Controlling Board membership may be altered to provide okay for Medicaid expansion

It looks like Gov. John Kasich will get his Medicaid expansion approved by the Controlling Board.

I previously shared with you his plans to bypass the Ohio General Assembly, which had removed the expansion from prior bills and is still debating the issue.

Last week, the Department of Medicaid submitted a request to the panel seeking authorization to spend federal funds totaling $500,000 million in FY14 and $2 billion in FY15 to extend the program to cover citizens up to 138% of the federal poverty level, as originally proposed by Gov. John Kasich in his biennium budget bill.

The item is scheduled for the Controlling Board's meeting on Oct. 21.

The Controlling Board is a 7-member body comprised of:

• The Director of Budget and Management, or designee (the President of the Board)
• The Chair of the Finance and Appropriations Committee of the House of Representatives
• The Chair of the Finance Committee of the Senate
• Two members of the House appointed by the Speaker of the House, one from the majority party and one from the minority party
• Two members of the Senate appointed by the President of the Senate, one from the majority party and one from the minority party

In order for the expansion to be approved, at least one Republican would need to vote in favor of it. The two House Republicans have previously expressed opposition to the plan, but the two Republican Senators have been silent on the matter.

Today Gongwer Ohio (subscription may be required) reported that House Speaker Bill Batchelder (R-Medina) "plans to alter his chamber's membership on the panel prior to next Monday's meeting and will seat at least one member that will give the go-ahead to the governor's plan."

Rep. Ron Amstutz expressed his displeasure with the governor's Controlling Board move last week. Rep. Cliff Rosenberger said he would vote against expansion at the Controlling Board, and told Gongwer he hadn't heard of any plans to replace him on the panel.

From Gongwer:

Rep. Rosenberger said he'd prefer to continue to debate the policy through the full legislature but added that he has been on record as opposing a straight expansion and instead prefers the "reform" approach embodied in various proposals, including the bill (SB 208*) introduced last week by Sen. David Burke (R-Marysville). (See Gongwer Ohio Report, October 10, 2013)

"There's an opportunity for members of the General Assembly to still hear those options," he said, adding that he's concerns about the impact of pushing the expansion through the board versus the legislature.

"I would be a 'no' vote on the Controlling Board on the issue," Rep. Rosenberger said.

While Speaker Batchelder has been a staunch opponent to expansion, as it was part of the vilified "Obamacare" package, swapping out his reluctant Controlling Board members could prove to be politically expedient as it would provide cover to some of his caucus members who support expansion.

A Controlling Board vote averts putting those members on record for where they stand on separate legislation, thus protecting them from potential primary challenges from the right. Meanwhile, he's also boosting the policy aims of his fellow Republican governor, whose name is being bandied about as a presidential candidate in 2016.

Also a matter of conventional wisdom: Gov. Kasich wouldn't have scheduled a Controlling Board item if he wasn't assured of the votes.

Senate President Keith Faber (R-Celina) said in an interview Tuesday that his caucus is aware of his opposition to expansion, however he has told his members on the panel - Sen. Bill Coley (R-Liberty Twp.) and Sen. Chris Widener (R-Springfield) - to vote their conscience and their districts.

Nevertheless, he also said he doesn't view the proposal before the board to be the actual "expansion," per se. That would come through an executive order from the governor, he said. The Controlling Board agenda item would merely authorize the transfer of funds.

Kasich has been criticized by conservatives in the state for his plan to expand Medicaid. Here is guest post that details the 'myths' associated with the expansion, as promoted by the Kasich administration talking points on the plan.

Others, including State Rep. Barbara Sears, left-leaning groups and many Democrats, support the expansion of the government program.

Had this been Democrats planning to replace board members in order to provide a favorable vote for their governor, I'm sure the Republican Party would be having a conniption. As it's a Republican governor, expect the party to stand behind their man, regardless of party principles.

Guest Post: The Myths of Medicaid Expansion

The following is a guest post from Rep. Ron Young, Republican from Leroy Township, District 61.

I believe Ronald Reagan summed up what we face today way back in 1961. He said, “In 1927 an American socialist, Norman Thomas, six time candidate for president on the Socialist Party ticket, said the American people would never vote for socialism. But he said under the name of liberalism the American people will adopt every fragment of the socialist program. One of the traditional methods of imposing socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it.”

