Two things we know about Ohio after Affordable Care Act vote

Thursday’s vote by most U.S. House Republicans to rewrite the Affordable Care Act demonstrated two things. One is that, on health care, Gov. John R. Kasich is among the few Republican adults in the room. “[The bill],” he said in a Tweet posted after the congressional vote, “remains woefully short on the necessary resources to maintain health care for our nation’s most vulnerable citizens.”

True. But maybe that’s the whole idea, which brings up the second thing: Many Ohioans who voted for Donald Trump will likely be hurt by Paul Ryan’s plan.

The bill would, in effect, freeze Ohio’s Medicaid expansion on Dec. 31, 2019, according to a Henry J. Kaiser Family Foundation analysis. After that, it appears, Ohio could keep offering expansion coverage to low-income Ohioans – at a much greater cost to Ohio.

Under the Affordable Care Act, Ohioans eligible for coverage under Medicaid expansion, according to Ohio’s Medicaid Department, are “age 19 through 64 with incomes at or below 138 percent of the federal poverty level ($16,394 for a single adult in 2016) … [Previously], most low-income adults in Ohio were ineligible for Medicaid unless they had an income that was generally below 90 percent [of the poverty level] and also possessed certain other qualifying characteristics such as parenthood, disability or pregnancy.”

For “standard” Medicaid, the U.S. Treasury pays about 63 cents of every $1 of Ohio’s costs; Ohio pays 37 cents. But for 700,000-plus Ohioans covered by expansion, the Treasury this year 95 cents per $1; Ohio’s treasury pays 5 cents. The federal share gradually drops to 90 cents (in 2000). Ryan’s bill would end that “enhanced” federal share except for Ohioans already enrolled in expanded Medicaid.

If, despite the bill, Ohio tried to keep offering expansion coverage, Ohio would have to pay its usual Medicaid cost-share – 37 cents per $1 – not the 10 cents Ohio had expected to pay. And it’s hard to imagine the state could find enough extra in-state money to cover more (post-Ryan) expansion clients.

Ryan’s fanboys must not care that freezing Medicaid expansion could hurt Ohioans who vote Republican. Of the 700,000 Ohio expansion enrollees, about half live in counties Donald Trump carried last year. And according to Ohio Health Department data, among Trump’s counties are five with the highest rates of 2010-15 deaths from unintentional drug overdoses per 100,000 Ohio residents: Brown (Georgetown), 40.2 deaths per 100,000 residents; Montgomery (Dayton), 35.3 deaths per 100,000 residents; Clermont (Batavia), 35.2 deaths per 100,000 residents; Butler (Hamilton), 33.2 deaths per 100,000 residents, and Adams (West Union), 32.7 deaths per 100,000 residents. (The statewide death rate was 19.2 per 100,000 residents.)

“I don’t support the House bill as currently constructed,” Sen. Rob Portman, a suburban Cincinnati Republican, said after it passed, “because I continue to have concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse.”

Rep. Mike Turner, a Dayton Republican whose district includes Montgomery County, voted “no” on the bill. Among those voting “yes” were Rep. Brad Wenstrup, a Cincinnati Republican whose congressional district includes Brown, Clermont and Adams counties, and Rep. Warren Davidson, a Troy Republican whose district includes Butler County.

True, maybe Paul Ryan’s bill is all about grand conservative principles, such as a trickle-down economy, or rugged individualism. But especially in southwest Ohio, it’s hard to imagine a principle more politically sacred than the right to life – a right that implies that sick or addicted Ohioans should get the care or treatment they need. Even if they’re broke.

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