After stripping a proposal for Medicaid expansion from their version of the state budget bill, Republicans in charge of the Ohio House want to suggest they have taken a half-step back, no doubt prompted by the impassioned and widespread negative reaction. The amended bill, which passed the House on Thursday, calls for a new legislative effort to reform the Medicaid program and Ohio’s health-care delivery system.
The House now asks the directors Ohio Medicaid and the Governor’s Office of Health Transformation to provide a reform plan to the legislature no later than Oct. 1. Among the goals, the plan would reduce Medicaid caseloads by moving individuals into employer-sponsored coverage or the new health insurance exchanges; lower state and federal costs; and reduce over the long term the number of individuals who enroll in the program. According to the Columbus Dispatch, Barbara Sears, the House majority floor leader, expects, meanwhile, that legislators “‘will go to school’ on Medicaid efficiency over the summer.”
An interest in full-blown Medicaid reform would be worth applause were it not such a convenient tactic to ride out the storm of public protests following the rejection of Gov. John Kasich’s plan for expansion. It isn’t as if the Medicaid program in Ohio has been hidebound, either, during the past several years. The governor could argue well that his Office of Health Transformation has been engaged in a relentless quest for efficiency in Medicaid and health-care delivery since he took office.
Kasich’s budget proposed an expanded Medicaid that would be closely in line with the federal Affordable Care Act. Republicans want no part of the legislation and would rather see it repealed. Thus, stripping it from the budget was akin to a poke in the federal eye.
The trouble with that move, unfortunately, is the Kasich expansion plan would work in Ohio’s favor: An estimated 275,000 low-income Ohioans, mostly workers, would be covered for the first time, their health likely to improve with regular access to primary care. The federal government would pick up 100 percent to 90 percent of the cost, relieving health-care providers of much of their spending on uncompensated care. Federal health dollars would spur economic activities and release state and local funds for other purposes.
The Ohio Senate, which will consider the budget bill next, surely recognizes the House proposal for what it is: strategic stalling. The ploy would start over the lengthy process of negotiating Medicaid reform, which will require federal approval, delaying coverage to thousands of Ohioans who need it. The sooner the state taps into the benefits of expansion the better. The Senate should reinstate Medicaid expansion in the budget bill.