Strickland Warns Proposed Medicaid Changes
Could Have Devastating Effect on Ohioans
[Read the full text of the proposal here]
5.03.16 - COLUMBUS — Ted Strickland sent a letter today to Centers for Medicare and Medicaid Services Administrator Andy Slavitt detailing concerns he has with proposed changes to Ohio’s Medicaid program that could result in prohibitive costs and loss of coverage to Ohio Medicaid recipients. The full text of the letter is below.
The Honorable Andy Slavitt
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Hubert Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201
May 3, 2016
Dear Administrator Slavitt:
I write to you today to express my concerns about a recent proposal that would create a severe cost barrier for Ohio Medicaid recipients and likely cause many individuals to drop their coverage.
This proposal would make it more difficult for those who need healthcare the most to acquire it. By erecting barriers to individuals receiving healthcare, it could reverse the gains in coverage made by the Affordable Care Act and send individuals back to the emergency room to seek care. This proposal has the potential to hurt over a million Ohioans and increase the cost of our healthcare system for every Ohioan.
The Medicaid program is designed specifically to help those who need access to healthcare the most. These proposed changes are unnecessary and would hurt Ohioans over the long term. I strongly urge you to examine the lasting effects this proposal would have on individuals receiving Medicaid in Ohio and to reject Governor Kasich’s application for federal approval.
Ohio’s 68th Governor
Kasich Ducking Responsibility For Medicaid Insurance Changes That He Signed Into Law
Hundreds of Thousands of Ohioans Will Lose Coverage
Under Kasich’s Budget
[Read the full text of the proposal here]
4.27.16 - COLUMBUS — Gov. John Kasich continues to campaign around the country claiming to be a “moderate” and “compassionate” Republican, at the same time that his administration moves to implement a plan that will kick hundreds of thousands of Ohioans off of their current health coverage.
“George Orwell would admire the chutzpah of naming a plan that will result in hundreds of thousands of Ohioans losing their insurance coverage the ‘Healthy Ohio’ plan,” said Ohio Democratic Party Chairman David Pepper. “The ‘Healthy Ohio’ plan and health coverage snatched away from vulnerable women, children and their families will be Governor Kasich’s legacy. Even though Governor Kasich is ducking responsibility for ‘Healthy Ohio,’ the buck stops with him. He signed the budget into law that authorizes ‘Healthy Ohio.’ He owns it.”
The Kasich administration estimates from 126,000 to 140,000 will lose Medicaid coverage every year of the “Healthy Ohio” plan. A spokesman for the administration told the Toledo Blade, “This is not our proposal. We are required by law to do this.” However, the proposal was part of House Bill 64, the state budget bill that Kasich signed into law on June 30, 2015.
The Center for Community Solutions had called on Kasich to use his line-item veto on ‘Healthy Ohio,’ but Kasich chose not to do so.
In their testimony on the “Healthy Ohio” plan, the center said, “Healthy Ohio as constructed would likely result in the broad disenrollment of currently covered beneficiaries through a set of complicated, punitive and errantly applied cost-sharing policies focused on a population largely unable to meet the financial and logistical requirements of the proposal, including vulnerable populations such as foster children and women with cancer.”
“Healthy Ohio” still awaits federal approval as a Medicaid waiver proposal.
Medicaid expansion affects about 12,000 in Sandusky area
Tom Jackson | Sandusky Register
4.20.16 - The expansion of Medicaid in Ohio provided access to health care for almost 12,000 people in four counties in the Sandusky area, according to figures released by the Ohio Department of Medicaid.
Erie County added the most additional Medicaid users, 4,522. But substantial numbers of new enrollees also were recorded by Huron County (3,037), Sandusky County (2,730) and Ottawa County (1,635).
One of the major components of the Affordable Care Act, also known as "Obama Care," was to expand health care coverage by expanding the number of people enrolled in Medicaid. The ACA including funding to encourage states to expand their Medicaid rolls, and coverage was to be offered to people who didn't quality before, including low-income people without children.
Medicaid expansion is optional, and not all states have agreed to carry it out.
