Tuesday, May 22, 2018
One of America's Great Newspapers ~ Toledo, Ohio

David Kushma

COMMENTARY

Ohio's medicaid expansion needs to continue

Gov. John Kasich heard the question again last week, during a visit to Georgia for the presidential campaign he has yet to announce.

Whether the question is posed defiantly or politely, its essence remains the same: How can a Republican governor, especially one with White House aspirations, rely on the Affordable Care Act — that is, Obamacare — to expand his state’s Medicaid program of health coverage for poor and disabled people?

Mr. Kasich told his audience that the expansion will save Ohio money, the Atlanta Journal Constitution reported. Then he added: “My [other] choice in that decision was to ignore some of the most vulnerable people in our population. I’ve been criticized for this decision. Do you think it bothers me? It doesn’t.”

But even as the governor defends his smart and compassionate Medicaid policy to Republicans across the country, state lawmakers of his own party seek to repudiate it — if not directly, then by imposing harsh new conditions on eligibility that would hurt many of the people the expansion is intended to help. I presume Mr. Kasich is paying attention to this attempted Statehouse sabotage while he’s on tour.

The Medicaid expansion, funded by federal dollars, is one of Governor Kasich’s most important achievements, despite his standard-issue criticism of Obamacare. Since it took effect last year, it has made health care available to nearly a half-million more Ohioans, most of them working-poor, who can’t afford private insurance. Medicaid now covers almost one of every four Ohioans.

Because of this broadened access to primary care, pilot programs suggest, Ohioans’ health is improving. High blood pressure and diabetes are managed better. The use of expensive hospital emergency rooms for routine care is down.

Treatment for drug addiction is more widely available. And contrary to the notion that wider coverage creates a sense of dependency, the average length of Medicaid enrollment is nine months.

As the governor repeatedly points out, Medicaid reforms tied to the expansion are cutting costs within Ohio’s program. The expansion is stabilizing finances for hospitals and other medical providers across the state, as they reduce their expenses for unpaid charity care. It also is restraining the growth of health-care costs for those of us who are fortunate enough to have private insurance.

At the brink

But all these good things are in jeopardy, because lawmakers could end the Medicaid expansion next month. Or they could agree to preserve it in the new two-year state budget that takes effect July 1. The budget bill approved by the state House maintains the expansion.

An alternative is approval by the obscure state Controlling Board — the course Mr. Kasich pursued two years ago, when the Republican-dominated General Assembly balked at the initial Medicaid expansion. Some Senate leaders evidently would prefer to remove the issue from the budget and dump it on the Controlling Board again, even though the House budget discourages a return to the board.

One way or another, the expansion needs to continue. Scott Borgemenke, the senior vice president of advocacy for the Ohio Hospital Association, says he is “cautiously optimistic” that it will be renewed in the coming weeks.

“But we’re being vigilant in trying to fight back our frustration,” Mr. Borgemenke told me late last week. “People aren’t talking about this issue anymore. They think it’s the accepted policy of the state, and they don’t know why it’s being revisited. We kind of feel like we’re shadowboxing.”

If the Medicaid expansion rolls on, the governor must reject any effort to blunt its gains and create further obstacles to health care through unnecessary legislative restrictions that are based on politics rather than sound policy.

Medicaid proposals in the House budget, misnamed “Healthy Ohio,” would require individuals and families (including children) covered by the expansion, and some other recipients, to pay monthly premiums into “Buckeye” health savings accounts, on top of current co-payments for basic medical services. That could price many of the poorest recipients out of the market.

The House plan would impose annual and lifetime limits on coverage that a catastrophic illness could wipe out. There supposedly would be exceptions, but they are vaguely defined.

The initiative would deny Medicaid coverage for a year to anyone who misses a payment or fails to file paperwork on time; that provision doesn’t spare children. Imagine what such a delay could do to a pregnant woman who seeks prenatal care, or to someone with a serious illness that requires immediate treatment.

The proposal would create an expensive and difficult bureaucracy for the state to manage. It would unjustly penalize recipients who don’t have bank accounts.

And as the liberal advocacy group Policy Matters Ohio notes, federal Medicaid regulators might not approve these new mandates. If that happens, the expansion itself could be threatened.

Whose responsibility?

The Republican sponsors of these measures offer the old saw that they would promote “personal responsibility” and encourage Medicaid recipients to work. But as Ohio Medicaid Director John McCarthy has observed, most clients added during the expansion already are working or are excused from doing so. Of the rest, most have serious physical or mental health issues that would keep them from working.

The effect of these so-called reforms would be to cancel many of the gains of the governor’s Medicaid expansion. The Center for Community Solutions estimates that the new rules could deny coverage to hundreds of thousands of Ohioans.

John Corlett, the center’s president — and a former state Medicaid director — said in an analysis this month of the House plan: “It’s not clear what objective of the Medicaid program the Healthy Ohio proposal would advance.” He called the initiative “a new, costly, complex, and punitive program, which will harm the health and well-being of ... Ohio children and adults.”

Mr. Kasich sounded an uncertain trumpet when he included in his proposed budget new $20-a-month premiums for some Medicaid recipients who live at or just above the poverty level. He needs to push back now against allowing the House provisions to become part of the final budget.

This legislative back-and-forth has implications for Ohioans far from the artificial environment of the Statehouse. Both the governor’s budget and the House version, defying the goals of the Medicaid expansion, would reduce coverage for some poor women who are pregnant, who seek family planning services, or who seek treatment for breast or cervical cancer.

Ohio’s infant death rate remains among the highest in the nation. For black babies, our state’s rate is the worst. At times since the turn of the century, the infant mortality rate in Lucas County has exceeded the statewide average.

Expanded access to care for mothers and their babies would reduce the number of premature and low-birth weight babies. That saves a lot of money that otherwise would be spent on costly treatment later on. But the champions of personal responsibility in Columbus want to take us in the opposite direction.

The Medicaid expansion was, and remains, the right thing to do. It needs no apologies from anyone, least of all Governor Kasich. Instead of repealing it by degrees, Statehouse politicians need to maintain and strengthen it. That — not tiresome us-against-them rhetoric — is essential to Ohio’s progress.

David Kushma is editor of The Blade.

Contact him at: dkushma@theblade.com or on Twitter @dkushma1

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