Trumpcare isn’t the only threat to hundreds of thousands of low-income Ohioans who depend on Medicaid expansion for health care. So is the Ohio House’s version of Ohio’s proposed 2017-19 budget.
Tucked into the Republican-run House’s budget rewrite are amendments that could keep otherwise eligible low-income Ohioans from getting or keeping Medicaid expansion coverage.
Republican Gov. John Kasich opted to offer Medicaid expansion, an expansion that covers more than 700,000 Ohioans. To be eligible, an Ohioan must be “age 19 through 64 with [income] at or below 138 percent of the federal poverty level ($16,394 for a single adult in 2016),” the Medicaid Department says.
As previously noted, half of those 700,000 Ohioans live in counties Donald Trump carried, including 2,600 in Clinton County, home of House Speaker Clifford Rosenberger, a Clarksville Republican, and 21,000 in Stark County, home of Senate Finance Committee Chairman Scott Oelslager, a North Canton Republican
One booby-trap Ohio House Republicans slipped into the budget would require Kasich’s administration to again ask federal Medicaid regulators to let Ohio impose so-called “Healthy Ohio” (somewhere, George Orwell smiles) requirements. Heathy Ohio is a Rube Goldberg-like contraption that, in effect, would require Medicaid clients to contribute to a “Buckeye Account,” which is sort of like a Health Savings Account. (Historically, HSAs have been big faves of Statehouse Republicans, maybe because their banking pals can charge fees on HSAs.)
But if Medicaid clients fail to contribute to the account, they can be kicked off Medicaid. And maybe that’s really the goal: A study by the Kaiser Commission on Medicaid and the Uninsured reported that “premiums and enrollment fees have been shown to act as barriers to obtaining and maintaining coverage for low-income groups.” (Emphasis added.)
2016 editorial: Feds should reject Ohio Medicaid waiver that’s really a ‘Less-Healthy Ohio’ plan
The Obama administration rejected Healthy Ohio; Trump’s administration might approve it.
And House Republicans’ rewrite would require Kasich to ask federal Medicaid regulators to make Ohioans covered by Medicaid expansion jump over one of five additional hurdles: Be at least 55; have a job; be enrolled in school or training; take part in drug- or alcohol-treatment; or have “intensive health care needs.”
Yet Policy Matters Ohio found that “work requirements ignore the fact that 43 percent of Medicaid expansion enrollees were already employed between 2014-2015, and that 75 percent of those not employed were looking for work. It is that group – job seekers – who will be hurt by these changes.
Unemployed Ohioans would lose health care coverage under proposed changes to Medicaid expansion
The House also wants Kasich’s administration to get an OK every six months for Medicaid spending from the Controlling Board, composed of six legislators and a nonlegislator president representing Kasich.
House Republicans want more restrictions on Medicaid spending
It’s not clear whether House Republicans want the board to have veto power over all Medicaid spending or just expansion spending. Either way, it’d be a Full Employment Act for the Statehouse lobbyists.
Irony must be lost on the House. When Kasich used the Controlling Board to expand Medicaid, bypassing the legislature, GOP diehards pitched a fit, griping that the board usurped the General Assembly. But today? The Controlling Board is tickety-boo.
True, what fueled House swipes at Medicaid expansion maybe wasn’t so much budget math as House math – amassing “yes” votes. In 2015’s comparable budget vote, five House Republicans voted “no.” This year, of 66 Republicans, 12 voted “no.” With 50 votes required, the rewrite passed 58-37. (Four Democrats voted “yes,” including Rep. Martin Sweeney, of Cleveland.)
Related: Ohio should bar new enrollees in expanded Medicaid – Jim Renacci (Opinion)
Bottom line, politically: Of 66 Republicans in Rosenberger’s caucus, just 54 voted “yes.” That’s slim majority support for what’s supposed to be a majority’s budget consensus.
That suggests, one, that the House Medicaid amendments were less about Medicaid than about lassoing Republican “yes” votes on the budget rewrite, and, two, that the Ohio House Republican caucus is shifting. To the right.
Thomas Suddes, a member of the editorial board, writes from Athens.
To reach Thomas Suddes: tsuddes@cleveland.com, 216-999-4689
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