Last Friday, the day before Toledo residents woke up to a warning that mysterious toxins had tainted their drinking water, Ohio Gov. John Kasich (R) announced his new pick to head the state's Department of Health. Kasich's choice was bizarre, to say the least.
It wasn't just that his appointee, Richard Hodges, wasn't a doctor, as all but two of the past 30 years' Health Department directors have been. But since 2011, Hodges has served as the head of the Ohio Turnpike Commission; before that, he was a lobbyist for the state workers' compensation bureau. Even during his six years in the Ohio House of Representatives — like Kasich, he's a Republican — Hodges focused primarily on employment law, chairing the Commerce and Labor Committee.
He is not, in short, the person you hope is first on the governor's speed-dial when poisonous algae blooms permeate the water supply for Ohio's fourth-largest city.
Confronted by critics who challenged Hodges' public health record, Kasich's office produced a resume showing that in the 1990s, Hodges spent four years as the head of planning and marketing for a hospital. This still may not satisfy the Ohio law that requires that if the head of the Department of Health is not a licensed medical doctor, he or she must at least have "significant experience in the public health profession."
Look, from a public health perspective, Hodges' nomination seems nonsensical. But that's because his selection has little to do with public health — and everything to do with abortion.
For 20 years, Ohio has been an unexpected pioneer in the escalating state-level movement against abortion. Its latest innovation is a law that requires every abortion clinic to make a deal with a local hospital so that patients can easily be transferred to a hospital if an emergency arises. And here's the twist: Public hospitals are forbidden from giving such transfer agreements to abortion clinics. A relatively small number of hospitals in Ohio are public (18 out of 207, according to the Ohio Hospital Association), but they were among the most willing to give transfer agreements. Catholic Healthcare Partners is the largest nonprofit health system in Ohio, which means that since abortions aren't performed in Catholic facilities to begin with, its hospitals would reject a clinic's request for a transfer agreement out of hand. Clinics in Cleveland and Columbus have had more luck finding a willing private hospital, but in cities like Cincinnati and Toledo, there are fewer to choose from.
If clinics fail to obtain the agreement, the state now has permission to yank their license. The person tasked with determining when a clinic can be shuttered for failing to obtain a transfer agreement? Yes, the director of the Department of Health.
Hodges' predecessor, Ted Wymyslo, resigned in February, just weeks after drawing fire from both abortion-rights and anti-abortion groups for hesitating on whether to close an abortion clinic near Cincinnati. He didn't give a reason for his departure, but the director of NARAL Pro-Choice Ohio conjectured at the time that he "wasn't acting fast enough" for abortion opponents, although he did eventually close the clinic. In Hodges' nomination, some see an effort to accelerate the pace of clinic closures. "The agency has applied a legal vise provided by Republicans in charge of the legislature," wrote the Akron Beacon-Journal's editorial board on Tuesday. "In that way, Hodges seems the expedient choice, more soldier than general in advancing the agenda."
This speculation may seem paranoid, but it's not wholly without reason. Some of Kasich's other health care appointees have a clear perspective on abortion: In 2012, he tapped Mike Gonidakis, the president of Ohio Right to Life, to the state medical board.
Other governors have also realized that state health departments are powerful tools for imposing and carrying out anti-abortion regulations. After his election, Iowa's Republican governor, Terry Branstad, made a slew of new appointments to the state board of medicine — including a Catholic priest. The board subsequently voted to reverse a decision it had made three years earlier, when the pre-Branstad appointees had investigated a new system used by Planned Parenthood to dispense abortion drugs via telemedicine. The telemedicine program allowed women in rural areas to videoconference with doctors in cities to discuss their decision to have an abortion; the doctor would then virtually unlock a real-world drawer containing drugs that effectively induced a miscarriage. In 2010, the board determined the program was safe and effective. In 2013, with the new slate of appointees, they voted to shut it down.
A sympathetic medical board and health commissioner can be crucial for imposing anti-abortion legislation, as a recent battle between Virginia's Board of Health and the former attorney general, Ken Cuccinelli, showed. In 2012, the board voted to exempt the state's existing abortion clinics from a new regulation that would require them to meet new structural codes, an expensive retrofitting process that would force many of them to close. Cuccinelli pressured the board into voting again, and over the following months, the governor replaced many of the members with people who had explicit ties to anti-abortion groups.
In Ohio, abortion clinics have been fighting to keep their licenses, but many are failing. At the beginning of 2013, the state had 14 abortion providers, and soon the number could be down to seven. As more states pass anti-abortion laws that require regulatory bodies to enforce them, it seems likely that more governors will nominate people like Hodges and Gonidakis to positions of power within their health departments. In some ways, this is not surprising — after all, health department directors are political appointees, so the process has never been free from ideology. But public health is an issue that has, until recently, been relatively nonpartisan — after all, Republicans and Democrats presumably both want the citizens of their state to have safe water — and Hodges' nomination raises questions about whether, in the rush to close abortion clinics, basic concern for public health is falling by the wayside.