Today, our nation and Ohio are experiencing an expansion of government intrusion into our health care industry of unparalleled magnitude. Full implementation of Obamacare will mean about one- sixth of our nation’s total economy will fall under even tighter government regulation and bureaucracy. 

My comments in this report are focused on the impacts of expanding the Medicaid program. Contrary to some reports, it is impossible to oppose Obamacare and yet support Medicaid expansion. Medicaid expansion is a major part of Obamacare and represents about half of all Obamacare spending. 

In order to understand why Medicaid expansion is bad for Ohio, we need to first understand a few points about the current Medicaid program. 

• About two million Ohioans are on the Medicaid program today, or about 20 percent of Ohio’s total population.
• The current program is by far the biggest expense of the state’s budget, consuming about 42% of it, because Medicaid spending increases much faster than inflation. It is crowding out education, infrastructure improvements, prison funding, and other critical needs. The current program, even without expansion, is financially unsustainable
• The program has been in effect for more than 40 years and is designed to care for pregnant women, children and individuals with disabilities of low or no income. Medicaid expansion is designed to a different population, healthy individuals who fall below the poverty line. The largest group in this population is comprised of single young adults with no dependent children. Of course, this begs the question, are we incentivizing people not to work?  

Former Speaker of the House Nancy Pelosi is famous for her statement regarding Obamacare, “We have to pass this bill so we can find out what’s in it.” However, I believe one of her even more insightful quotes is, "Think of an economy where people could be an artist or a photographer or a writer without worrying about keeping their day job in order to have health insurance."  

 

Her vision of incentivizing unemployment to create an underclass of starving artists is absurd. However, while operating an employment firm in Ohio for more than 30 years, I can recall numerous occasions where individuals rejected job offers and even promotions in order to retain government benefits. Incentivizing unemployment and underemployment is a real problem with the Medicaid program. 

MEDICAID MYTH BUSTING 

In an effort to win public support, a number of myths have been perpetrated regarding Medicaid expansion. By contrasting some of these myths with reality I believe a clearer portrait of the effects of Medicaid expansion can be seen.  

MYTH #1: “Medicaid offers good health care and expanding Medicaid will save countless lives.” 

REALITY: The health outcomes for those our government places on Medicaid are poor and the best research supports this statement. It should not be surprising that Medicaid offers sub-par medical services. Medicaid patients have a significant problem getting access to medical care. One major reason for lack of access is that Medicaid pays doctors only a fraction of what private insurers pay. According to a Heritage Foundation 2012 study, “Medicaid Patients Have Worse Access and Outcomes than the Privately Insured,” Medicaid typically pays physicians only 56% of the amount private insurers pay. Other studies indicate that for a physician in Ohio practicing in an office setting the reimbursement average for Medicaid is even lower. 

As a result, many doctors choose not to see Medicaid patients because it is more difficult to keep their practices alive if they do. That, in turn, makes it hard for Medicaid patients to get doctor’s appointments for annual checkups, routine care, and even urgent medical problems. A 2011 study published in the New England Journal of Medicine found that many doctors even refuse to see Medicaid children complaining of seizures, uncontrolled asthma, and even broken arms.  

These types of access problems also cause huge overcrowding issues in hospital emergency rooms. Since they have difficulty finding available doctors, Medicaid recipients visit emergency rooms at much higher rates than the uninsured. According a study reported in USA Today, “Uninsured Don’t Go to the ER more than the Insured” by Mary Brophy Marcus, Medicaid recipients visit the ER about twice as much as the uninsured.  

After reviewing the research described below I hope each reader will ask a simple question. Is it moral to promote a health program that consumes hundreds of billions of taxpayer dollars, but offers such questionable health outcomes? 

RESEARCH 

University of Virginia Study: A very large study by the University of Virginia found that surgical patients on Medicaid are 13% more likely to die during their hospital stay than those with no insurance coverage and 97% more likely to die than those with private insurance. The Virginia group evaluated 893,658 major surgical operations from the Nationwide Inpatient Sample database from 2003 to 2007. They adjusted the database in order to control for age, gender, income, geographic region, operation, and co-morbid conditions (having 2 or more diseases simultaneously). That way, they corrected for the obvious differences in the patient populations (for example, older and poorer patients being more likely to have ill health). 

