If the Ohio General Assembly fails to enact legislation for Medicaid expansion by the end of this year, it will not be for lack of study and discussion. Or broad public support.
A priority on John Kasich’s agenda, the proposal to extend Medicaid coverage to Ohioans whose annual income does not exceed 138 percent of the federal poverty level has floated around the Statehouse since February. So far, nothing has emerged from either the House or Senate besides promises of reform within a time frame that keeps shifting. For his part, the governor continues to talk about working something out with lawmakers that would allow an expansion proposal to advance within the normal legislative process.
There is no lack of public support for expansion. Advocates range from chambers of commerce and labor unions to hospitals, local governments and civic organizations. While Kasich is giving patience a workout, a new coalition of citizens groups, Healthy Ohioans Work, has developed a fallback strategy. On Monday, it won certification from the state attorney general that allows it to proceed with a campaign to put Medicaid expansion on the November ballot in 2014.
The drive to put the Medicaid question directly before voters clearly expresses rising frustration at the apparent lack of urgency at the Statehouse. The frustration is justified because Ohio and its working-poor families lose federal assistance the longer lawmakers dither. The federal obligation is to pay 100 percent of the cost for the first three years for those newly eligible for Medicaid under the Affordable Care Act. The share gradually will decline to 90 percent in 2020 and remain at that level. Ordinarily, the federal match for Medicaid in Ohio is about 64 percent.
The law takes full effect Jan. 1. To be sure, Ohio can take the option whenever it chooses. But each day it sits out, an estimated 275,000 Ohioans miss out on health coverage, and critical health services, including mental health care, are underfunded. According to estimates released earlier this month by the independent Health Policy Institute of Ohio, the state stands to gain between $1 billion and $1.3 billion (or $5.4 million to $7.3 million a day) in federal matching funds alone during the first six months of Medicaid expansion. That’s not small potatoes in a state contending with a 16.4 percent poverty rate and 1.3 million uninsured.