Will Ohio Gov. John Kasich expand Medicaid?

'Too important to leave hanging'

by Sarah Jane Tribble for Cleveland.com

January 13, 2013

CLEVELAND, Ohio -- For Ohio’s health care industry and patient advocates, all eyes are on Gov. John Kasich and the two-year state budget he’s expected to propose on Feb. 4.

Will the Republican state leader expand Medicaid and offer government-supported health insurance to an estimated additional 600,000 of the state’s poorest?

“We will all know together,” said Greg Moody, the leader of Kasich’s office of health transformation, which is charged with revamping the state’s Medicaid program.

Moody declined on January 9 to provide any hint as to the administration’s decision, but he did say an answer will be in the budget. If the expansion is in the proposed budget, the plan will still have to be approved by state legislators. If it is not included in the budget, political experts say expansion would be very unlikely.

“We want to be clear: This is too important to leave hanging,” Moody said. “One way or the other, if it’s an expansion, we need to plan. If it’s not an expansion, we need to plan.”

If Ohio expands Medicaid, the state will fulfill an option under the federal Patient Protection and Affordable Care Act to provide coverage to adults living at up to 138 percent of the federal poverty level — about $32,000 per year for a family of four and $15,400 per year for an individual.

Currently, Ohio covers adults with dependents at up to 90 percent of the federal poverty level and doesn’t cover childless adults. A family of four earning $20,745 or less qualifies for current coverage.

If Ohio expands Medicaid, the federal government would pay the full tab, 100 percent, for three years for the newly qualified individuals. After that, the federal government would cover 95 percent and phase down to 90 percent.

2012 Federal Poverty Level (FPL) Guidelines

Current coverage is at 90 percent of the FPL. Below are the qualifications based on household income:
Single: $10,053
Two-person family: $13,617
Three-person family: $17,181
Four-person family: $20,745
Single: $15,415
Two-person family: $20,879
Three-person family: $26,344
Four-person family: $31,809.

Less than two dozen states offer the expanded coverage or have agreed to offer it since federal reform passed.

Kasich’s decision is “a very important point in time for the state of Ohio,” said Oliver “Pudge” Henkel, chief external affairs officer at the Cleveland Clinic, which i s a proponent of expansion.

Ohio’s Medicaid program currently has 2.2 million people enrolled, which costs the state $18.8 billion. Hospitals often pick up the tab and pay for free or discounted care for those who don’t qualify for Medicaid but can’t afford private insurance.

If Ohio does not expand Medicaid, the estimated 600,000 residents currently without insurance are expected to continue seeking free and discounted care at clinics and hospitals. Under an expansion, hospitals will begin to be reimbursed through Medicaid for that care.

“A positive decision on Medicaid expansion will be a real shot in the arm for those who are really concerned about providing access to everyone,” Henkel said.

Hopes are high

On a recent sunny morning, a small group of advocates gathered at the century-old Trinity Cathedral near downtown Cleveland to talk about Medicaid.

The advocates represented the 18-month old Greater Cleveland Congregations group and included the Very Rev. Tracey Lind of Trinity Cathedral.

Lind was upbeat about the chances of Ohio expanding its Medicaid guidelines, but careful not to predict.

“Relationships are being built that have never been built before,” Lind said, describing the group’s lobbying efforts.

The Greater Cleveland Congregations, which includes more than 20,000 members of 40 churches, synagogues and mosques, won their first big advocacy victory in November when they helped the Cleveland Metropolitan School District gain approval for a taxpayer-approved levy. Now, they are working for the passage of Medicaid expansion.

If Kasich puts Medicaid expansion in the proposed budget, they will begin lobbying state legislators to keep it in the budget for approval in June.

They have also joined with the region’s hospitals, free-care clinics, and patient advocates to create the Northeast Ohio Medicaid Expansion Coalition.

“From our perspective, this is not a partisan issue. It’s a moral issue,” Lind said. “We all know that politicians respond to community voices.”

Several long-time lobbyists and former Medicaid officials said they had never seen anything like this group. John Corlett, a former state Medicaid director who is now government relations director of MetroHealth System, said the group has “some additional clout,” as most lobbyists aren’t from faith-based organizations.

The coalition has met with Moody’s office and been in conversations in recent weeks, telling the stories of what they see and the people they meet.

Lind said every Sunday for the past five years, a nurse has come to Trinity Cathedral to provide free care for those in need. Lind shared a story of one family whose child was covered by Medicaid but the parents earned $1,000 too much the previous year to qualify and had no health care.

Across the table, Louise McKinney from Cleveland’s St. John African Methodist Episcopal Church and Donna Weinberger from Kol Halev congregation spoke of suburban families and high school graduates without insurance. They provided examples of part-time workers who needed coverage. And they talked of members who were doctors or nurses that had expressed a desire for the expansion.

“When we sat down with Moody,” recalled Weinberger, “our voices describing our congregations, well, you could tell it really made an impression on him.”

Shifting numbers

Possibly as early as Tuesday, a new report done jointly by Ohio State University, the Health Policy Institute of Ohio and others is expected to be released. That report will likely differ from the estimates that Kasich’s administration has put forth on Medicaid expansion.

Many expect expansion to cost less than previously predicted.

“It will show that it will be strongly in our financial best interest to do this,” the Clinic’s Henkel said.

Moody conceded that the numbers could be lower: “They have shifted,” Moody said. “We had some early criticism that our numbers were too high.”

The state released estimates in June, predicting 1.1 million more people would enroll in Medicaid because there are many who are already eligible but have not signed up for various reasons.

The Affordable Care Act requires that all individuals have health insurance and Kasich’s administration predicted in April 2011 that those eligible will cost the state an additional $2.3 billion by 2018.

The report out this week is expected to change the price-tag connected to paying for those who already qualify for Medicaid because it will be based on more recent population data, Moody said.

“It will have an effect on our numbers,” Moody said.

Nick Wiselogel, communications manager for the Policy Institute, said the report will include statewide estimates on how much it will cost to cover people who already qualify for Medicaid. It’s also expected to include information on the economic impact of a potential expansion, such as how much local governments may save when Medicaid covers the individuals that cities and counties currently cover through mental health services or prison services.

If Ohio’s estimates change, the state won’t be alone. On January 10, Florida Republican Gov. Rick Scott issued a new and lower cost estimate on how much it will cost the state to expand Medicaid.

Instead of $26 billion over a decade, it will cost the state $3 billion to expand Medicaid, according to news reports.

Such a lowering of estimates could make it easier for Kasich to include the expansion in his budget proposal, said

Bill Ryan, president and chief executive of the Northeast Ohio hospital group Center for Health Affairs.

“If you are looking for something rosy to hang your hat on, that may give them a little bit of comfort that it’s not as big a bite to take as they thought,” Ryan said.

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