Residents to find out next week if Ohio expands Medicaid

State on the clock to make decision on health care

1/28/2013

A week from today, Ohioans will know whether the Kasich administration will expand Medicaid to allow more people to benefit from the federal health-care law.

Although there will be other elements of the Patient Protection and Affordable Care Act that will benefit residents if Ohio does not expand Medicaid, here’s what’s at stake if Ohio does not expand the program:

Many Buckeye State citizens will not be eligible for Medicaid, the national health coverage program initially established largely for those with low incomes, chronic disabilities, and elderly senior citizens. Those most affected include: some parents, childless adults, and disabled people based on certain income requirements. (See chart on Page 5). If people in these same categories lived in a state that participates in the Medicaid expansion they would be eligible for benefits.

When Gov. John Kasich introduces his two-year state budget on Feb. 4, he is expected to also announce whether Medicaid will be expanded; if so, then the bill passed in 2009 would provide coverage to many Ohio adults whose earnings are up to 138 percent of the federal poverty level.

For a family of four, the federal poverty level would be slightly less than $32,000, and for an individual, it would be $15,400 annually.

Since Obamacare became law, Americans anxious to know how it will be advantageous for them and their families have hung onto every bit of news about the topic. Many people do not have health-care coverage and among those who do, sometimes insurance companies have denied benefits to some who have pre-existing conditions and insurers have also dropped consumers who reached an annual or lifetime cap. The new bill removes those restrictions.

“Prior to this, you had a cap, but this removes those caps,” said Jan Ruma, vice president of the Hospital Council of Northwest Ohio. “As long as you don’t commit fraud, they cannot cancel your health care after you become ill or injured and they cannot limit your health care.”

Some aspects of the law have already gone into effect, such as coverage for children with pre-existing conditions, and those who are younger than 19 cannot be denied coverage. Other parts of health-care reform go into effect next year.

Among those mandates are that most people will be required to have health insurance. Also, businesses with more than 50 employees will have to provide insurance for full-time workers. Individuals and businesses that buck the requirement could face penalties.

Meanwhile, Ohio and several other states have taken issue with Obamacare, which mandates that states expand Medicaid and create exchanges — menus or lists — from which to choose health care. (Both state and the federal governments pay Medicaid costs.) However, last year the U.S. Supreme Court said the federal government could not coerce states to expand Medicaid programs or threaten those that refuse to expand with the loss of federal funding for those programs.

Aside from the fact that the Ohio governor and some of his Republican gubernatorial peers initially objected to the Medicaid expansion mandate, there were concerns that the costs to states would be astronomical. However, some of those other states — such as Arizona, Nevada, New Mexico — have since embraced Medicaid expansion.

Why? It comes down to dollars and cents: Between 2014-16, the federal government would pay 100 percent of the cost of coverage. After that, the federal government’s share would always remain at 90 percent, according to the law.

Earlier this month, the independent Health Policy Institute of Ohio revealed that expanding Medicaid would benefit Ohio because the state would realize savings in other programs, and a rise in tax collections and revenues connected with federal health-care spending. Moreover, the report said the state coffers would gain $1.4 billion more than expected during the next four, two-year state budgets.

The specifics of ACA, however, are not yet known.

“What we don’t know is what the Medicaid coverage looks like. Health-care coverages talks about basic benefits, but we don’t know if there will be co-pays, or [whether] it looks exactly like Medicaid looks like in Ohio now,” said Ms. Ruma, who is also executive cirector of Toledo/Lucas County CareNet, and a member of the HPIO board of directors.

A plus to Obamacare, however, is that health-care plans would be required to provide preventive care, such as screenings and immunizations.

HealthCare.gov contains a fairly extensive list of preventive services covered by the health care act. The Web site states that these “preventive services must be covered without your having to pay a copayment or coinsurance or meet your deductible. This applies only when these services are delivered by a network provider.”

A downside of the law could be that it might take longer to obtain doctor’s appointments because once more people have access, lines and wait times could be longer.

“We haven’t done anything to increase the capacity of the system in terms of doctors or hospital beds. By increasing access, the Affordable Care Act will bring more people into trying to access services, but the capacity hasn’t been impacted,” Ms. Ruma said.

“The biggest impact this can have on access in Ohio is whether Ohio expands Medicaid. As a result of more people having coverage and the federal government paying that portion, in the grand scheme of things, there will be cost savings,” she added.

So more waiting is expected for two reasons: Ohioans must wait to learn whether the state expands Medicaid, Ms. Ruma said. But also, “We have to wait to see what benefits packages look like.”

Contact Rose Russell at: rrussell@theblade.com or 419-724-6178.