According to the Henry J. Kaiser Family Foundation, 32 states and the District of Columbia have accepted the expansion of Medicaid, but 19 states have not accepted it, at least so far.
Ohio is one of the states that accepted Medicaid expansion. Gov. John Kasich favored Medicaid expansion and pushed it through, against the opposition of many members of his own party.
Proponents of Medicaid expansion argue that it helps hospitals by providing payments for people who otherwise would not have coverage, reducing the need for uncompensated charity care.
Last October, Firelands Regional Medical Center reported that as an apparent result of the Affordable Care Act, the hospital's charity care and bad debt had gone from $7.7 million in 2012 to $3.5 million in 2015, while the number of uninsured patient accounts fell during the same period from about 15,000 to about 10,000.
Medicaid expansion accounted for much of that, with the new health insurance exchanges set up by the ACA playing a smaller role, Martin Tursky, president and CEO of Firelands, told the Register.
Medicaid expansion proponents also argue expansion improved the health of many patients who had no coverage before, and who had to deal with health care issues by showing up in hospital emergency rooms when a health problem presented itself.
Dr. James Misak, a Cleveland family medicine doctor, told reporters Wednesday on a telephone conference call hosted by U.S. Sen. Sherrod Brown, D-Ohio, that the MetroHealth hospital system received permission in 2013 to carry out an early expansion of Medicaid in Cuyahoga County. (Ohio's Medicaid expansion did not take effect until the beginning of 2014.)
Misak said the Cuyahoga County initiative extended coverage to more than 28,000 Cuyahoga County residents. Independent research showed that the local expansion improved control of diabetes and high blood pressure among the patients, resulting in them using the emergency room less, he said.
Medicaid enrollment in Ohio (as of February 2016)
Location Added by expansion Total enrolled
Erie County 4,522 18,421
Huron County 3,037 15,030
Sandusky County 2,730 13,755
Ottawa County 1,635 7,104
State of Ohio 661,000 2,944,055
Public comments sought on proposed Medicaid changes
Tom Jackson | Sandusky Register
4.20.16 - Officials have begin taking public comments on a controversial Ohio proposal to require many Medicaid recipients in Ohio to pay into health savings accounts and to make co-payments on their medical care.
The state is seeking a waiver from the Obama administration — permission to put the plan into effect — and has scheduled two public hearings on the matter and is taking comments by email and postal mail (see box.)
One hearing will be Thursday in Columbus, while the other will be April 26 in Cincinnati.
U.S. Sen. Sherrod Brown, D-Ohio, a critic of the proposed Medicaid changes, told reporters Wednesday that he questions why a public hearing isn't being held in Cleveland.
According to a fact sheet published the Ohio Department of Medicaid, the Healthy Ohio Program, as the changes are called, calls for every non-disabled adult enrolled in Medicaid to be enrolled into a health savings account.
Every enrollee would be require to pay 2 percent of the family's income, up to an annual limit of $99, into the health savings account. The Ohio Medicaid program would then put an additional $1,000 in each HSA every year.
Recipients would be required to make copayments, but only after they had spent all of the cash in their health savings accounts.
Details of the complete proposal are available at 1.usa.gov/1WFWs3V.
Proponents of health savings accounts, such as the libertarian Cato Institute in Washington, D.C., argue that the accounts give patients more control over their health care spending and lower costs by encouraging patients to save money where they can, because they are spending their own money.
The Healthy Ohio program was passed by Republicans in the Ohio General Assembly.
Although Gov. John Kasich had proposed making some Medicaid recipients pay premiums, administration officials have distanced themselves from one aspect of the plan. They told lawmakers that the Obama administration was unlikely to agree to boot people out of Medicaid coverage if they don't pay their premiums. Lawmakers, however, passed the plan, and the governor signed it into law.
State Rep. Jim Butler, R-Oakwood, the main Healthy Ohio proponent, explained in a press release last year that Medicaid recipients would pay a maximum of $8 a month into their HSA accounts, with many people paying less. Participants can reduce their payments by earning points for such actions as quitting smoking or losing weight.
