Medicaid Expansion Unites Common Enemies

Governor, Democrats, mental health advocates criticize Ohio House Republicans’ budget

click to enlarge Gov. John Kasich working that polling magic
Gov. John Kasich working that polling magic

Ohio House Republicans are poised to reject the Medicaid expansion and the $500 million per year in federal funding that would come with it for the next two years — a move that has united Republican Gov. John Kasich, Ohio Democrats, mental health advocates and other health groups in opposition.

The Medicaid expansion is part of a measure in the Affordable Care Act (“Obamacare”) that encourages states to expand their Medicaid programs to include anyone at or below 138 percent of the federal poverty level with the use of federal funds. For the first three years, the federal government would pick up the entire tab for the expansion. After that, payments would be phased down over time so the federal government would be paying 90 percent of costs.

Ohio House Republicans oppose the measure because they say they’re worried federal funding will dry up in the future, even though there is no historical precedent of the federal government failing to pay its commitment to Medicaid.

Kasich’s proposal for the Medicaid expansion includes an automatic trigger that would immediately stop and retract the expansion if federal funding falls through, but Ohio Republicans previously voiced concerns in hearings that the trigger would hurt Ohioans who have become accustomed to government-provided health insurance without any plan to make up for the lost coverage.

A report from the Health Policy Institute of Ohio found the expansion would help insure 456,000 Ohioans by 2022 and save the state money in the next decade by producing economic growth and shifting health-care expenses from the state to the federal government.

For advocates of mental health and addiction treatments, Ohio House Republicans’ rejection of the Medicaid expansion and other budget items means mental health and addiction services will miss out on $627 million per year, according to

a report from the Office of Health Transformation

.

Ohio House Republicans’ budget plan would include $50 million more annual funding for mental health and addiction services, but that’s also not enough to make up for the $140 million in annual funds cut around the state since 2002 and the $17 million being cut over two years through the dissolution of the tangible personal property tax replacement funds.

Cheri Walter, chief executive officer of the Ohio Association of County Behavioral Health Authorities (OACBHA), says the Medicaid expansion is a great opportunity to emphasize mental health services around the state.

“On the mental health side, ... sometimes it can take two or more years for someone to get a disability determination that makes them Medicaid eligible,” she says. “In addition to making more people Medicaid-eligible, it will speed up the process for many others.”

Walter says for addiction patients in particular, getting access to health services can be difficult because alcoholism and other forms of addiction are not technically disabilities. By including more income levels in the Medicaid program, less people will fall through the cracks, she says.

OACBHA was one of the many groups that rallied at the Ohio Statehouse Thursday in support of the Medicaid expansion. The crowd, which received support from Ohio Democrats and Kasich, was estimated to reach 2,500.

Until the U.S. Supreme Court ruling on Obamacare, the Medicaid expansion was required, but the court ruled that states must be allowed to opt in and out.

The Medicaid expansion was one of the few parts of Kasich’s budget plan that Democrats and progressives approved, while the two other major proposals in Kasich’s plan — school funding and a tax cut proposal — were criticized for disproportionately benefiting wealthy Ohioans (

“Smoke and Mirrors,”

issue of Feb. 20).