Medicaid expansion hitting snags

Ohio lawmakers would need to have bill to Kasich by October

Ohio Gov. John Kasich.

COLUMBUS — If Republicans in that state up north can do it, why not Ohio, supporters of Medicaid expansion asked on Wednesday.

“Are we going to allow $13 billion in federal monies to leave Ohio and go to Michigan?” asked Terry Russell, state executive director of the National Alliance on Mental Illness. “As a Buckeye and an Ohioan, I can’t bear the thought.”

Gov. Rick Snyder this week convinced his GOP colleagues controlling the Michigan Legislature to send a Medicaid expansion bill to his desk.

But fellow Republican Gov. John Kasich has been unable so far to do the same in Ohio.

While stressing that he opposes the Affordable Care Act, Mr. Kasich has bucked conservative elements of his own party by backing expansion of eligibility for the federal-state health coverage of last resort to those earning as much as 38 percent over the federal poverty level. That’s about $32,000 a year for a family of four.

But there appears to be little momentum for Ohio GOP lawmakers to get an expansion bill to Mr. Kasich in October, the general timeframe offered by the administration to have the expansion up and running by the start of the 2014.

The expansion would add an estimated 275,000 people, 18,356 of them in Lucas County, onto the rolls over two years, the vast majority of them working adults without children.

The federal government has promised to pick up the entire tab of the expansion for the first three years with the reimbursement rate gradually dropping to 90 percent after that. That’s expected to bring in $13 billion in federal funds over seven years.

Among those speaking out for the expansion as a way of helping people with medical or mental health issues to become or remain productive members of society was Maurice Clarett, the former running back for Ohio State University’s football team who ran the winning touchdown in the 2002 championship game.

After his attempt to enter the NFL draft after his freshman year was blocked in court, he spent time in prison for robbery and weapons convictions before having a brief career in the United Football League.

Clarett was eventually medicated for depression, addiction, and other problems.

“It isn’t to excuse anything I did when I was at Ohio State or to excuse the behavior that I had,” he said. “It was something that I realized that I was in denial about. … In the urban community especially, you don’t want the stigma.”

Darneatha Steward of Toledo, a mother of three, credited her Medicaid-supported treatment with local New Concepts for keeping her family together.

“I wasn’t being a mother,” she said. “My oldest daughter was the mother. She was there cooking, cleaning, putting the kids to bed while I laid passed out. ... I knew I had to do something quick.”

Legislative hearings on Medicaid over the summer have been infrequent. Meanwhile, a number of competing bills have been introduced that would tie expansion to cost-containment, work incentives, and other reforms that might require waivers from federal rules.

Michigan’s bill also depends on federal waivers.

Two conservative think tanks, the Buckeye Institute for Public Policy Solutions in Ohio and the Mackinac Center for Public Policy in Michigan, warn against counting on waivers to restrain costs.

Even if approved, waivers would be temporary and vulnerable to court challenge, they said.

“The decision to curtail what will have become an entitlement program, removing hundreds of thousands of recipients from Medicaid rolls, will necessarily be difficult to execute — even if the federal government has not delivered on a promised or hoped-for waiver,” their joint study reads.

Contact Jim Provance at: jprovance@theblade.com or 614-221-0496.