselves and having complications Secondly these infected students are at risk of rapidly spreading the infection around to unvaccinated and other vulnerable people And thirdly, back to our fence post example, kind of the more fence posts we have that are not strong, that increases the risk of everyone in the community to have that infection, even vaccinated people and medically vulnerable people. So thank you so much for hearing my testimony. That was very short, and hopefully the written is clearer. You did a great job. Thank you. Are there any questions that this witness? Oh, Dr. Simani? Yes. Thank you so much for coming in to testify. We've talked a lot about the vaccine injuries, and I think I'd like you to kind of elaborate on the actual statistics because I think we heard some statistics about deaths in Ohio and the compensation, the VCIP, you know, what they've shown as reported deaths across the country or over the years. If you could elaborate on that and then also on measles specifically because we're seeing outbreaks of that, the risk of whether it's long-term complications or death with the disease itself? Yeah, yeah, yeah. So I'll take the second part of that question because I'm really more knowledgeable about that, Dr. Samani. With measles, the long-term complications are deaths to one in three in 1,000 infected people. I was telling one of my practice partners yesterday that I was testifying today. She saw a five-year-old die of an extremely rare complication of measles because he had been exposed when he was an infant and had been unable to be vaccinated. So she saw a very healthy five-year-old die, a very painful death. So the 1 in 20 get pneumonia. I have the statistic here. The meningitis is 1 in 1,000 get encephalitis, and then 1 in 3 out of 1,000 die. So we don't see, I think, you know, we live in a setting where we don't see these communicable diseases prevalent because vaccines have been so successful. But now we are seeing more and more outbreaks, and I think specifically the part of this bill that concerns me has to do with school districts and, you know, educators being able to use science to guide their responses during an outbreak. Thank you. Representative Miller. and then Representative Bromley. Thank you very much, Chair. Thank you, Doctor, for coming in. Thank you for your work with our kids. Really appreciate the work that you're doing. I noticed, would you, do you utilize the CDC data as kind of your guiding factor with vaccinations and the schedule and research? You know, I use a variety of sources. I rely on the American Academy of Pediatrics vaccination schedule currently. Okay, very good. I noticed the CDC had published information recently stating that over 60% of adults age 24 and over have a waning of their MMR vaccine and that they're actually able to transmit and contract subclinical measles. I don't know if you were aware of that, but since that is the case, according to the CDC, and herd immunity requires 95 immunity, It sounds like, is that even possible in a community? It seems like it's contradictory, some of those things. So why are we treating unvaccinated children differently than no longer adults who are immune I mean those are just some of the questions I have as we talk about the outbreak and herd immunity that been discussed through this processing committee Thank you for that question Representative. I thought about that when I was preparing my testimony about, like, who are all the other people in the school who we need to be thinking about who are interacting with kids? What I can say as a health care professional, like, we have to get our MMR titers checked before we can be health care professionals. So we know how important it is to be vaccinated in a setting where we're interacting with young people. I think a question was asked earlier about what should a school do. I would, as a citizen in Ohio, I would rely on informed policy from these legislators to guide schools, to guide those kind of decisions, and with school nurses and folks, to make decisions about the staffing and the personnel during an outbreak. Yeah. Thank you. Next is Representative Brownlee. I almost called you Dr. Brownlee. Well, I would love to add that. Thank you through the chair, and thank you for your testimony. Just focusing back on to – I appreciate your analogy on fence posts. When schools are enforced, they are not allowed to make a choice as to whether or not kids who are unvaccinated or presenting with illness come into school, does that impede on the choice of those children and those parents who are medically fragile and unable to get some of these vaccines, whether it's hepatitis or measles or any of the others, to attend school safely and to be part of that community? Yeah, I will say I care for lots of people with autoimmune conditions. And