Medicaid expansion in Ohio back in play

The first of a likely series of Republican bills to revive Gov. John Kasich’s proposal to bring state health insurance to the working poor in Ohio was formally introduced Tuesday.

The bill would make an estimated 275,000 Ohioans newly eligible for Medicaid, a centerpiece of Kasich’s state budget plan that house Republicans nixed earlier this year. The expansion, sponsored by state Rep. Barbara Sears, R-Sylvania, would apply to those making between 100 percent and 138 percent of federal poverty guidelines, or up to about $32,500 for a family of four.

Sears’s plan is light on specifics, but includes a framework intended to address concerns from some conservative Republicans about accepting from the federal government an estimated $13 billion during the next seven years to pay for the expansion.

Among elements unique to Sears’ plan: a goal to promote job training for the new Medicaid recipients who are able to work, and the inclusion of a “circuit breaker” meant to allow Ohio to pull the plug if the federal government doesn’t live up to its promise to completely fund the costs of the expansion for the first three years, and 90 percent after that.

Sears’ plan also lays out goals to decrease Medicaid’s per-patient cost while improving health outcomes, and to encourage personal responsibility for patients through cost sharing.

Greg Lawson with the Buckeye Institute, a conservative think tank that opposes Medicaid expansion, said Sears’ bill is only a minor improvement over Kasich’s initial plan.

He’s still not convinced Ohio could actually back out if the state wanted to.

“Rep. Sears’ bill is perhaps as good as it could get if you’re going to do Medicaid expansion, but we say it’s not good enough,” Lawson said.

Meanwhile, pro-expansion advocates are heartened by the latest sign that Medicaid expansion might make it through.

“I’m really encouraged. I think it took a lot of courage on her part,” said Terry Russell, executive director of the National Alliance on Mental Illness in Ohio.

“I view it as a very positive step, that at least there are some people in the Republican caucus who believe there are ways to improve the Medicaid program, and that not doing anything shouldn’t be an option,” said Bryan Bucklew, executive director of the Greater Dayton Area Hospital Association.

Sears’ bill was referred Tuesday to the House Finance and Appropriations Committee, where additional details could be hammered out. Whether or how that will happen is unclear; the committee’s chairman, Rep. Ron Amstutz, R-Wooster, is working on his own Medicaid plan.

Republicans are making efforts to re-brand Medicaid expansion, as called for under Democratic President Barack Obama’s Affordable Care Act, as Medicaid “reform” as they pursue measures meant to improve the program.

Kasich isn’t partial to any one plan, said spokesman Rob Nichols in an email.

“There can be many routes to the same place and as long we get (Medicaid expansion) done, the governor doesn’t care who gets the credit,” Nichols said.

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