Kasich supports Medicaid growth

Plan to ease rules for coverage

2/5/2013

COLUMBUS — Despite not supporting President Obama’s health-care reforms, Gov. John Kasich announced Monday he will support an expansion of Medicaid, the program that provides health care for low-income Ohioans.

Up to 450,000 people could be covered by the expansion.

In Lucas County, about 103,000 people are enrolled in Medicaid; the expansion means an additional 25,000 people will be eligible for the program, according to the Lucas County Department of Job and Family Services.

Under the Affordable Care Act, commonly called Obamacare, states were required to expand this program to cover more individuals. But when the U.S. Supreme Court upheld the law last year, it made the Medicaid expansion optional for states.

Mr. Kasich is the fifth Republican governor to support such an expansion; he has tried to draw a distinction between expanding Medicaid and Obamacare, which he opposes.

Many uninsured Ohioans get the bulk of their health-care treatments in emergency rooms, which is not efficient, and passes costs along to everyone else, Mr. Kasich said when making the announcement Monday.

“We all pay for them,” he said. “I don’t think that is a sustainable way to do business.”

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States have a strong financial incentive to opt for the expansion — agreeing to it means millions of uninsured people will have health-care coverage, and the federal government will pay for all costs in the first three years of the program, and 90 percent of the costs in the long run. The normal federal reimbursement rate for most other Medicaid programs is about 62 percent.

If the federal government fails to live up to its side of the deal, the Kasich administration said it would its reverse position on the expansion.

The expansion would cover individuals whose income is up to 138 percent of the federal poverty level, which is about $31,800 for a family of four. Currently, some adults are only eligible up to 90 percent of the federal poverty level; childless adults aren’t eligible for the program at all.

“Given the results of the presidential election, the Supreme Court’s decision, and Washington’s inaction on real health-care reform, Obamacare is the law of the land, and Ohio needs to work to reduce its impact,” states literature associated with the governor’s budget.

A recent study suggested the state would come out ahead financially in health-care savings and in increased health-care jobs and tax revenue, and would largely break even after the reimbursement rate drops. Opponents, however, say they are against the expansion of what they consider a government entitlement program.

Many in the health-care industry, such as the Ohio Hospital Association, had pushed for the expansion.

“Accepting federal funding for Medicaid expansion means greater access to health care, economic mobility, and jobs for many Ohioans,” said Becky Williams, president of the Service Employees International Union District 1199, which represents many health-care workers.

Paramount Advantage, a member of ProMedica, applauded the decision as “it will make coverage available to many more Ohioans and reduce the $1.2 billion in uncompensated care costs for the uninsured now borne by Ohio’s hospitals,” according to a statement.

Andrea Price, president and CEO of Mercy, also released a statement that said in part: “We are pleased that Governor Kasich has included expansion of Medicaid eligibility in his budget proposal. As the front line of health care in our community, Mercy believes the expansion represents a crucial step in creating healthier communities and building a better health-care system for Ohioans.”

Advocates for low-income Ohioans also were happy with the governor’s move.

“This will allow people to get health care sooner, so they will be healthier. It will reduce costs for other Ohioans. It will make people more employable. ... People with chronic health issues can get treatment,” said Eugene King, executive director of the Ohio Poverty Law Center, which advocates for low-income issues.

“This decision will support the mother of two children who is on a four-month waiting list at a community mental health center,” said Gayle Channing Tenenbaum, a children’s services advocate and co-chairman of Advocates for Ohio’s Future.

“Today, she struggles with depression and taking care of her children,” she said. “She is hanging on to her job by a slim thread. Medicaid expansion will allow her to get the treatment she needs and strengthen her family and her chances of success at work.”

About 2.2 million Ohioans are now enrolled in Medicaid. An additional 300,000 people are estimated to be eligible, but not enrolled for a variety of reasons. Many people covered under the approximately $18.5 billion program are children and the elderly. Medicaid is the largest payer of long-term care (nursing homes) in the state, and also covers 38 percent of Ohio’s children.

Mr. Kasich said he was also supporting the expansion as a way to restore the state’s mental health safety net.

Scott Sylak, executive director of Lucas County’s Mental Health & Recovery Services Board, said he believes the expansion will likely be positive for its clients, but he is reserving judgement for the moment.

“The devil is in the details,” Mr. Sylak said.

Critics have said an expansion would have hidden administrative costs that aren’t covered by the federal government, future cuts in federal Medicaid funding could also leave Ohio covering more costs, and the program shouldn’t be broadened from a more narrow safety-net into something that covers more individuals, including childless adults.

State Rep. Barbara Sears (R., Monclova Township), the No. 3 Republican in the Ohio House, has been a major critic of the federal health-care law, and she remains wary of the Medicaid expansion.

“I want to study the Medicaid expansion further,” she said. “I have concerns about its long-term sustainability. You don’t hand over a program that can’t last but a few years. I certainly understand the upfront appeal to doing it. It seems to take care of some things by doing this in the short-term. It’s the long-term that really concerns me.”

Robert Alt, president of the conservative Buckeye Institute, said the state would be better off not expanding the program and allowing low-income individuals to use federal subsidies to purchase health-care coverage on a state exchange.

While some governors may fear changes in federal Medicaid financing will leave states on the hook for more costs, Henry Aaron, a senior fellow in economic studies at the Brookings Institution sees that as unlikely, and predicts most states will adopt an expansion in the long run.

“This is too good a deal to pass up for the state of Ohio,” Mr. Aaron said.

Blade Columbus bureau chief Jim Provance contributed to this report.

Contact Kate Giammarise at: kgiammarise@theblade.com or 419-724-6091, or on Twitter @KateGiammarise.