Brown, who didn't mention to reporters that Ohio is proposing to provide $1,000 a year to the health savings accounts, emphasized that the program would raise costs for participants and would eliminate some from the Medicaid rolls.
Brown said the proposal would "gut" Medicaid expansion and invited Ohioans to go to his website, brown.senate.gov, and leave comments explaining how Medicaid expansion has helped them.
The senator said that more than 600,000 Ohioans have obtained Medicaid coverage as a result of the expansion, but that the Healthy Ohio proposal would increase Medicaid costs for up to 1 million Ohioans.
Want to comment?
WHAT: Comments are being sought on Ohio's proposed Healthy Ohio program.
PUBLIC HEARINGS: (1) 2 p.m. Thursday, April 21, Ohio Department of Medicaid, 50 W. Town St., Columbus (2) 2 p.m. April 26, Mercy Health Home Office, 1701 Mercy Health Place, Cincinnati in Rooms S144A & B. Visitors must use the main entrance.
WRITTEN COMMENTS: By email: HealthyOhio@medicaid.ohio.gov.
By mail: Healthy Ohio Program 1115 Demonstration Waiver, Bureau of Health Plan Policy, Ohio Department of Medicaid, 50 W Town St., 5th Floor, Columbus OH 43218.
By fax: (614) 995-1301 (please include Attn. Healthy Ohio Program 1115 Demonstration Waiver in the subject line)
U.S. Sen. Sherrod Brown calls plan to make Medicaid
recipients pay 'politics at its worst'
- U.S. Sen. Sherrod Brown on Wednesday sharply criticized a plan to require Medicaid recipients to help pay
for their care, calling it a cynical political play that would throw people off their insurance and increase costs for all Ohioans.
In a conference call with reporters, Brown said the proposal – dubbed the "Healthy Ohio" program – will actually undercut health care for hundreds of thousands of people if it is approved by federal regulators.
"This is politics at its worst," Brown said. "Think about it – the Healthy Ohio program. How cynical is that? It would make it harder for Ohioans to afford and access care."
The Democratic senator's broadside on the proposal comes a day before the state holds its first public hearing on the plan in Columbus. The proposal would require all non-disabled adults with income to make a monthly payment into a health savings account to help pay for the cost of their care. Failure to make the payment would result in a loss of coverage.
The payment would be 2 percent of a person's income, capped at no more than $99 annually, or $8.25 a month. However, health care providers -- who have a business incentive to get people covered -- can also help to make those contributions, further reducing the financial burden on Medicaid recipients.
Will the proposal to make Medicaid recipients pay actually increase costs for everyone else? Give us your thoughts in the comments.
Some supporters say the plan would inject needed personal responsibility into the Medicaid program and help to reduce costs. The Kasich administration is seeking to implement the program in 2018.
State Rep. Jim Butler, one of the architects of the proposal in Ohio's legislature, said it is Brown who is playing politics with Medicaid and ignoring key details of the plan to improve it.
Butler said it is modeled after a Medicaid program in Indiana that was approved by the Obama administration. He pointed to survey data from that program indicating that participants who stuck with it reported using preventive services at much higher rates; the participants also reported a much lower reliance on the emergency room to get care, which helps to reduce costs.
"The most important thing is to incentivize proper care and engender a cost consciousness" in Medicaid recipients, Butler said. "Those are all important parts of empowering the patient to have the best care and have the knowledge to make the best decisions in consultation with their doctors."
But Brown argued the plan would claw back a lot of the gains made when Gov. John Kasich expanded Medicaid under the Affordable Care Act, commonly known as Obamacare, to more than 600,000 Ohioans.
Brown said the proposal would effectively throw hundreds of thousands of people off the Medicaid rolls, and increase uncompensated care costs that are borne by everyone.
Before passage of the Affordable Care Act, he said, health care providers in Ohio faced up to $2.3 billion dollars of uncompensated care each year for people who could not pay, often resulting in a "hidden tax" on privately insured people of about $1,000 a year per insured family.
