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Leaders on Both Sides of Medicaid Expansion Debate Key Issues

A coalition of backers of Medicaid expansion has started its petition drive to put the issue before voters if lawmakers don’t expand the program to 275,000 low income Ohioans as Gov. John Kasich had proposed in his original budget.

Medicaid expansion supporters have been battling arguments against it for months. But one of the main debates is over the $13 billion in federal dollars that they say Ohio could capture over seven years if expansion were in place by January 1.

Jon Allison is the former chief of staff for Republican Gov. Bob Taft. He is now leading a coalition of supporters in a petition drive to put expansion before voters if lawmakers don’t approve it. Allison says he understands that conservatives who oppose expansion would rather have the state develop its own program to cover the hundreds of thousands of people who could be in the expanded Medicaid program, but he says it doesn’t make sense in reality.

“When Ohio taxpayers, Ohio businesses are on the hook to pay federal fees and taxes to pay for the Affordable Care Act, the thought that we would leave those dollars on the table instead use state tax dollars – I don’t know how I could sell that to the General Assembly,” says Allison.

Robert Alt is the president of the conservative think tank the Buckeye Institute, and has written several position papers on why he feels Medicaid expansion is a bad idea. And he says the idea that money will be left on the table is an often-repeated fallacy.

“It’s a matching funds program. There are no funds left on the table – if we don’t expand Medicaid, those funds never get spent. Or quite frankly, they never get borrowed from China. It’s not that they go to California. They just don’t exist,” says Alt.

But there’s also a concern over who actually would benefit from Medicaid expansion. Alt says it would cover mostly able-bodied men – and he says the effect of expansion likely would be one the backers wouldn’t want.

“I find the name of your organization interesting – it’s Healthy Ohioans Work. Well, part of the problem that legislators are confronting is, if we expand Medicaid we’re not allowed to put work requirements on there. And studies have shown that if we put more people on Medicaid it will actually take people who are currently working and encourage them not to work.”

Alt says a state-created program would allow Ohio to put work requirements on people enrolled in it – something that Medicaid won’t permit.  Allison says there have been conversations about how to include some links to workforce development into Medicaid expansion, but that Alt’s conclusion is unfair.

“Respectfully, to paint this as a solution which would essentially incentivize a bunch of underemployed single adults to give up on trying to work and earn a living goes a little too far. I mean, the flip side of that is we have unemployed single adults who would benefit from this, many of which have health issues that they’re dealing with,” says Allison.

Allison says the Healthy Ohioans Work coalition, which includes unions, religious, social services and community organizations, and hospitals and business groups, has until late December to gather signatures, and plans to go ahead with its ballot issue if no action is taken on Medicaid expansion by the end of the year. Alt says he doesn’t think the coalition is as monolithic as Allison suggests, and that the expansion push is driven mostly by hospitals who he says would profit from Medicaid expansion.