The only certainty about Medicaid expansion in Ohio at this point is that it will not be in the two-year budget bill now under discussion. Keith Faber, the Senate president, last week followed the short-sighted lead of House Republicans to put aside the expansion plan presented in Gov. John Kasich's budget proposal.
It is a disturbing reflection on Statehouse priorities when lawmakers put distaste for the federal government (not to mention fear of retribution from the tea party) above the demonstrated need across the state to address the consequences for health and the state economy that large numbers of residents cannot afford health insurance.
Faber and Speaker William Batchelder have indicated that Medicaid "reform" -- not necessarily expansion -- will remain in discussion, separate from the budget debate. The promise is that subcommittees in the two chambers will work with officials in the governor's office to come up with a plan for Medicaid reform that is best for Ohio.
In a climate of unrelenting Republican hostility to anything related to the federal health legislation, it passes as a hopeful sign that lawmakers did not slam the door all the way shut. But what little assurance there is must be tempered. When lawmakers get a sudden urge to explore alternatives, it serves often to stall or derail action.
It is a good measure of the skepticism surrounding talk of Medicaid "reform" in the Republican-controlled Statehouse that advocates of expansion are beginning to weigh the option of a ballot initiative in November. As reported by the Cincinnati Enquirer last week, they are moving to "cover the bases" in case legislative leaders don't deliver.
The decision to drop Medicaid expansion from the budget is equally disappointing on other levels. It ignores the findings of reputable independent studies, such as those led by the Health Policy Institute of Ohio, detailing the health and economic benefits that would derive from implementing reform along the lines of the Affordable Care Act, as Kasich has proposed. For instance, the average health insurance premium in 2012 cost $5,615 for single coverage and $15,745 for family coverage, according to the Kaiser Family Foundation survey. Expanding Medicaid would enable Ohio to cover more than a quarter-million residents who make less than $16,000 a year. These are not people seeking to game the system. Most earn wages that would not cover the cost of premiums.
The proposal has garnered strong support well beyond the typical welfare advocacy groups. Hospitals of all sizes have argued strongly for it to relieve financial strains. Government agencies, prisons and mental health facilities among them, recognize the advantage in expansion. Chambers of commerce have stressed the economic impact of health spending. But House and Senate leaders utterly disregard the breadth of the support. ___