As the state budget process winds down, it’s looking more and more likely that Republican legislators will reject one of the most obviously positive policies to ever come before them — even as a clear majority of Ohioans support it.
As part of the Affordable Care Act (“Obamacare”), states are asked to expand their Medicaid programs to 138 percent of the federal poverty level. That’s an annual income of about $15,856 for a single-person household and $32,499 for a family of four — not luxury living by any means.
But the federal government isn’t just asking states to do this and expecting they’re nice enough to do it; instead, the federal government is upping its backing of the state-federal health care program. For the first three years, the federal government will pay for the entire — 100 percent — of the expansion. After that, the federal commitment would phase down to 90 percent, where it would indefinitely remain.
It seems like a great deal, but Republican legislators have not bought in. Time and time again, Gov. John Kasich and Democratic legislators have asked Republican legislators to reconsider their opposition — only to be shot down in committee and floor votes in the Ohio House and Senate.
In the meantime, numerous reports have found the Medicaid expansion is supported by a majority of Ohioans and would greatly benefit state and hospital budgets:
• About 63 percent of Ohioans support the Medicaid expansion, according to a new poll from the Health Foundation of Greater Cincinnati. But the issue has a clear partisan divide: About 82 percent of Democrats support the expansion, while 55 percent of Republicans oppose it.
The University of Cincinnati’s Institute for Policy Research posed the question to 866 Ohioans between May 19 and June 2 as part of the Ohio Health Issues Poll, which the Institute for Policy Research has conducted for the Health Foundation since 2005.
• In an analysis released in January and revised in March, the Health Policy Institute of Ohio found the expansion would insure nearly half a million Ohioans and save the state about $1.8 billion in the next decade. That’s right: Ohio could insure half a million people and save money doing so, but Republican officials are still saying no.
• Moody’s, an independent credit and research agency, has warned that if states don’t take up the expansion, either state governments or health care providers will suffer as a result. As part of Obamacare, states were expected to expand Medicaid all along — it was mandated until a U.S. Supreme Court ruling deemed the mandate “coercive” — so funding for uncompensated care was cut. That means if states don’t take up the Medicaid expansion, hospitals or state governments will have to pick up the tab for uncompensated care without extra Medicaid funds, and Moody’s says that will put great budgetary strain on both parties.
Republican legislators, backed by State Treasurer Josh Mandel, have responded to these facts by saying they don’t believe the federal government can actually afford to pay for its new Medicaid commitment. They argue that even though there’s no historical precedent for the government failing to pay its Medicaid commitment, there’s also no historical precedent for the Medicaid expansion the federal government is currently pursuing.
The problem with that argument: There is a precedent for the federal government greatly expanding Medicaid. It’s called Medicaid. In Ohio, Medicaid insures about 2.2 million people, with the federal government paying about 64 percent of the cost. The state got to that point thanks to a massive federal expansion that began in 1965.
But even if the federal commitment is a problem, that’s why Kasich — one of the few Republicans to support the expansion — put an automatic trigger in his budget plan that would pull back the entire expansion if the federal government withdrew any of its funding.
Republicans point out the trigger would leave hundreds of thousands of Ohioans stranded. They argue that would be cruel, especially after those Ohioans have become accustomed to having health insurance.
But you know what’s really cruel? Not letting those Ohioans obtain access to health insurance in the first place. Most reasonable people would gladly say that they prefer having some sort of insurance, even if it’s for a little while, over no insurance at all.
With Medicaid continually siphoning state budget funds, taking anything that will help states save money on health care should be obvious. It’s time Republican legislators put aside their scaremongering about the federal debt and do what 63 percent of Ohioans approve of.
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