More and more, the chances that an expansion of Ohio’s Medicaid program will appear in the state budget appear to be less and less.
But the debate is far from over.
While they hedge that there are no guarantees, legislators, lobbyists and the administration, continue to talk with optimism that something will be done to provide health coverage for the working poor.
The form that could take is uncertain. But legislators in both the Republican-controlled House and the Senate say something could be accomplished before summer. Whatever that ends up being, it seems likely it will not be billed as an expansion of Medicaid, but rather as Medicaid “reform.”
“My expectation all along is that we’re going to find an opportunity to do Medicaid reform,” Senate President Keith Faber, a Republican from Celina, said after the Senate approved its version of the state budget Thursday — legislation that did not include the Medicaid expansion proposed by Republican Gov. John Kasich.
“What that entails, I’m not sure,” Faber said. “Whether it’s quote, unquote, expansion, as some have called it, I’m pretty sure it won’t be. But does [the change] allow more people to be covered at less cost? I’m pretty sure it will be.”
But finding the right mix of elements is a tricky proposition. Provisions that might gain support from wary conservatives who steadfastly oppose the federal health care law that includes the expansion must also satisfy Washington if Ohio is to take advantage of promised federal funding for expansion.
That leaves the Kasich administration in the position of dickering with lawmakers over what shape the program could take while dickering with the federal government on what it would find acceptable.
House Speaker William G. Batchelder, for example, said he favors including some form of drug testing. “A number of people we talk to every week who own businesses … say the single biggest problem they have in hiring is drugs. We just can’t keep going like that.”
But would that pass federal muster?
“They can turn us down, if they want,” he said. “We can tell them to pound salt. It’s just one of those things, in my opinion.”
The administration won’t discuss its conversations, other than to say it is pleased that progress is being made. “We don’t negotiate on these types of issues through the press,” said Rob Nichols, a spokesman for the governor.
Kasich did give a nod toward reform in a column June 3 in USA TODAY, invoking the name of Ronald Reagan and noting the former president expanded Medicaid “not just once, but several times.”
“We’ve improved health outcomes through better care coordination and also reduced taxpayer spending by $2 billion,” Kasich wrote. “We followed Ronald Reagan’s lead and found ways to provide a better service at a lower cost. First, Reagan was fiscally responsible, but he was also pragmatic and compassionate.”
Already there are at least three bills to extend Medicaid coverage to the state’s working poor in the General Assembly. At least two more are expected.
One introduced recently by Rep. Barbara Sears, a Toledo-area Republican, is similar to what the governor proposed. Her bill, though, labels key proposals as reforms.
That’s purposeful, she said, and not just because reforming a government program is easier to sell than expanding one.
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