these parents and the kids and their families rely on their schools to keep them safe. So I think policy needs to be guided by science in this regard and how to respond to an outbreak to protect as many people as we can from really devastating effects of illness that we don't want to see here. Thank you. Thank you for your testimony. We do have a hard stop at noon. We have three more people, so I'm going to allow these three people to give their testimony, but I'm not going to allow any question and answer. I do have, I sit on agriculture, and it's over there, and I have to listen to some testimony over there. So, and I apologize, but Olivia Safadi, how does he pronounce it? Yes, Safadi. Safadi. Well, I almost got it right. Thank you. Welcome. Thank you. Chair Schmidt, Ranking Member Samani, members of the House Health Committee, Thank you for this opportunity to testify in opposition of House Bill 561. I am Dr. Olivia Safadi. I am a second-year family medicine resident. I'm here on behalf of the Academy of Medicine of Cleveland and Northern Ohio in the interest of protecting medicine. Our organization represents more than 7,200 physicians and medical students in Northeast Ohio. We've appeared before this body several times to affirm our collective medical opinion that vaccinations are safe, effective, and critical to public health. I want to begin with a personal story. My grandmother, she contracted polio as a child just a few years before the polio vaccination was developed. She survived, but decades later, she developed post-polio syndrome. It's a condition that emerges years later after the initial infection. She lived with joint degeneration, muscle weakness, chronic pain and fatigue, as well as partial paralysis of her diaphragm for more than 20 years. Her medical journey and her strength in the face of irreversible chronic illness is the reason I chose to go into medicine We vaccinate not just to prevent illness but to prevent lifelong suffering Surviving an infection is not the same as being spared from it Many vaccine-preventable diseases leave lasting, life-altering complications. These long-term consequences are often invisible in policy decisions, although I'm glad it has been brought up multiple times. But they are very real for the patients that we care for. House Bill 561 weakens the ability of public health and school officials to protect children from preventable diseases by restricting the ability to temporarily exclude unvaccinated children during outbreaks. It increases the risk of exposure and further spread within our community. Currently, Ohio's non-medical kindergarten vaccine exemption rate is higher than the national average. This bill is not about improving access to information or transparency. Families who want exemptions are already obtaining them and at increasing rates. We should be encouraging families to talk with their doctors about their vaccine's concerns, not weakening opportunities for these potentially life-altering conversations. Additionally, the specific removal of the hepatitis B vaccine is of deep concern to us. Hepatitis B is a highly infectious virus, can be transmitted through blood and bodily fluids, conditions that do occur in child care settings. When infants and young children become infected, they are far more likely to develop chronic hepatitis B, which can lead to cirrhosis, liver failure, and liver cancer. We have a safe and effective vaccine that prevents this. Removing it reverses decades of progress against a disease we know how to prevent. Existing law already provides flexibility. House Bill 561 goes further not to improve care but to limit the ability of public health professionals to respond to outbreaks and protect vulnerable populations. Parents send their children to school with the expectation that their health and safety will be protected. This bill undermines that. We respectfully urge you to vote no against this dangerous bill. Thank you for the opportunity to testify. Thank you so much for your testimony. Now I will call on Kristen Dinkalacher. Welcome to the committee. And I have to say, I recognize, I knew right away you were from Cincinnati, but I don't know why I recognize the name. Because there's lots of Dinkalachers on the west side of Cincinnati. Yes, you are. I mean, I know. I heard the name and went, what side is Cincinnati? Yes. My husband is probably watching laughing because I tell him every single day in clinic, someone says, are you related to Pat Dinkielacker? And I start shaking my head because I know, well, when they say, are you related, I start shaking my head. I know where it's going. But anyway, we're different Dinkielackers. It's a very common Cincinnati. Anyway, welcome to the committee. Thank you very much. Thank you. Okay. So I just want to use my time as wisely as possible.