"This could bring that hidden tax back," Brown said. "This healthy Ohio plan kicks people off health care plans. And when we kick people off their health care plans, costs rise for everyone."
Butler said no one would be thrown off Medicaid, and that the number of people expected to drop out because of the new program requirements would be far fewer than Brown is suggesting.
He also said anyone who fails to make their payments could pay their balance and re-enroll if they get sick. "I think Sherrod Brown is the one playing politics with this," Butler said. "And it's not something we should be playing politics with. It's very serious and important."
A state document outlining the proposal indicates it would result in between 125,000 and 140,000 people dropping their insurance. The document also indicates it would save the state about $1 billion in Medicaid costs over the first five years of its implementation.
Prospects for federal approval remain uncertain, and even the Kasich administration has raised questions about its viability in Washington. Ohio's proposal is expected to be filed with the federal Centers for Medicare and Medicaid Services (CMS) by June 30. CMS could approve or reject the proposal in its entirety, or jettison pieces it disagrees with, while keeping others.
Brown encouraged the public to submit comments on the plan and said he intends to lobby CMS to reject it completely. "This change is not a done deal," he said. "I'm encouraging people to make their voices heard."
Ohio Supreme Court upholds Ohio Controlling Board Medicaid expansion
By Catherine Candisky | The Columbus Dispatch
12.20.13 - The Ohio Supreme Court upheld Gov. John Kasich’s expansion of Medicaid coverage to an estimated 275,000 poor, uninsured Ohioans today.
In a 4-3 ruling, the court found that the state Controlling Board, a bipartisan legislative panel that oversees government spending, acted within state law when it accepted federal aid to fund the expansion.
“The (groups challenging the expansion) fail in their quest because they have not adequately shown that the Controlling Board had a clear legal duty to follow the directives of the legislature when those directives are not expressed in the final, enrolled bill,” Chief Justice Maureen O’Connor wrote in a 15-page decision
The three dissenting justices – Justices Terrence O’Donnell, Sharon Kennedy and Judy French – said they would have dismissed the case without issuing a ruling on its merits.
“The role of the judiciary is to decide legal questions,” O’Donnell wrote. “This case, however, involves a political question concerning whether a legislative agency acted contrary to the policy goals of the General Assembly.”
Two anti-abortion groups and six Republican lawmakers filed suit last month to block expansion after the Controlling Board – a panel of six lawmakers and one appointee of the governor – voted 5-2 to approve the expenditure of $2.56 billion in federal aid. The spending authority was sought by the Kasich administration to use funds available through the Affordable Care Act to states agreeing to expand Medicaid eligibility.
Conservative legislators and abortion foes argued Ohio would face “dire budgetary consequences” and that the Controlling Board improperly overrode the GOP-led General Assembly, which had rejected Kasich’s proposal to extend coverage to those earning up to 138 percent of the federal poverty level – just under $16,000 a year for an individual.
State attorneys claimed that the Controlling Board and state Medicaid Director John McCarthy, a Kasich-appointee who submitted the spending request, both acted within their authority. The lawsuit, attorneys stressed, challenged the decision to accept the federal funds and not the decision to expand Medicaid.
O’Connor noted that Kasich vetoed a provision in the budget that would have blocked the expansion, and the legislature did not attempt to override that veto. Blocking the administration’s action through the Controlling Board would amount to a back-door veto override.
“The General Assembly would have the power to command the Controlling Board, in all cases, to disregard the governor’s veto in the implementation of appropriations,” she wrote. “This interpretation is clearly contrary to the ‘checks and balances’ that are critical to our constitutional democracy.”
The Affordable Care Act (Obamacare) will cover 100 percent of expansion costs for three years beginning Jan. 1 and 90 percent or more after that, bringing an estimated $13 billion in federal money to Ohio during the next seven years. Opponents, however, say the federal government doesn’t have the money and could stick states with the bill.
The state Medicaid program currently covers nearly 2.4 million poor Ohioans, mostly children, parents and the disabled. The 275,000 gaining eligibility beginning Jan. 1 are primarily adults under age 64 without dependent children.