Ohio Senate GOP releases Medicaid plan

Republican proposal does not resemble governor’s

10/11/2013

COLUMBUS — Ohio Senate Republicans on Thursday unveiled their long-awaited Medicaid reform plan, but it has no resemblance to Gov. John Kasich’s proposal to expand eligibility under the new federal health-care law.

The GOP governor, meanwhile, is looking at a possible end-run around recalcitrant legislators of his own party by turning to a seven-member legislative panel that might be able to loosen the state’s purse strings to make expansion happen.

State Sen. Dave Burke (R., Marysville) introduced a bill setting broad goals of keeping annual growth in health-care costs below 3 percent, calculated per patient per month, and improving results for patients from the taxpayer-funded health-care they receive. It also would create an oversight panel to work with lawmakers and the governor’s office to meet those goals.

While the proposal doesn’t factor in the additional 275,000 or so people that Medicaid expansion would bring into the system over two years, the reforms would apply to that population if expansion occurs. Medicaid is the federal-state health insurance of last resort for the poor, disabled, and infirm.

“Whether or not Medicaid expansion occurs by any means is a separate issue,” Mr. Burke said. “However, bending the cost curve of Medicaid is always solid policy.”

The bill establishes broad goals, but does not give the new legislative Joint Medicaid Oversight Committee teeth to force changes in Medicaid services, health-care provider rates, or bureaucracy to make it happen.

Mr. Burke, a pharmacist whose district stretches as far north as Sandusky Bay, previously had an ally in a Senate Democrat, Sen. Capri Cafaro of Hubbard. But she has since introduced her own bill combining similar reforms with expansion.

“I do not believe, nor do statistical models suggest, that reform can fully be effective in the absence of including expansion,” Ms. Cafaro said. “Furthermore, I chose a much more detailed approach to the issue, while Senator Burke has elected to employ a more broad-based framework.”

Mr. Kasich has bucked his own party in pursuing Medicaid expansion, despite his oft-stated personal opposition to the Affordable Care Act, often called Obamacare. He decided that Medicaid expansion makes sense for Ohio, particularly because the federal government promises to pick up all of the expansion-related costs for the first three years before gradually reducing reimbursement to 90 percent.

Expanding eligibility to mostly childless, working-poor adults earning up to 38 percent over the federal poverty level, about $32,000 a year for a family of four, is expected to draw about $13 billion in federal dollars to Ohio over seven years.

Senate President Keith Faber (R., Celina) said he believes Mr. Kasich has the authority to turn to the Ohio Controlling Board, consisting of four Republican legislators and two Democrats and led by Randy Cole from the GOP governor’s Office of Budget and Management.

Assuming Mr. Cole and the two Democrats go along with the plan, Mr. Kasich would have to sway at least one Republican.

“I’m certainly a defender of legislative rights, and I would think a better solution would be a legislative option, but the governor does have that authority,” he said.

This would represent the broadest reach to date of the board’s authority to move money around and would likely invite a lawsuit.

This week, an expansion bill introduced months ago by Rep. Barbara Sears (R., Monclova Township), was re-referred to another committee to jump-start hearings. But a vote by the controlling board could render her bill moot.

“Ideal? Maybe not, but the controlling board is a good option,” she said. “Certainly, the legislature has affirmed that the governor has the authority to do it. The legislature created the controlling board and gave it its authority. Legislators sit on it.”

In the meantime, there’s still Plan C, a proposed voter-driven law to expand eligibility, for which petitions are already in the field.

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