COLUMBUS — The 5-4 U.S. Supreme Court ruling on the Affordable Care Act gives the Kasich administration the choice of whether to open Ohio Medicaid to an additional 700,000 to 900,000 uninsured Ohioans, but it is unclear if the state will go ahead with it.
Ohio Medicaid, a state and federally funded health plan for disabled and low-income people, would see its enrollment balloon by as much as 40 percent — 3.1 million enrollees, up from the current 2.2 million — and costs would climb $5 billion a year, according to the governor’s Office on Health Transformation.
Ohio Medicaid costs $18 billion a year in state and federal money and covers 300,000 Ohioans in the Miami Valley.
Gov. John Kasich said he wants Congress to repeal and replace the Affordable Care Act.
“We are very concerned that a sudden, dramatic increase in Medicaid spending could threaten Ohio’s ability to pursue needed reforms in other areas, such as education,” Kasich said in a written statement. “Going forward, we remain committed to minimizing the law’s drag on the economic growth Ohio is beginning to experience, protecting the inviolate relationship between doctors and patients, and preserving as much free market competition in health care as possible.”
Before the court ruling, Ohio and other states were going to be forced to open their Medicaid programs to more low-income people by 2014 or risk losing all federal funding for the program. The U.S. Supreme Court said such coercion of the states is unconstitutional.
Under the Affordable Care Act, the federal government would cover the cost of expanding Medicaid for the first three years and then dial back its share to 90 percent and have states pick up 10 percent of the cost.
Despite the federal match, Ohio will have to assess the costs and benefits, said Ross Bridgman, a health care policy attorney with Vorys, Sater, Seymour and Pease. “This is not a no-brainer. This is going to be a fundamental policy decision, not just for Ohio but all the states,” he said.
For current enrollees, the feds pick up 64 percent while the state covers 36 percent of the cost. Ohio officials estimate that 319,000 Ohioans who are now eligible but not enrolled will sign up for Medicaid, which will cost the state an additional $369 million in 2014. Those people are covered at the 64-36 split – not the enhanced match.
Lt. Gov. Mary Taylor, who is director of the Ohio Department of Insurance and an outspoken critic of the Affordable Care Act, said the Kasich administration is unsure whether to go forward with the expansion. When asked why the state would opt out of Medicaid coverage that is fully funded by federal funds for the first few years, Taylor said the administration needs to think about long-term costs.
“We are frustrated with the additional costs and the additional spending this is going to force on Ohio,” she said.
The next step for Ohio is to “think through the advantages and disadvantages of the Medicaid expansion. We really didn’t have that choice before, and now we do. That’s something we will be looking at carefully and other policy makers will be examining,” said Amy Rohling McGee of the nonpartisan Health Policy Institute of Ohio.
Cathy Levine, co-chair of Ohio Consumers for Health Coverage, said the administration should expand Medicaid because it aligns with its efforts to modernize Medicaid and streamline enrollment.
“It’s inconceivable that they would leave federal money on the table that enables us to expand coverage to uninsured Ohioans,” Levine said. Levine said the law will give Ohioans peace of mind to find affordable and plentiful options for health care.
“Can anybody promise they’re not going to get a terrible disease or a serious injury? Most of us don’t plan to get million-dollar illnesses,” Levine said. “If we all pay into the system, health care costs will be reduced.”
Roughly 1.5 million Ohioans are uninsured, but an expansion of Medicaid would cut that figure to 712,000 by 2017, according to an analysis from Milliman Inc. on the impact of the Affordable Care Act on Ohio. Remaining uninsured Ohioans would gain coverage through the individual health insurance exchange marketplace, the report said.
Ohio received a $1 million federal grant to plan a state insurance exchange, and 35 states have received federal money to establish state exchanges. If the Kasich administration opts out of setting up a state exchange, the federal government will step in and create the exchange.
Taylor said Thursday that she sees no advantage to establishing a state exchange and that having the federal government do it is the “lesser of two evils.”
Rep. John Carney, D-Columbus, disagreed and said his Statehouse colleagues on both sides of the aisle want a state-run exchange. Carney and Rep. Nickie Antonio, D-Lakewood, introduced legislation this year to set up an exchange developed and regulated by a bipartisan board of directors.
Carney said insurance companies, hospitals and other health care groups helped shape the plan, which he said reflects Ohio’s interests. Ideally, Carney said, exchanges would be part of a seamless system for people who earn more income and become ineligible for Medicaid.
“They fall into a crack and are oftentimes put in a position where they have to choose having health insurance or shelter and food,” Carney said. “The whole point of the exchange is to get people to the point where they are able to have their own health insurance plan.”
The Affordable Care Act is one of the few pieces of legislation on which Josh Mandel, Republican candidate for Senate, has taken a position. Speaking at a medical device manufacturing plant outside Columbus, Mandel, who is state treasurer, told employees that expanding Medicaid rolls will take money from other state-funded departments.
“Whether or not you’re on Medicaid, we will all feel it because the reverberating effect it will have on our budget will impact our schools, will impact our colleges and universities, will impact our police departments and fire departments and the ability to provide important services for families and services,” Mandel said.
Although conservatives decry the decision and liberals applaud it, Bridgman said neither people’s worst fears nor their highest hopes are going to come true with the Affordable Care Act. “This is incredibly polarized. My advice to everyone out there watching this is to take a breath and stop freaking out.”