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Economy and Business


Ohio lawmakers explore their Medicaid expansion options
If Medicaid expansion isn't in the state budget, it could end up on the state ballot
by WKSU's STATEHOUSE CORRESPONDENT JO INGLES


Reporter
Jo Ingles
 
Ohio Senate Pres. Keith Faber says Republicans are looking at alternatives to expand Medicaid.
Courtesy of State of Ohio
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In The Region:

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.

Gov. John Kasich wants to expand Medicaid as part of the state budget so thousands of low-income Ohioans can get medical care, but that doesn’t look likely.

Ohio Public Radio’s Jo Ingles looks at what other options lawmakers are considering.

INGLES: On Medicaid expansion options 101

Other options:
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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 say they don’t want to throw good money into what they consider a flawed government program.

So the lawmakers are asking the federal government for a waiver to give the state more flexibility to “reform” the program. Sen. 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. 

“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,” Faber said.  “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.

Buy private insurance 
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 rather than simply enroll in the current Medicaid program.
Backers of governor's plan to expand Medicaid say it would extend the federal health care coverage to 366,000 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.
She is getting  treatment for her high blood pressure -- in the least cost effective way— in a hospital emergency room instead of a doctor’s office or medical clinic.

“I really avoid going until I need to and that’s not fair,” Barham, “because when I go in, they already know my blood pressure is high.  And they won’t take care of me.”

Pressure from care-givers
Doctors and hospital 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 hospitals, especially those in rural areas, to close. 

John Begala with the Center for Community Solutions is one of the people who has been leading the charge for Medicaid expansion as part of the state budget. But he says he’s realistic; if that doesn’t happen, he says it could work the way state lawmakers are trying to do it. 


“We are quite supportive and very flexible on this,” Begala said. “And as early as last summer, our organization was promoting looking at options that include market-based options." Still, he says, "I think what the Kasich administration is pursuing makes a lot of sense. It makes special sense for Ohio.”

Patience, but not to default
Still, Begala says while his group is giving lawmakers time to make the changes 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. 

“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,” Begala said. 

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 has insurance.

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