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Ohio health-law reaction draws fire

Kasich administration accused of playing politics on implementation

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COLUMBUS — Armed with a U.S. Supreme Court decision upholding its constitutionality, supporters of President Obama's health-care law accused Gov. John Kasich's administration Friday of playing politics when it comes to implementing the law.

Lt. Gov. Mary Taylor, who doubles as state insurance director, told reporters on Thursday that the administration is "leaning" toward not setting up its own marketplace for uninsured Ohioans to shop for what they hope will be more affordable policies. The state instead may default to the federal government to impose one on Ohio.

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The state has until Nov. 16, less than two weeks after the presidential election, to tell the federal government what it plans to do.

"The reaction had more to do with corporate interests and politics than it had to do with implementing the law," said Brian Rothenberg, executive director of the liberal Progress Ohio, at a gathering of about 30 people in downtown Columbus.

"It is time to come together to implement this this fall," he said. "It is time to stop the rancor that has divided this nation and state. … The law will be on the books regardless of who's in the White House. It is very unlikely there will be 60 votes in the Senate to change this law."

The court upheld the bulk of the law, including its most controversial provision requiring that nearly all Americans acquire health insurance. But it struck down one of the sticks that the federal government hoped to use to keep states in line when it comes to expanding eligibility under the federal-state insurance program of last resort, Medicaid.

The court said the federal government cannot withhold existing Medicaid funding from states that refuse to accept the program's expansion, despite the fact that the federal government promises to pick up most of the tab.

Ohio is balking at additional costs, particularly for the estimated nearly 400,000 Ohioans who are already eligible for Medicaid but, for a variety of reasons, have never enrolled. Now mandated to buy insurance or face penalties, many would be expected to finally enroll.

The extra federal subsidies under the health-care law might not cover those who are already eligible under prior law.

The state estimates that it will have to pay $369 million more a year for those new enrollees even before the planned expansion of Medicaid eligibility to 133 percent of the federal poverty level. It figures the state's Medicaid costs will climb to $665 million by 2018.

"Clearly, the governor and I are frustrated in this decision," Ms. Taylor said Thursday after the ruling. "We're frustrated with the additional cost and the additional spending it's going to force on Ohio. We just came through a tough budget where we closed an $8 billion shortfall.

"Quite frankly, from our perspective, here we go again," she said. "We feel like the wind is in our face. We are concerned that this could cripple the recovery that we are experiencing here in Ohio."

Minority Democrats have introduced identical bills in the Ohio House and Senate to implement exchanges, but neither has seen a vote.

Sen. Mike Skindell (D., Lakewood), sponsor of the Senate bill, said the state would be better off creating its own exchange rather than relying on a one-size-fits-all federal solution.

"The state would determine how much consumer protection is involved in it," he said. "Who will run the exchange? A private entity? A public entity? Do you want minimum coverage or do you want something to address the health and insurance needs of our own citizens? It should be tailor-made for your state."

The bills would create the exchange program and the agency and board of directors that would manage it. Its mission would be to accept, review, and rate health plans and to provide a menu of choices before the individual mandate takes effect on Jan. 1, 2014.

Individuals could compare plans and enroll via a Web site and a toll-free telephone number.

The agency would initially be funded with the help of the federal government. Ultimately, Mr. Skindell said, it would be funded by fees charged to participating insurance companies.

Ms. Taylor has estimated that the state's annual cost to run such an exchange would be $43 million.

The board would consist of the Ohio superintendent of insurance, the director of Medicaid, director of health, and an actuary, economist, employee benefits specialist, and representatives of labor, consumers, and small businesses, all appointed by the governor.

Members of the board could receive up to $60,000 a year plus expenses.

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

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