Oregon Study: The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate the health impacts of the expansion. Approximately 2 years after the lottery, data was obtained from 6387 adults who won the lottery and received Medicaid coverage. Data on health outcomes was also collected on 5842 adults who lost the lottery and did not receive Medicaid coverage. This randomized and controlled two year study that was published in the prestigious Harvard School of Public Health showed that Medicaid coverage generated no significant improvements in measured physical health outcomes. 

A University of Pennsylvania study published in Cancer found that, in patients undergoing surgery for colon cancer, the mortality rate was 2.8% for Medicaid patients, 2.2% for uninsured patients, and 0.9% for those with private insurance. The rate of surgical complications was highest for Medicaid at 26.7%, as compared to 24.5% for the uninsured and 21.2% for the privately insured. 

A Columbia-Cornell study in the Journal of Vascular Surgery examined outcomes for vascular disease. Patients with clogged blood vessels in their legs or clogged carotid arteries (the arteries of the neck that feed the brain) fared worse on Medicaid than did the uninsured; Medicaid patients outperformed the uninsured if they had abdominal aortic aneurysms. 

A Harvard Study suggests there are some instances where Medicaid coverage may save lives. The authors compared three states that expanded their Medicaid programs — Maine, Arizona, and New York — with neighboring states that did not — New Hampshire, Nevada and New Mexico, and Pennsylvania. The Medicaid expansion was associated with increased mortality in Maine, and with decreased mortality in Arizona and New York. 

While the results suggest Medicaid could be helpful in some instances the study has problems. For example, demographic differences between New York and Pennsylvania could explain the entirety of the “benefit” that the authors ascribed to New York’s Medicaid program. Yet the authors’ conclusion — that Medicaid saves lives — hinges entirely on the comparison of New York with Pennsylvania. Without it, the authors would have shown no difference in outcomes between those with Medicaid and the uninsured, because the results in Maine and Arizona would have canceled each other out. 

Another obvious problem with the study is that the Harvard economists looked only at county- level data about mortality and Medicaid; they had to make assumptions about which patients had enrolled in the program, and when. The extensive clinical research showing Medicaid’s poor outcomes, such as the UVA study, has reviewed millions of individual patient records to learn what happened to specific patients with specific forms of health insurance. 

MYTH #2: “If we don't expand Medicaid Ohio will lose federal tax dollars that are earmarked for us. It would be foolish of Ohio to turn down all these free federal dollars."

REALITY: There are no federal Medicaid dollars earmarked for Ohio and it is not free money. There is no pot of gold with Ohio's name on it in Washington waiting to be dispersed the day we expand Medicaid. Most of the money we would receive from the federal government by expanding Medicaid would simply increase the national debt. Many members of the Ohio General Assembly are constantly bemoaning excessive and out of control federal spending. This is reasonable given the fact our federal government is currently more than $16 trillion in debt and going deeper in debt every day. Not only do they not have a balanced budget, they don't even have a real budget. To expand Medicaid only makes the hole this nation is digging for our grandkids deeper. 

MYTH #3: “The federal government has made some great promises to Ohio in the form of special dollar matches if we expand our Medicaid program. The federal government funds about 62% of Ohio’s current Medicaid program. For the expanded program they have promised to pay 100% of the cost of the program for 3 years and 90% of the cost thereafter. A promise from our federal government is rock solid. They have to live up to their promises; we should trust them and take the deal.”  

REALITY: There are no iron clad guarantees in any of the promises offered by the federal government. The federal government can change the Medicaid match amount at any time. To accept Medicaid expansion means Ohio is trusting its financial future to a government that is deeply in debt and addicted to over spending. The calls for a balanced federal budget and entitlement cuts should send a chilling message to those that would support the expansion. Also, we must consider potential changes caused by future administrations. Remember Medicaid is not a road project, or some other short term building project. No one foresees an end date for Medicaid. Whatever budget sources we use to fund the program must be deep, dependable and wide.  The current program is growing so rapidly that its cost is often described as unsustainable. Expanding the program now by signing on hundreds of thousands of new participants would be irresponsible.  Perhaps the old saying, "today's promises are tomorrows taxes" applies in this case as new revenue would have to be found to sustain the program at some point in the future. In any case the long term commitments required to make this deal even somewhat financially feasible are very dubious. 

