CLEVELAND — Ohio’s 2014 Medicaid expansion helped more than a million low-wage workers, disabled adults, caretakers, and students to access health care. But the federal government slashed funding for enrollment outreach and consumer assistance last year, and the proportion of uninsured Ohioans has increased from 5.6 percent to 6 percent, according to U.S. Census Bureay surveys. Ohio is one of only 14 states where the number of uninsured increased.

This increase is troubling for several reasons.

First, a recent evaluation of Ohio’s Medicaid expansion confirmed that access to medical care improves health, including earlier diagnosis and treatment of chronic conditions. About a third of people continuously enrolled in Medicaid reported improved physical health and a quarter reported improved mental health.

Ashwini Sehgal co-directs the Center for Reducing Health Disparities.
Ashwini Sehgal co-directs the Center for Reducing Health Disparities.  User Submitted Photo

One recipient stated, “I am getting my cancer medicine because I have Medicaid.” Quite simply, healthier people have better lives: they suffer less and feel better.

Second, Medicaid reduces the need for costly emergency department visits and hospitalizations because primary care providers are able to deliver preventive and cost-effective care for conditions such as diabetes, heart disease, and depression. Another Ohio Medicaid recipient said in the state report, “Before I had insurance, I would just go to the emergency room at the hospital and let them bill me. Sometimes I wouldn’t pay them. I couldn’t afford it.”

Such experiences are all too common and contribute to the burden of uncompensated care for Ohio health providers and taxpayers.

Third, Medicaid facilitates and enables employment. By getting the treatment they need, Ohioans are able to work or look for a job. Health insurance can be an economic tool to help manage the financial risk of medical needs. A single accident or acute illness may bankrupt an uninsured patient. Most adults covered by Medicaid in Ohio have a job, but they work in low-wage occupations that don’t offer health insurance. A typical person working full time in six of Ohio’s ten largest categories – like food preparation, retail, hospitality, janitorial – makes wages low enough for a family of three to qualify for Medicaid. For people earning low wages, Medicaid helps them and their families keep their heads above water.

Fourth, Medicaid is essential for people with a disability that interferes with their ability to work. People who suffer from diabetes may have trouble walking some days. People with a bad back may not be able to stock shelves or stand at a cash register. Attending to the medical needs of disabled individuals not only improves their health but also helps some return to work. One Ohioan said in the state report that having Medicaid means “that I’m able to pay my rent and get the healthcare that I need to stay healthy so I can keep working.”

Fifth, Medicaid plays a key role in addressing the opioid epidemic by covering treatment for people who are struggling with addiction. Ohio has the unfortunate distinction of being one of the top three states in opioid death rates. The Medicaid expansion has provided additional resources to cover adults with addictions. For example, about half of all spending in our state on buprenorphine addiction treatments is financed by Medicaid, according to data compiled by the Henry J. Kaiser Family Foundation. One recipient of Ohio Medicaid expansion coverage stated in the recent state evaluation that Medicaid “means I can get help with my addiction, gets me the counseling that I need. If I didn’t have it, I would probably end up back in jail.”

Sixth, the Medicaid expansion is funded mostly by federal dollars that would have gone to other states if Ohio had not opted in. Making good use of these federal funds helps Ohioans access health care, improve health outcomes, and stabilize household economics. Health coverage also helps working enrollees to maintain jobs and helps job-seekers to persevere in their search.

The latest attack on Medicaid involves imposing work requirements on Medicaid recipients even though most able-bodied, working-age Medicaid recipients already work or are looking for jobs. Work requirements will add another layer of red tape and will lead to many individuals losing coverage, especially low-wage workers who often have highly variable hours. These workers could easily fail to get monthly required work hours because of scheduling at their jobs.

Overwhelming evidence shows that supporting Medicaid will improve both our fiscal health and our physical health. Ohioans need access to quality health care to lead healthier, happier, and more productive lives. Ohio’s legislators should safeguard the Medicaid expansion, because it allows more people to do just that.

Dr. Ashwini Sehgal is co-director of Cleveland’s Center for Reducing Health Disparities, established by Case Western Reserve University and MetroHealth Medical Center. The views expressed are his own.


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The number of Ohioans without health coverage is rising as attacks on Medicaid increase: Ashwini Sehgal (Opinion) –