It won't be the most eloquent, but I just want to touch on some things that I heard. And I am a general pediatrician. Oh, I didn't address you. I'm so sorry. Okay. I have been in general pediatrics for 12 years. I don't, I'm not associated with an academic hospital. I don't have any leadership roles. My job is just seeing families and kids every day in clinic. And so when I saw this bill and I read it, I thought of all the unintended consequences that people may not be thinking about that are very dangerous for my patients and the children in Ohio. And maybe, you know, people just haven't thought about it, and I just want to point it out. So if you put this option to opt out and you highlight it and parents probably have to sign a form, you know, yes, I was given this option, and you call attention to it, parents are going to choose that just even for convenience sake. So they may believe in vaccines. They may want to, but parents are busy. I know it's like, oh, I'm just going to sign that. I'll get to that later when life slows down. Life never slows down. They forget about those vaccines, back of their mind, and then those kids never get their vaccine. Also, we need parents coming into the office to talk about vaccines. There is so much misinformation online, social media. Parents are being bombarded by it, right? And then your algorithm goes, and it's just this echo chamber where everything, where these facts, or not facts, what's presented as facts is not actually true. And so parents are getting that in their minds, and it's scaring them, like reasonably. like totally reasonable, it's frightening. So it gets in their minds and, you know, they're like, ah, I can see them saying, you know, I'm just going to opt out before coming to talk to their doctor. Those conversations we have in the office are very valuable. So for example, we saw it today, Representative Gross, she's not here, but she threw a very, like she dropped a bomb with that. Like, did you know that MMR has killed 105 kids in Ohio? And so people are like, wow, I didn't know that. But there's a story behind that, right? So we didn't, I can't ask her where she got that from, but I've heard this before. And where she, where people are, people hear this and they're not thinking, okay, where is this from? Where's the data? Why haven't heard before? Well, there's a system where you anybody can report adverse reactions to vaccines even parents And so you could attribute you could you could attribute that vaccine to something that happened like up to three years later It doesn mean that the vaccine caused your child to die So if a kid gets a vaccine and six months later dies of SIDS, the parent could say, vaccine, you know, I'm putting this adverse event in there. And then that goes on the numbers. So there's stories behind misinformation. And it's my job to educate parents to let them know, like, hey, this is why that's being put out there, but let me tell you the truth. Let me show you the facts. And then that's when parents get all the information. That's where the transparency comes. They have the information to make a decision that is informed. So I will say, I'm not, yeah, I have so much to say. But if you truly want transparency, do not put this on, do not put opt out, call attention to it, put it on a platter, because we need to be having those conversations, especially now with social media and misinformation. Sorry. Thank you.
Thank you. And I love your passion. Thank you so much. Michelle Bieber, you're the last one. Thank you for coming, and thank you for your patience and understanding.
So fast and cliff notes version. Chair Schmidt, Vice Chair Dieter, ranking members, Monty, and members of the committee. My name is Michelle Bieber. I am a board member of the Ohio Association of Child Care Providers I also an owner of small child care centers in Northwest Ohio I do have opposition to House Bill 561 It raises concerns for child care providers, families, and especially small businesses in Ohio. I provide care for infants, toddlers, preschoolers, school-agers, many of whom we have served that have been medically fragile or have immune vulnerabilities. Protecting the health and safety of children and families we serve is our number one priority in our center. This is also supported by the rules and regulations by DCY. There are already current laws that require children enrolled in licensed care centers to be immunized. They may qualify for three exemptions. At the same time, private child care centers maintain the right to adopt their own enrollment policies, including requirements around vaccinations, as long as these policies are communicated to families, which they are. We're required to have it in our parent handbook, and it is on the medical statements. As well, this also removes critical choice for families and providers. This is a detriment, and it's taken rights away from centers. This change would remove options for families with vulnerable children. It also affects family members who are in and out of the facility, such as pregnant mothers, grandparents, family members with morbidity issues who support the attending children This also reduces parental choice whether publicly funded or private pay It is not a one This also introduces regulatory burdens such as strict notifications that could bring in penalties, minor errors, 14-day complaint investigation timeline, severe consequences such as license removal or immediate closure. We already have issues with children getting into child care centers. This is adding another caveat. Whereas when public schools are closed, child care is very different than public school. There is a continuous money stream for public entities, whereas private entities, we don't get that continuous money stream. So we are very, very different. In conclusion, parental choice is imperative to the essential flexibility for small private businesses as me being a child care center. I respectfully ask the committee to consider removing child care centers from the bill or allowing private business centers to continue adopting vaccination policies. I appreciate your time today and consideration. Thank you.
Thank you. And thank you all for your testimony. This is a lot to consider. this concludes our third hearing on House Bill 561 and this meeting is adjourned. Thank you.