Ohio groups push for Medicaid expansion

Like many Republican states, Ohio is struggling to achieve agreement between the governor and the legislature on Medicaid expansion.

Ohio Governor John Kasich, a Republican, introduced his budget proposal for fiscal years 2014 and 2015, which includes a plan to expand Medicaid coverage. However, a house committee later removed the expansion provisions, and the legislature placed the issue outside of the budget process. State Senate President Keith Farber recently commented that a deal could be reached by the end of the year but not in time for finalizing the budget.

Advocates are coming out of the woodwork to help drive the state to adopt the federal health reform provision to expand Medicaid eligibility to all low-income populations under 138% of federal poverty level (FPL). Ohio could add some 366,000 residents to its rolls, including single adults without children.

“Governor Kasich’s plan is as prolife as it gets,” says Mike Gonidakis, executive director of Ohio Right to Life. “What keeps getting lost in this conversation is that most of these poor, single women work.”

Gonidakis says the new populations added to expanded Medicaid would benefit from the “basic right to healthcare.”

Federal funding

According to the Health Policy Institute of Ohio, by expanding Medicaid, Ohio would net $709 million in savings through 2022 because of higher federal match payments associated with Medicaid enrollment. It would also gain $1.8 billion in revenue in that time frame from taxes associated with managed care enrollment.

David L. Bronson, MD, president of Cleveland Clinic Regional Hospitals and past president of the American College of Physicians, says providers are concerned about losing disproportionate share hospital (DSH) payments from the federal government, which would not be offset by reduced uncompensated care if Medicaid is not expanded. The Cleveland Clinic alone would lose 75% of its DHS payments, he says.

“It’s more than just the Cleveland Clinic,” Dr. Bronson says. “Small safety net hospitals are dependent on these payments to survive.”

He also says the Ohio Medicaid system had a negative reputation, but it’s become more effective and efficient.

“A lot of good people are struggling to figure out how to do the right thing here,” he says. “There are a lot of fixed opinions, and it’s time to update people on Ohio Medicaid.”

Carol Caruso, senior vice president of the Greater Cleveland Partnership, a chamber of commerce organization, says not expanding Medicaid in Ohio will result in cost shifting to the insured and as much as $90 million a year in penalties for small businesses that do not offer insurance. The bipartisan partnership members voted unanimously to advocate for expansion, so the business community is clearly onboard, she says.

The groups don’t believe the Medicaid decision will be left up to voters as a ballot issue. Gonidakis says there are enough votes in the state house and senate to pass a stand-alone bill.