Ohio lawmakers this morning will begin hearing testimony on Gov. John Kaisch’s proposal to expand Medicaid eligibility over the next two years to about 366,000 Ohioans with incomes slightly above federal poverty guidelines.
The proposed expansion, included in the governor’s biennial budget unveiled last week, has the backing of most state Democrats, business groups, labor unions and medical associations who say expanding Medicaid under President Barack Obama’s signature health law would fill state coffers with federal dollars while providing health coverage for a large swath of the state’s 1.5 million uninsured.
Still, some members of the Republican-dominated legislature continue to raise concerns that the federal government might renege on its pledge to cover most of the cost of expansion, while others reject the notion of adding to the government’s already onerous $16.4 trillion national debt.
“I think it would be a big mistake to assume it (Medicaid expansion) is automatically going to go through,” said Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association, whose group has been lobbying for expansion as a way to reduce the approximately $1.2 billion that Ohio hospitals spend each year for providing care to the uninsured.
The expansion of Medicaid to adults earning $15,415 or less a year would cut the number of Ohio uninsured by about 457,000 by 2022, while generating about $13 billion in federal spending over the next seven years, according to the governor’s budget.
‘Being fiscally responsible’
Despite the potential benefits, Bucklew said he continues to receive calls from local lawmakers expressing reservations about expanding Medicaid. And he expects those concerns to be part of the legislative debate.
“I think you’re going to hear a lot of questions, and you’re going to see the debate move in a couple of different directions,” he said, referring to the hearings on Medicaid before the House Finance Committee. “I don’t think it’s a done deal yet.”
State Rep. Ross McGregor, R-Springfield, a member of the finance committee, said he simply wants to make sure the governor is being fiscally responsible.
“It’s not that I have a problem with expanding Medicaid, I just want to make sure it can be done in a fiscally responsible manner that will not burden the state in the coming decades,” he said. “My main concern is that the state is going to be able to financially support the expansion as the federal government lowers their reimbursement.”
He said the federal government’s commitment to cover 100 percent of the cost of expansion during the first three years beginning in 2014, then gradually reducing its contribution to 90 percent by 2020, offers him little reassurance.
“For the federal government to guarantee something; you’ve got to take that with a grain of salt,” McGregor said. “I would be shocked if that were not a line of heavy questioning (during the Medicaid hearings) in terms of what are we installing to protect the state should the federal government not live up to what they’re committing.”
Are there guarantees
Kasich has included an opt-out trigger that would shut down the Medicaid expansion if the government does not live up to its end of the bargain.
But that would be easier to say than to do, said state Sen. Peggy Lehner, R-Kettering, who will be among those legislators next to hear the Medicaid debate when it moves from the House. She noted that government benefits are rarely taken away once they’re appropriated.
“Once you provide this coverage, how do you take it back?” asked Lehner. “People get used to having it, and it becomes difficult to take away from people, especially when they’ve been paying for it” with tax dollars.
Like many of her House counterparts, Lehner said she’d be looking for stronger guarantees of federal funding.
“I think general consensus is that if it stays as it is, it’s almost a no-brainer” to expand Medicaid, she said. “But I think all of us are going to be looking for assurances that we haven’t bought into what appears to be a bargain today only to discover that it is unaffordable tomorrow.”
To hear Republicans even consider expanding Medicaid under the health care law might seem like a contradiction for the party that overwhelmingly opposed it. But Kasich, one of six Republican governors to support a Medicaid expansion, has insisted his decision is not an endorsement of the health care overhaul.
Instead, he said he simply wants to leverage federal dollars that would otherwise go to other states if Ohio does not participate in the Medicaid expansion.
“Whenever federal resources are being distributed to the states — and there’s nothing we at the state level can do to prevent that spending — then Ohioans shouldn’t be robbed of their fair share,” Kasich wrote last week on the conservative website RedState.com.
Still, supporting a Medicaid expansion must be “a bitter pill to swallow” for Kasich and his Republican colleagues, said Bryan Marshall, a political science professor at Miami University.
The risks to expand
“This is basically a major pillar of Obamacare that Kaisch is embracing,” he said. “But the political winds have changed, and because of that, I think you’re going to see an increasing number of Republican governors find ways to embrace the expansion of Medicaid.”
Despite their political leanings, Marshall thinks most Republican legislators will eventually line up behind a Medicaid expansion, at least in part, because they do not want to appear appear cold and uncaring — the way Obama portrayed his Republican challenger Mitt Romney in the last presidential election.
He said many Republicans are afraid of further alienating minority and women voters who would benefit most from expanding Medicaid and who were largely responsible for propelling Obama into his second term as president.
“More moderate Republicans realize they need those voters to win national elections,” Marshall said. “The debate over Medicaid is part of a larger fight between hard-line conservatives that are still going to resist, and another group of Republicans who see the electoral imperative to reach out.”
On the state level, approval of a Medicaid expansion in Ohio will depend largely legislators’ risk tolerance, Lehner said.
“Anytime you have change, you’re going to have to take some risk,” she said. “At the end of the day, it’s going to come down to how risk-adverse is the legislature.”