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As Ohio Medicaid Debate Continues, Health Providers Have Their Fingers Crossed

Ohio Governor John Kasich announced last week he’ll circumvent the legislature to try to expand Medicaid eligibility under the Affordable Care Act. Meanwhile, state legislators are considering two separate Medicaid reform bills—and health care providers have their fingers crossed.

If Medicaid isn’t expanded, about 50,000 people in the Dayton area alone (and an estimated 275,000 in the state) will end up in a gap where they’re too low-income to use the Obamacare marketplace, but not low-income enough to qualify for Medicaid. The marketplace and the subsidies that come with it only apply to people who make between one and four times the federal poverty level.

The Affordable Care Act was designed to cover people who make up to 138% of the poverty level through more robust Medicaid programs, but a Supreme Court decision undermined that requirement, leaving it up to each state whether or not to expand.

Republicans in the Ohio statehouse have joined legislators across the country in calls to reject federal funds for Medicaid expansion, citing the cost of an ever-growing program as a major concern.

But Bryan Bucklew of the Greater Dayton Area Hospital Association says health care for the uninsured is already costly—because they depend on emergency rooms.

“It’s kind of a double-negative there in terms of you’re providing less efficient, less effective care to the population, and it’s more expensive, and people are gonna be paying for it anyways,” he said. Bucklew is one of many health care advocates across the state pushing for expansion.

Meanwhile, Republican State Senator Dave Burke and Democratic Senator Capri Cafaro have each proposed reforms to Medicaid that would cap costs, although the caps use different formulas. Senator Cafaro’s plan would also expand the program using ACA funds, while Burke’s would not.

Kasich has gone head-to-head with Ohio Republicans over the issue, and last week announced he will proceed with the program without legislative approval. Instead, he’ll bring a request to accept federal funds to the seven-person Controlling Board Monday, and the Columbus Dispatch reports the request is expected to pass. For their part, statehouse Republicans appear to be moving quickly towards a debate of reforms, rather than lingering on a battle over expansion.