Mary Stout knows all about the pains of being uninsured.
A hospital has offered to provide her much-needed knee replacement surgery for free under its charity care program. But the 60-year-old Cuyahoga Falls resident said she can’t afford the bills for required testing before surgery.
Her husband, Roger, 59, doesn’t get insurance through his job as a substitute custodian for a local school district. And the couple can’t find coverage on their own because of their age and health problems.
“It makes it hard,” she said.
More than 30 hospitals, social service agencies and other groups throughout Summit, Stark and surrounding counties are pushing the state to expand Medicaid eligibility to help the Stouts and thousands of other residents like them.
The Akron-Canton Medicaid Expansion Coalition is one of seven regional groups in Ohio urging state lawmakers to raise the income limit to qualify for health coverage through the state-federal program for the poor and disabled.
Gov. John Kasich’s budget proposal would boost Medicaid eligibility next year to 138 percent of the federal poverty level ($15,415 for an individual).
Members of the local group were in Columbus last week to urge lawmakers to keep Medicaid expansion in the budget.
“Our focus right now is we want to keep Medicaid expansion,” said Thomas Turner, co-chair of the local coalition and vice president of development, physician services and government relations for Mercy Medical Center in Canton. “This is really good for people.”
Last year, the U.S. Supreme Court upheld the federal health-care reform law but ruled states had the right to opt out of expanding Medicaid.
The federal government will pay 100 percent of the cost for three years for Medicaid patients newly eligible through the expansion in states that opt to raise the income limit to 138 percent of poverty. Federal funding then phases down to 90 percent.
Currently, Ohio adults without children must have annual incomes of less than $7,068 for single residents or $12,132 per couple and very limited resources to qualify for coverage.
About 593,000 Ohio residents — including roughly 64,000 residents in the Akron-Canton area — are uninsured with incomes below 138 percent of poverty, according to the U.S. Census Bureau and the Governor’s Office of Health Transformation. About half work but aren’t offered coverage or can’t afford it.
The state estimates 275,000 low-income residents would qualify for Medicaid through the expansion. Another 231,000 who already are eligible but not yet enrolled in the public program are expected to enroll after 2014, when federal insurance mandates go into effect.
Stout said she’s hopeful lawmakers will expand Medicaid to help people stuck making too much to qualify for coverage but too little to afford private insurance.
For three years, the Stouts have been getting help through Access to Care, a program that matches low-income, uninsured Summit County residents with doctors willing to provide free care.
The program identified the Stouts as among the participants who would qualify for Medicaid if the expansion moves forward.
Though Access to Care has been “wonderful,” she said, some providers won’t participate, leaving her and her husband to come up with the cash or forgo care.
Medicaid coverage “would make life a little bit easier for us,” she said.
Opponents, however, question what Medicaid expansion will end up costing the state.
In its recent policy report, the Buckeye Institute for Public Policy Solutions stated “policy makers should not trade dubious short-term gains for long-term losses.”
The institute warned further federal funding reductions could shift the burden of Medicaid expansion to Ohio taxpayers. The group’s report also said the state will face additional administrative costs.
The Governor’s Office of Health Transformation indicated Ohio can roll back the expansion if federal rules change.
Without expansion, hospitals say they will absorb federal payment cuts without the benefit of uninsured patients getting coverage.
To pay for Medicaid expansion, the federal health-care reform law “slashes Medicare and Medicaid payments for care provided in Ohio’s hospitals by more than $7.4 million from 2013 to 2022, regardless of whether Ohio lawmakers support Governor Kasich in his effort to extend Medicaid to thousands of working poor,” Mike Abrams, president and chief executive of the Ohio Hospital Association, wrote in a recent letter to leaders of the Ohio House and Senate.
Summa could lose $26 million through 2022 if Medicaid isn’t expanded, said Tracy Carter, co-chair of the local coalition and director of government affairs and health policy for Summa Health System’s Summa Foundation.
“It’s so important for our economic sustainability,” Mercy’s Turner said.
Cheryl Powell can be reached at 330-996-3902 or email@example.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.