Ohio’s lawmakers are studying ways to change Ohio’s Medicaid program so that it can operate efficiently under new federal standards. But there’s a disagreement on how to do that. Some advocates want to expand the current Medicaid system so that thousands of low income Ohioans can get medical care. They want that expansion as part of the state budget but that doesn’t look likely. So what are the options for Ohio if it doesn’t follow through with Medicaid expansion? Ohio Public Radio’s Jo Ingles takes a look at that question.
If you talk to Republican Senate President Keith Faber, he’ll tell you up front that he doesn’t think the current Medicaid program works well. And he’s not alone. Republican lawmakers who lead the house and senate don’t want to expand Medicaid as part of the Ohio budget. Many of them say they don’t want to throw good money into what they consider a flawed government program. So lawmakers are asking the federal government for a waiver to give the state more flexibility to “reform” the program. Make no mistake…Senator Faber says lawmakers are not saying “no” to Medicaid expansion….they are saying “no” to it as part of the new two year state budget.
Faber: "We believe that there’s a path to Medicaid reforms that covers people who need it in the short term while reducing costs in the long term. Our focus is clear. Any Medicaid proposal must include systemic Medicaid reform and flexibility from the federal government that allows us to have a system that works for Ohio. Preferably this is a reform that allows us to provide more services to more individuals for less money."
Faber and Republican lawmakers would like to see a plan that allows low income Ohioans to use federal dollars to purchase health coverage through private insurers as part of a reformed program rather than simply enroll in the current Medicaid program.
Backers of the current plan to expand Medicaid as part of the budget say it would extend the federal health care coverage to 366 thousand low income, working Ohioans who do not have health coverage.
Cassandra Barham of Cincinnati is one of the people who might benefit. She says she cannot afford health insurance now. That’s not to say she’s not getting treatment for her high blood pressure. She is. It’s just that she’s doing it in the least cost efficient way….in a hospital emergency room instead of a doctor’s office or medical clinic.
Barham: "I really avoid going until I need to and that’s not fair. Because when I go in, they already know my blood pressure is high. And they won’t take care of me. The first thing they say is emergency room for them to give me the medication there yet not give me a prescription. Does that still help? No."
Indeed, doctors and hospital lobby groups say they want Medicaid expansion to include people like Barham. Hospitals, in particular, fear that if that expansion doesn’t happen, their federal reimbursements will decrease in the future, forcing the closure of hospitals, especially those in rural areas.
John Begala with the Center for Community Solutions is one of the people who have been leading the charge for Medicaid expansion as part of the state budget. At least he’d prefer it that way. But he says he’s realistic that if it doesn’t happen that way, it could possibly work the way state lawmakers are trying to do it.
Begala: "We are quite supportive and very flexible on this. And as early as last summer, our organization was promoting looking at options that include market based options so I think what the Kasich administration is pursuing makes a lot of sense. It makes special sense for Ohio."
Still, Begala says while his group is practicing patience and giving lawmakers time to make the reforms they want, he’s not willing to wait forever. He says if they don’t do it by the end of this year, his group is looking at another alternative….letting Ohio voters decide whether to expand Medicaid.
Begala: "We’ve retained legal counsel to advise us on the process of getting to the ballot, either through initiative or referendum in a statutory or constitutional change."
If it does come down to that, Begala has reason to hope Medicaid expansion will pass at the ballot box. A recent Columbus Dispatch poll shows Ohioans approve of expanding Medicaid 62 to 29 percent.
But those who don’t like the idea of Medicaid expansion say a vote by Ohioans two years ago proves otherwise. That’s when Ohioans voted, nearly two to one, for a constitutional amendment, proclaiming the state is exempt from the new federal mandate that virtually everyone have insurance.