Ohio governor weighs Medicaid expansion

• Medicaid expansion key part of Obama health care overhaul
• Would bring in %2414 billion in federal funds and extend coverage to 600%2C000 more Ohioans
• Critics say they don%27t trust federal promises to cover cost

CINCINNATI -- Ohio could be among a growing contingent of Republican-led states leaning toward expanding Medicaid coverage for hundreds of thousands of low-income residents.

In an interview with The Cincinnati Enquirer this week, Ohio Gov. John Kasich hinted he would call for expanding the joint federal-state health care program for poor and disabled in his pending two-year budget proposal, which is due Monday.

Doing so would bring billions of dollars to the state, and extend Medicaid coverage to thousands of low-income people currently left out.

But it's a decision rife with political controversy. The expansion could result in one of every four Ohioans being on Medicaid.

Most Republicans have criticized the expansion, which is a key part of President Barack Obama's health care overhaul.

That means Kasich will have to convert members of his own party if he wants to bring $14 billion in federal funds to the state and extend coverage to nearly 600,000 additional low-income Ohioans.

"There are certainly philosophical reasons that some have which makes them not particularly interested in seeing any part of the (Affordable Care) Act enacted," said Col Owens, co-chairman of Ohio Consumers for Health Coverage.

House Speaker William G. Batchelder, a Republican from Medina, told the Columbus Dispatch on Tuesday that his concerns aren't just philosophical but also rooted in expense of the program. Batchelder couldn't be reached for comment Wednesday by The Enquirer.

If Medicaid keeps getting a bigger proportion of the state's overall spending, what will get squeezed out in the future, asked Republican state Sen. Shannon Jones, chairwoman of the Senate Medicaid, Health and Human Services Committee.

Medicaid is already the single largest program in Ohio's current two-year budget. It accounts for roughly $18.7 billion, or 32 percent, of the more than $55 billion budget, which runs through the end of June. Washington covers 64 percent of that $18.7 billion tab.

For states that expand Medicaid programs, the federal government will cover the full cost for the first three years. Federal funds are set to scale back to cover 90 percent of the program's costs by 2020.

Opponents to expanding Medicaid say they're not buying the federal government's promises.

"It's just a way to entice the states to buy in," said Twila Brase, president of Citizens Council for Health Freedom, a Minnesota-based non-profit. "The federal government is not in the black. It's very much in the red and we believe they'll eventually say there is no way we can continue fund at 90 percent. A state looking at its future has to ask, 'What are we really on the hook for long term?' "

Across the country, states are weighing the decision.

The U.S. Supreme Court's ruling last year upholding the 2010 Affordable Care Act allows each state to opt out of expanding Medicaid. That leaves the decision in hands of the governors and state leaders.

So far, 17 states and the District of Columbia have signaled they'll go ahead with an expansion. In Kentucky, Democratic Gov. Steve Beshear has spoken favorably about the expansion, but has not committed.

Nationally, Republican governors in Arizona, Nevada and New Mexico have said they will accept the federal expansion.

At least 11 states with GOP governors have said they will refuse the expansion.

Proponents of the plan say the expansion more than pays for itself over time, with a 9-to-1 return on the state's investment.

While Ohio would be on the hook for spending $2.5 billion more between now and 2022, it would net about $4 billion in savings and new revenue, according to a report from the Health Policy Institute of Ohio.

Some of the new revenue, about $17.5 billion, would come from individuals' earnings from thousands of new health care jobs. Another 41.8 billion would be collected from sales and insurance taxes paid on Medicaid managed care premiums.

"It's not only the right thing to do, it's the most economical thing to do," said Tony Dattilo, CEO at Greater Cincinnati Behavioral Health.

His non-profit serves 12,000 severely mentally ill people across the region. He estimates about 55 percent are covered by Medicaid now. That figure would climb to about 85 percent if the program is expanded.

Also awaiting a decision are at least 38,000 adults in Hamilton County who are currently uninsured but would meet the new income guidelines, set at 138 percent of the federal poverty line, or $15,415 for an individual.

A key feature of the expansion is that it would create a new category for individuals without children or disabilities, a population never covered by Medicaid in the past.

Should Kasich's budget include Medicaid expansion, there will undoubtedly start a tug-of-war in the legislature, Candace Novak, director of advocacy and government relations at Mercy Health Partners.

"But with the governor's support, there is greater likelihood that it will stay in" the final budget, she said.