John Kasich reprised a portion of his State of the State address last week. The governor told health-care advocates gathered near the Statehouse that in pressing for the proposed Medicaid expansion they must approach lawmakers “with intensity, but kindness, but with firmness that cannot be shunned aside. … And we have to let them know that if they stand and support these programs, for those folks who live in the shadows … that when they stand with us we’re not going to ignore them.”
“This is a big human thing, that’s what it is,” the governor argued. He added that all he needs is “for all of us to put our hearts and minds together” and then take the right and smart path.
The personal stories are powerful, of those suffering from mental illness, many losing their jobs, lacking health coverage, falling into a choice between medicine and food or housing. The stories have been told in legislative hearings. They were part of a meeting on Friday at Community Support Services in Akron, organized by the local chapter of the National Alliance on Mental Illness. Advocates, providers and others explained the difference the Medicaid expansion would make in real lives, enhancing the entire community.
Yet as much as the heart tugs, the governor rightly stresses the complementary and decisive role of the mind, of cool calculation in weighing the Medicaid expansion.
Medicaid serves the poor, disabled and indigent elderly. The expansion, part of the Affordable Care Act, would extend health coverage to those with incomes up to 138 percent of the poverty level, or $15,415 a year for an individual, $31,809 for a family of four. The federal government would pick up almost the entire tab, the governor finding the financial advantage hard to resist, especially as hospitals face cutbacks in payments for the free care they provide.
At the Friday meeting, Dr. Steven Jewell highlighted how the expansion would address what long has been a source of frustration and harm. The medical director at Child Guidance and Family Solutions noted that early and thorough intervention, through medicine, counseling and other elements of support, leads to far better outcomes for those suffering with mental illness, often restoring productive lives. Yet Medicaid as currently operated works against such effective intervention.
Jewell explained that lower-income poor adults without children do not qualify for Medicaid unless they are disabled. So their first bout with a mental illness essentially goes untreated. The system encourages the condition to worsen, until qualifying for disability, adding unnecessarily to the pain and misery, to those falling through the cracks, not to mention the overall cost.
More, Jewell pointed to a too frequent failing once patients begin to show improvement. They lose their disability status, and access to affordable treatment and to the healthier lives they easily could have.
Expand Medicaid, and this disabling disability hurdle would be removed, the state embracing the evidence showing that every $1 in such treatment yields $7 in return.
Judge Linda Teodosio of the Summit County Juvenile Court bolstered the case. She pointed to the difference treatment has made for children, the county sending 132 to the Department of Youth Services in 2009. Three years later, the number declined to 29, the entire state following the same track, from 1,579 to 633.
Teodosio offered a telling postscript, reminding her audience that young adults without health coverage and suffering from mental illness still have children. As those parents struggle, so do their kids. The judge emphasized that the leading predictor of a child landing in juvenile court is involvement with the welfare system.
So Medicaid expansion promises a wider benefit: Improve the lives of adults through health coverage, and the lives of children improve, diminishing their chance of getting into trouble and, ultimately, lowering the rate of crime, fewer juveniles taking a destructive road into adulthood.
Know that in Summit and other counties, local levy dollars increasingly have been devoted to the stream of federal and state money for Medicaid services. That means fewer local funds have been available to invest in key services for mental illness that Medicaid does not cover, involving, for instance, housing, job training and those afflicted with both a mental illness and a drug addiction.
The Medicaid expansion would begin to liberate these local dollars, inviting a stronger system for repairing and elevating lives.
Consider the county jail. Local officials have struggled with the problem of those with mental illness cycling through the jail and onto the streets. In part, officials have lacked the resources to respond well. With the expansion, that could change.
Many lawmakers resistant to the Medicaid expansion cite their concern for ever-growing government, the effort simply unaffordable. Yet here is a way for government to make a practical and enduring difference in the lives of many people, providing the steady health-care coverage that amounts to expanding opportunity.
So many want to contribute. All they need is the treatment that works.
Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514, or emailed at email@example.com.