Debate needed on Medicaid expansion

5/14/2013

Medicaid expansion is one of the most consequential decisions that Ohio has faced in years. Too often, advocates such as Blade Editor David Kushma portray expansion as a binary choice: expand or do nothing (“Drop the teacup, lawmakers, and expand Medicaid,” op-ed, May 5).

This is a false choice. Many advocates of expansion dismiss the legitimate concerns of opponents.

The expansion predominantly covers single, able-bodied adults, but it lacks the work or job-training requirements of other welfare programs. Medicaid already covers children in families that earn up to 200 percent of the federal poverty level (FPL).

Under Obamacare, families with children at up to 90 percent of FPL (96 percent for working families), and those at or above 100 percent of FPL, will still receive heavily subsidized coverage through federal health exchanges, even without Medicaid expansion. Any plan should promote work and personal responsibility for new able-bodied recipients. Expanding Medicaid does not.

Multiple academic studies indicate that health outcomes for Medicaid recipients are no better, and often far worse, than those for people without insurance. Why should we spend billions of dollars on a program that does not produce good results for those we are seeking to help?

There is no such thing as a free lunch. The Obama Administration recommended “small” changes to the enhanced federal matching rate under Obamacare that is so often cited as a reason to expand Medicaid. That idea would have cost Ohio $2.5 billion in state dollars over five years.

The administration stated that it chose not to make the change immediately, to encourage states to sign on to expansion. But there are no assurances once states agree to participate.

Ohio can opt in to Medicaid expansion, but it cannot opt out even if the federal government required Ohio to pick up more of the tab in the future. Federal law would permit withholding all Medicaid dollars if Ohio attempted to leave the program, so there will be no exit.

Now is the time for a more inclusive debate. State-based reforms can offer targeted assistance to those in need, while giving a hand up rather than a handout to the able-bodied men and women that Medicaid expansion targets.

ROBERT ALT, President

GREG R. LAWSON, Policy Analyst Buckeye Institute for Public Policy Solutions Columbus