Future uncertain for Medicaid expansion

JOHN SEEWER Associated Press Published:

TOLEDO (AP) -- Ohio Gov. John Kasich's plan for expanding Medicaid under the new federal health care law and giving more low-income Ohioans access to health insurance might not be dead, but whatever comes next will have a much different look.

Republicans who control the state legislature are taking the Medicaid expansion out of the governor's budget and want to come up with their own plan. They're insisting that any proposal must control the costs of what is the largest health insurer in the state.

Some questions and answers on what that type of changes are ahead and whether Medicaid expansion will happen at all.

Q: Why is the governor's proposal meeting resistance?

A: There are quite a few reasons. Many Republicans are philosophically against the idea of increased spending on government programs and opposed to President Barack Obama's health care law that calls for mandated health coverage. They also don't trust the federal government's promise to pay for the bulk of the expansion and worry that states will get stuck with a huge bill in a few years. Another concern is the rising cost of Medicaid, which eats up more state and federal government spending than Ohio's public schools and universities combined.

Q: Is there political pressure on Republicans to reject the expansion?

A: A lot of Republicans campaigned against Obama's health care law and don't want to be seen as supporting it now by backing Medicaid expansion, which is one of the key elements of the Affordable Care Act. Conservative groups opposing the health care law have been warning Republican lawmakers that they would face challengers in the next primary election if they went along with the Medicaid proposal. That's a big concern for some.

Q: So what do they do next?

A: Republican leaders in both the Ohio House and Senate say they'll begin crafting their own Medicaid plan along with help from the governor's administration. They say there are too many questions and more time may be needed to come up a solution. They also insist that cost savings must be part of the proposal.

Q: What will this new plan look like?

A: Knowing that Medicaid expansion would be a tough sell, the Kasich administration has been in talks with federal officials for months about whether the health care law allows any flexibility to use the money from Washington to provide private coverage to some who would eligible under the Medicaid expansion. One thought is to use the federal money to buy private insurance for low-income residents. Another possibility is using Medicaid expansion money to allow those who earn just above the poverty level to instead buy into health plans through an insurance exchange developed under Obama's health care law.

Q: Why do it that way instead of expanding Medicaid?

A: Republicans who are adamantly opposed to the Affordable Care Act may find it more acceptable to subsidize the purchase of private insurance for low-income residents rather than adding them to the state's Medicaid rolls.

Q: Can Ohio do that on its own?

A: No, federal officials must approve any changes.

Q: Will Republicans support an alternative plan?

A: There's clearly at least a willingness to consider the idea. House lawmakers agreed to continue discussing the Medicaid issue even after stripping expansion from their version of the state budget. Ohio Senate President Keith Faber said this week that he thinks the path to Medicaid includes one that covers people who need health care it in the short term and reduces costs in the long term. Still, the governor may need the help of Democrats to get more people health care into a taxpayer-funded health insurance program.

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