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.