The Tribune Chronicle's Dec. 5 editorial, "Ohio can't afford big Medicaid," asserted that Ohio's "success of holding down increases in Medicaid spending may tempt some state officials to go along with the major expansion" and went on to predict expansion would prove unaffordable. But this stance ignores the reality that the costs of providing health care for Ohio's 1.5 million uninsured citizens already are being borne by Ohio's hospitals, employers and 10 million other residents. Moreover, foregoing the enhancement option altogether would dismisses a unique opportunity to streamline Medicaid eligibility, promote long-term stability of the state's finances, and create more rational incentives in the health care delivery system.
The U.S. Supreme Court's decision on the Affordable Care Act (ACA) made it optional for states to expand Medicaid coverage for adults with income up to 138 percent of the federal poverty guidelines. According to the Health Policy Institute of Ohio's Medicaid Atlas, more than 20 percent of adults in Trumbull County - and more than 47 percent of children - live at or below 138 percent of the federal poverty level. Many of the families in Trumbull County who aren't offered health coverage through their employer and who can't afford a private plan finally would have access to coverage if Ohio pursues the Medicaid option.
From 2014 through 2016, any expansion of Medicaid in Ohio would be covered entirely by federal funds, meaning newly eligible Ohioans under an expansion would not require additional state dollars to be insured by the program. Of course, taxpayers in states that choose not to extend Medicaid to more of their citizens will be paying for those in states that do so. Expansion funds also provide a chance to strengthen our state's health care safety net while recognizing that any expansion should be repealed if the federal government fails to honor its financial promises.
Ohio also has a chance to build a more flexible Medicaid program, with greater opportunities for personal responsibility, less cost shifting onto privately insured families and employers, and less financial risk for the state. By law and by mission, Ohio hospitals are required to provide medically necessary care, to all sick or injured people, including uninsured individuals with incomes at or below the federal poverty line. When uninsured patients can't pay for their care, hospitals must make up the losses. Hospital uncompensated care levels are at all-time highs. In the last five years, Ohio hospitals' uncompensated care costs have increased by over 50 percent. Even though Medicaid only covers part of the cost of providing care - 83 cents on the dollar - covering more uninsured Ohioans through Medicaid would provide some degree of counterbalance to the spiraling shift of costs to families, employers and hospitals.
Hospitals recognize that enhancing and streamlining the Medicaid program will present certain challenges. Simply dismissing this opportunity might be penny wise but certainly pound foolish, as it ignores the challenges faced by families without health insurance and the resulting unsustainable impact on Ohio's economy and health care delivery system. As the front line of health care, the Ohio Hospital Association, on behalf of Ohio's hospitals, encourages policymakers to take advantage of this chance to help secure a better health care system for Ohio.
Robert W. Shroder
Senior Vice President,
Catholic Health Partners
Chair, Ohio Hospital
Health Care Transformation Taskforce