Lisa Bernard-Kuhn reports:
Countless health care groups and non-profits applauded Gov. John Kasich’s decision Monday to expand Medicaid coverage to hundreds of thousands low-income Ohioans under his proposed two-year state budget.
The move positions Ohio among a growing contingent of Republican-led states that are leaning toward extending coverage, an option given to states under the federal Affordable Care Act, the law dubbed Obamacare and opposed by most GOP officials.
The proposal will now be up to Ohio’s legislature to decide. That means Kasich will have to get to work converting members of his own party in order to bring $13 billion in federal funds to the state and extend coverage to at least 275,000 additional low-income Ohioans.
“I am not a supporter of Obamacare,” Kasich said Monday, “but I think (Medicaid expansion) makes great sense for the state because it will allow us to deliver care using our dollars for people who, up until now, haven’t been able to afford (healthcare insurance) through their job, or they were not able to find a job.”
About 2.2 million Ohioans currently have Medicaid coverage.
Kasich estimated that at least 275,000 more Ohioans would be eligible under the expanded program. But other estimates show as many as 600,000 Ohioans could be eligible.
Another 300,000 Ohioans are expected to fall into a category officials call the “woodwork effect”: People who are currently eligible but not enrolled and expected to sign up in the coming years. The federal government would not be on the hook for covering the costs those individuals, officials have said.
In Hamilton County, at least 38,000 adults would meet the new income guidelines. Among them is Dennis Gaitskill of Over-the-Rhine. The 53-year-old is a resident of the Jimmy Heath House, a facility operated in part by Greater Cincinnati Behavioral Health Services. The non-profit serves local residents battling alcohol addiction and homelessness.
In two years Gaitskill has lived at the house, he says the facility has helped coordinate his medical care and is helping him find a job. But without Medicaid, or an employer to help cover his health insurance costs, he’s had to lean on local clinics in lieu of a primary care doctor. He often goes without some pricier prescriptions. He also has to wait months for test results that would otherwise take a just days to get back from a primary physician.
“Now, I just get lost in the system,” he said.
Under the expanded program, 80 percent of Jimmy Heath’s 80 clients would be eligible for Medicaid.
“It’s going to be huge for our folks,” said Gregg Pieples, program director at Jimmy Heath. “At least 18 percent of them have a cancer diagnosis. As it stands now, many are still going to the emergency room to get care.”
The expanded program “deserves thoughtful consideration by the legislature,” said House Speaker William G. Batchelder, R-Medina, who has opposed the Affordable Care Act.
“I believe the governor’s plan is put together in a context which has as great of an appeal as we are going to see in the face of the newly enacted federal healthcare law” he added.
Under the program, Medicaid coverage will be expanded to adults living at 138 percent of the federal poverty level, or about $32,000 per year for a family of four and $15,400 per year for an individual. Currently, Ohio’s Medicaid program covers adults and their dependents at 90 percent of the federal poverty level and does not cover single individuals or childless adults. A family of four earning $20,745 or less qualifies for current coverage.
The move will also bring $13 billion in federal money into the state, tighten the safety net for those with mental illness and keep people from using the emergency room as their primary care, Kasich said.
Col Owens, co-chairman of Ohio Consumers for Health Coverage, said the move will make it “possible for the system to do the right thing” and improve that way Ohioans get care.
“It will dramatically reduce the cost-shifting that goes on now, where consumers are paying for the care of uncovered people,” he said.
As with all states choosing to expand Medicaid, the federal government will cover 100 percent of the program for three years for the newly qualified individuals. After that, the federal government would cover 95 percent and phase down to 90 percent.
One wrinkle in Kasich’s proposal is a so-called “trigger” that will allow Ohio to roll back the extension if the federal government changes its financial commitment.
“We would prefer that was not in there,” Owens said. “We think this … should get thorough debate, if that time should come, by the public officials who are elected at that time.”
The trigger could quell some opponents who have argued that expanding the program would put Ohio on the hook for covering the increased costs, should the federal government withdrawal its financial commitment.
Still, opponents have other qualms too. Many have argued that an expanded Medicaid would only further overwhelm an already broken system. “Increasing the number of Ohioans on the rolls of Medicaid is not real health care reform and will ultimately trap Ohioans in a system that badly needs patient-centered reform,” said Seth Morgan, policy director for Americans for Prosperity Ohio.
Medicaid, as it has been in the past, consumes the largest chunk of Ohio’s budget with $21.46 billion in spending proposed in 2014 and $23.64 billion in 2015.
Proponents of the plan say the expansion more than pays for itself over time with a nine-to-one return on the state’s investment. While Ohio would be on the hook for spending $2.5 billion more between now and 2022, it would net about $4 billion in savings and new revenue, according to a report from the Health Policy Institute of Ohio.
Some of the new revenue, about $17.5 billion, would come from individual’s earnings from thousands of new health care jobs. Another 41.8 billion would be collected from sales and insurance taxes paid on Medicaid-managed care premiums.
If approved by the legislature, the extension would go into place by January 2014.