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Medicaid expansion obstacle for Ohio House budget

State lawmakers' plans on collision course with Kasich

COLUMBUS — House Republicans on Monday threw up a bureaucratic obstacle for Gov. John Kasich’s administration to get around to access the state’s share of the cost of expanding Medicaid under the endangered federal health-care law.

A proposed two-year budget, passed by the House Finance Committee, heads for a full House vote today. Two Democrats joined most Republicans in support of the bill while a single Republican voted no.

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The Ohio budget is working its way trough the statehouse.

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It would put the state’s matching share in a separate fund and then require the administration to seek approval every six months from the Ohio Controlling Board, a quasi-legislative budgetary panel, to release its match to the billions drawn down in federal funds. 

That was the same panel that Mr. Kasich used in 2013 to do an end-run around fellow Republicans in the General Assembly to first implement the expansion.

The federal government currently picks up 95 percent of the tab, but that will gradually drop to 90 percent by 2020.

Release of the money would be conditional upon the state seeking approval from the federal government of new work requirements within the expansion population as well as for a co-premium plan proposed by Mr. Kasich.

House Bill 49 does not include a controversial proposal floated by conservatives that, if adopted, would have marked the beginning of the end for the Medicaid expansion.

The amendment would have prohibited the program from adding uninsured people to its rolls above the more than 700,000 it already serves.

Those who would have been dropped off the rolls because their income had increased would not have been able to return later if they lost their jobs or their income dipped again.

“We felt it would more than likely been held up in courts because of treating the same class of people differently,” said Rep. Ryan Smith (R., Bidwell), chairman of the House Finance Committee.

In addition to putting House Republicans on a collision course with their own governor, adoption of that amendment would have had ramifications throughout the budget where Medicaid has supplemented mental health, drug and alcohol treatment, and other services.

The GOP-controlled General Assembly has never directly approved the expansion, but it has provided enough Medicaid funding to cover the tab.

While that’s true again with this latest plan, this time the budget would require the state to seek federal approval to enforce work mandates on the expansion population. Exceptions would include those older than 55, considered medically fragile, in school, in job training, or in substance abuse treatment.

Democrats tried to extend the exemption list to military veterans, pregnant women, and new mothers up to a year after giving birth.

The Senate will get its turn at the budget next. A final plan must reach Mr. Kasich’s desk by June 30.

The governor and GOP leaders in both chambers have agreed to reduce Mr. Kasich’s $66.9 billion, two-year general fund budget by $800 million. The House plan would punt at least part of that problem to the Senate.

“All I could find in cuts was $360 million...,” Rep. Alicia Reece (D., Cincinnati) said. “I came with a shortage of $437 million ... I’m not confident that the Senate can make all the decisions.”

The bill eliminates Mr. Kasich’s tax reform plan that would have traded higher taxes on sales, tobacco, and shale oil and natural gas production for another income tax cut.

It does provide for a sales tax break on prescription eyeglasses and contact lenses. The committee, however, reversed position on extending the sales tax to online hotel bookings via online agents like Expedia and Travelocity. 

The tax was added to the budget bill last week but was removed Monday before the final vote.

The House plan offers $90 million more over two years in basic aid for K-12 schools, but roughly half the districts are still expected to see cuts as a result of dropping enrollment.

The committee added some protection for growing school districts whose growth in aid would be capped at 5.5 percent, providing some compensation if the same districts are slated to see cuts related to the state’s continued phaseout of replacement revenue an unpopular business tax repealed a decade ago.

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

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