Medicaid coverage for 715k Ohioans hangs in balance as debate rages

Gov. Kasich is arguing to keep Medicaid expansion under Obamacare, but Republicans in Congress and in Columbus have other plans.

While John Kasich crusades across Ohio and the country to save Medicaid expansion — a key pillar of the Affordable Care Act — his Republican colleagues in Congress and the Ohio Statehouse are pretty clear that they don’t like it.

In his 2017 State of the State address in Sandusky last week, Kasich recounted coming across a man on the side of the road in a rough part of Columbus.

“That guy is all of our brothers. We can’t ignore them. That’s why I’ve spent so much time fighting over this health care, because I don’t want to leave them behind. I don’t want the drug addicted to be out somewhere. I don’t want the mentally ill to be discarded, and I don’t want those chronically ill to die because we couldn’t get them care,” Kasich said. “And we are going to keep fighting on it.”

The governor’s plea didn’t move Ohio House Speaker Cliff Rosenberger, R-Clarksville, and Senate President Larry Obhof, R-Medina, to applause.

“I think in one form or the other, probably everybody up here would prefer to see it repealed or some kind of repeal and replace,” Obhof said after the speech.

When asked if they favor continuing Medicaid coverage for 715,000 Ohioans signed up through expansion, Rosenberger dodged and said: “The toothpaste is out of the tube. We’re going to continue to do everything we can to make it effective and efficient. Now last time I checked, Congress doesn’t even have a bill before them.”

Getting rid of Obamacare was a top campaign promise from President Donald Trump and a substantial number of Republicans in Congress. Fiscal conservatives view it as too costly and they say it restricts choices for Americans.

U.S. Rep. Jim Jordan, R-Urbana, a leader in the Freedom Caucus, told AM 1290 and News 95.7 WHIO this week said he is still working on a bill to repeal Obamacare. “It has been a disaster for the American people.”

Related: Kasich slams GOP health care plan; Jordan plans to release his own

While efforts to repeal and replace Obamacare are in political limbo, make no mistake, Medicaid is a big part of the debate.

Medicaid is big money in U.S., Ohio

Medicaid is state and federally funded health care program for the poor, pregnant women and people with disabilities. Nationwide, it costs $545 billion and covers 74 million Americans.

Ohio Medicaid costs taxpayers $28 billion and covers more than 3 million people. In Ohio, it pays for one of every two births, three of every five people in nursing homes, and spends roughly $48,000 a minute, said Loren Anthes, a Medicaid policy fellow at the Center for Community Solutions, a Cleveland-based research group.

The feds pick up 63 percent of the tab in Ohio Medicaid and the state covers the rest. But under Medicaid expansion, which is part of the Affordable Care Act, also known as Obamacare, the feds cover 95 percent of the cost. Ohio, which was among 31 states to agree to expand Medicaid under Obamacare, receives an additional $3.6 billion in federal funds to cover 715,000 low-income Ohioans who signed up.

Greg Moody, the Kasich administration’s point person on health care, said Ohio is open to reforms.

“We’re not saying things don’t need to be fixed. But the basic access to coverage that has recently been accomplished has had a huge positive benefit,” Moody said. “Anything that abruptly disrupts that we think is not only dangerous for Ohio but dangerous for the country.”

What’s next?

Cindy Mann, former director of Medicaid under the Obama administration, said this week in Columbus that the American Health Care Act proposed by U.S. House Speaker Paul Ryan called for fundamental changes to Medicaid as a means to finance tax credits in the replacement health care plan.

Mann said she expects Republican leaders will continue to consider changes, such as shifting from a guarantee of federal funds for Medicaid to sending a set chunk of money — either a block grant or a per capital allotment — to states. It would then be up to state officials to determine how and who to cover.

Kasich has advocated in favor of Medicaid expansion, saying it provides health care for low-income people with chronic diseases, serious mental illnesses and drug addictions.

Related: Ohio sets new 1-week limit for some painkiller prescriptions

“The expansion of Medicaid has brought health care to 700,000 people, one-quarter of whom have chronic illness and one-third are struggling with mental illness or drug addiction,” Kasich said in his State of the State address. “Expanding Medicaid has freed up expanded resources in our communities to help more people, period. We’ve strengthened local hospitals. We’re a healthier state.”

Related: Gov. John Kasich takes on drug addiction, political infighting in address

Enrollees reported that being on Medicaid made it easier to work or look for a job and their medical debt declined, according to a survey conducted by the Ohio Department of Medicaid.

Moody described Ohio as a national leader on Medicaid reforms. “We are always on offense, not defense.”

Ohio is looking to shift more Medicaid enrollees, including the elderly and disabled, into managed care and coordinated care options to save money and improve health outcomes, said Ohio Medicaid Director Barbara Sears.

And Ohio’s ability to fight the opiate addiction crisis is intertwined with expanded Medicaid. In 2015, Ohio led the nation in accidental drug overdoses with 3,050, or almost eight each day.

Related: Drug overdose deaths skyrocket in Ohio

Still, not everyone is convinced that Medicaid is the right mechanism for fighting drug addiction.

“There is much to do to improve Ohio’s tragic drug addiction issue, but Medicaid expansion is not the right path. It remains unsustainable and we need to get the power back from Washington to fix our system so it works for real Ohioans, not just the health care lobby,” said Greg Lawson of the Buckeye Institute, a conservative leaning think tank that advocates for free market approaches.

Sears and Moody acknowledge that politicos who promised to get rid of Obamacare now feel obligated to deliver on that pledge. Elected leaders are divided over Obamacare.

“The problem is it became a political ‘all or nothing,’” Moody said.

“If you could just re-brand and call it by a different name, you feel like that could solve the problem,” said Sears, a Republican and former state lawmaker.

Ohio Medicaid by the Numbers

3 million: people covered

$28 billion: annual pricetag

1 in 2: births covered by the program

3 in 5: nursing home residents covered

715,000: people enrolled through expanded Medicaid, part of Obamacare

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