Retreat on Medicaid may fuel drug crisis

A House GOP plan to gut Ohio’s Medicaid expansion would severely undercut the state’s battle against the opioid epidemic, critics say.

“This is absolutely the wrong way to go,” said Cheri L. Walter, executive director of the Ohio Association of County

Behavioral Health Authorities.

“Medicaid expansion has given more people access to treatment than anything else we’ve done.”

In an apparent attempt to win conservative Republican votes for the proposed twoyear state budget, the amendment essentially would kill the Medicaid expansion, which now provides tax-funded health insurance to more than 700,000 poor adults, many working in low-income jobs.

Although it would save only $7.8 million in state money from the multibillion-dollar program, the proposal’s sponsor, Rep. Wesley A. Goodman, R-Cardington, said in a memo, “It is becoming quite obvious that Ohio needs to do something to arrest Medicaid spending before it overtakes our budget. ... Every dollar spent on this population, which is made up of able-bodied, childless adults, is one less dollar we have to spend on the truly needy.”

Goodman’s budget amendment would freeze enrollment in the Medicaid expansion, allowing current beneficiaries to keep coverage but banning newly eligible ones or a return by those who drop off the rolls. The latter would include people who lose coverage when their income increases but then lose their job or have their hours cut and again qualify for help.

Several say the move sends a mixed signal coming mere days after House leaders unveiled a $170.6 million plan to combat the drug crisis that claimed more than 4,000 lives in 2016, according to preliminary estimates.

“Lack of coverage is a huge barrier to accessing treatment,” said Julie DiRossi-King, director of policy and government affairs for the Ohio Association of Community Health Centers.

“As we’re looking for ways to combat our opioid epidemic, it feels counterintuitive to freeze coverage for those who are seeking treatment.”

The new amendment sets up a head-on collision with Gov. John Kasich, who has touted the benefits of Ohio’s Medicaid expansion.

State officials said 500,000 Medicaid beneficiaries have received mental-health and addiction services through the Medicaid expansion. Last year, Medicaid covered more than $650 million for such services.

Many details of the budget proposal, likely to be rolled out Monday with other amendments, remain hazy. Rep. Ryan Smith, R-Bidwell, chairman of the House Finance Committee, said he is still trying to learn more about the impact of a Medicaid freeze.

“I’m trying to run the traps on it to make sure how it would work and function,” he said. “I don’t know enough yet to form an opinion.”

Smith said the freeze proposal stems from a concern among some House Republicans about the growth in Medicaid expansion. The current enrollment of 715,000 Ohioans is 2

times larger than the initial 2013 estimate of 275,000, when the program was debated and — after an initial defeat in the House — ultimately approved to start in 2014. The expansion was allowed under the federal Affordable Care Act, which brings automatic opposition from some Republicans, who control the Ohio House 66-33.

In all, the state’s $27 billion Medicaid program covers 3 million poor and disabled Ohioans.

Earlier this week, House Republicans said they want ablebodied Medicaid recipients to work for the entitlement.

“There are some exemptions to this one: obviously being employed, if you are in a recovery program, medically fragile, if you are 55 or older, and if you are enrolled in an education or workforce-training program,” Smith said.

Conservatives have championed work requirements, saying they help people get back on their feet and become self-sufficient. Critics argue they hurt low-income workers who have the most difficulty finding and keeping jobs.

Steve Wagner, executive director of the Universal Health Care Action Network, said work requirements don’t make sense because people who are sick and can’t access health care or who have untreated conditions such as diabetes or mental illness are less likely to be able to work.

“People get between jobs — they don’t necessarily get a job the next day — so what happens to their Medicaid coverage?” he asked.

John Palmer, spokesman for the Ohio Hospital Association, said his organization is urging lawmakers “to ensure people who cycle on and off jobs don’t lose coverage.”

Palmer said that when people lose access to primary care, they often come to high-cost emergency rooms for treatment no matter how serious their ailment, flooding hospitals with nonemergency situations.