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In Medicaid Expansion Discussion, Coverage for Working Poor Hangs in the Balance

Antwaun Brown is currently uninsured, and doesn't know yet whether he'll be able to get covered by the ACA. medicaid insurance health
Lewis Wallace

Governor John Kasich will bring a Medicaid expansion proposal to the Ohio Controlling Board Monday. He’s gone around the Republican-run legislature in an attempt to approve billions in funds from the federal Affordable Care Act, and health coverage for hundreds of thousands of low-income people hangs in the balance.

When Amy Sylvester shows up at her appointment at Five Rivers Health Center in Dayton, she’s been up all night, because she works a 2am shift delivering papers.

“There’s time where when I can’t breathe, it feels like I’m about to die,” she says. She’s short of breath because of her severe asthma.

Sylvester lost her Medicaid coverage a couple years ago—when she lost a custody battle. Now, she’s falling into a gap in coverage: she’s too poor to get help from the Obamacare insurance marketplace, but she doesn’t qualify for Medicaid.

“I can’t get Medicaid, what other choice do I have? So I can’t stick around for my kids, I have to sit here and die?” she says

Her situation is nothing new: Medicaid has always been mainly for pregnant women, mothers and people with disabilities.

That was all supposed to change under the Affordable Care Act, which expanded Medicaid far beyond its previous scope, to cover anyone making less than about 16 thousand dollars a year or 138 percent of the federal poverty level.

But in 2012 the Supreme Court said states could decide for themselves whether to take on that Medicaid expansion. Ohio’s Republican-led legislature has opposed expanded eligibility, while the Governor has gone head-to-head with his own party to stem the opposition.

“Thousands of our patients will not be able to apply for the Affordable Care Act or the Marketplace exchange,” says Gina McFarlane-El of Five Rivers Health Centers. About a third of the people she serves are uninsured, an estimated 6,000 this year, and most would apply. Statewide an estimated 275,000 new people would get covered next year alone if Medicaid does expand, and that number would more than double within ten years.

Otherwise, McFarlane-El says all those individuals will fall into the same gap as Amy Sylvester.

“Some of them will continue to go without insurance, some of them will continue to struggle to paying for their medications, or using the emergency room, unfortunately as their primary care provider,” says McFarlane-El.

While Kasich pushes to approve federal funding for Medicaid without full legislative support, Robert Alt of the conservative Buckeye Institute says that’s fiscally irresponsible.

“In the long term, even if the government is able to keep its end of the bargain, Ohio has to pick up more and more of the tab,” he says. Buckeye and some Republican legislators have said they’ll sue to block the expansion. And Alt says any expanded eligibility should include work requirements.

Of course, many people who could become eligible are working, like Antwaun Brown. He works as a cook, and he’s pretty healthy. But he has high blood pressure, and medical bills he can’t pay. Just last year he pulled a muscle and had to go the ER for the pain.

“I tried to wait it out to see if would go away but it never went away,” he says. After waiting four days in severe pain, he finally went in. And he says he hasn’t even looked at the bill.

“To be honest I’m to the point where I really don’t open up all of them, because I know it’s going on my credit and it’s lowering my credit score every time,” he says.

The Ohio Controlling Board could approve the funding to expand Medicaid on Monday afternoon. If the proposal passes, the Governor’s office is almost sure to face a legal challenge in the burgeoning battle with legislators. Meanwhile, two different reform bills are also on the table in the statehouse. But if nothing passes within a couple of weeks, Medicaid expansion by 2014 will become logistically impossible regardless.

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