MYTH 4: “If the expansion program doesn’t work then we’ll just shut it down and walk away.”

REALITY: We could probably argue all day about how Health and Human Services, the courts, a future Governor, a future President, a future Secretary of Health and Human Services, etc., might interpret the law. Most of the “experts” seem to agree that once a state accepts the federal offer and expands Medicaid there is no easy withdraw from the expansion portions of the program. However, I believe the legal argument is a moot point. The reality is that Ohio would simply not drop hundreds of thousands of voting citizens from a Medicaid program. We do not have the political will to do such a thing. Just consider the political pressure being applied today for expanding the program and then consider how much greater that pressure would be if the subject of the discussion was one of taking it away. 

MYTH 5: “We will use the expansion of Medicaid as an opportunity to reform the program.”  

REALITY: It defies logic to expand a government program that needs to be reformed. If we can meaningfully reform Medicaid we should start with the existing program. After the reforms are in place and operating effectively then, and only then, should we consider expansion. 

CONCLUSION: Regardless of the sweeping rhetoric and marketing techniques used by those that support Medicaid expansion the science to support claims of significant improvements in public health are not supported by the facts. How many lives and families could be saved by leaving these billions of dollars in the private sector to create jobs and expand our economy, as opposed to burdening the nation with more debt and bigger government in order to expand a very questionable, if not failed, government program? 

UPDATED: Kasich seeks Controlling Board approval for Medicaid expansion

Gongwer is reporting that Ohio Gov. John Kasich's administration will seek approval from the Controlling Board to expand Medicaid up to 138% of the federal poverty level.

The Department of Medicaid on Friday submitted a request to the panel seeking authorization to spend federal funds totaling $500,000 million in FY14 and $2 billion in FY15 to extend the program to cover citizens up to 138% of the federal poverty level, as originally proposed by Gov. John Kasich in his biennium budget bill.

The Controlling Board’s next meeting is Oct. 21. GOP legislative leaders have thus far been coy about providing votes for the plan; at least one Republican vote will be needed to clear the spending through the seven-member panel.

“Only the General Assembly can authorize Medicaid to spend funds in this way, either through a bill or the Controlling Board,” Kasich spokesman Rob Nichols said in an email. “The Administration has been preparing to implement this change when the General Assembly gives its ok and we’ll be ready.”

Despite the shutdown, federal officials approved Ohio’s proposal to expand the entitlement program earlier this week...apparently, such approval is an 'essential' function of government.

See Jason Hart's post at MediaTrackers for more background on the continuing saga.

UPDATE: Statement from Chairman of the House Finance and Appropriations Committee and member of the State Controlling Board Ron Amstutz (R-Wooster):

"I have grave concerns about the place, the time and the substance of this proposed Controlling Board action. Based on our solid track record of passing tough bills, I would expect a far superior and more creative solution by legislative enactment than what I fear may result from effectively crimping the legislative process."

Guest Post - Oops! A whopping $47B Obamacare-Medicaid expansion error for Ohio

Opportunity Ohio found a whopping error in the recent claims that expanding Medicaid in Ohio would save us money. Aside from the fact that adding more people into a program cannot possibly result in less cost, the key is capping the rates. But what if we cap the rates and don't expand Medicaid?

As the Bard says, "Aye, there's the rub."

Here's the text of the report. For the full details, including footnotes, go here.

A number of individuals have falsely characterized a recent PowerPoint presentation given to the Ohio Senate Finance Committee’s Medicaid Subcommittee by the Health Policy Institute of Ohio (HPIO).

The Columbus Dispatch flashed a headline that erroneously claims the presentation proved “Medicaid expansion would cost Ohio less than doing nothing.” The Dispatch’s editorial board followed up by asserting that the presentation proved that expanding Medicaid would “save the state money in the long term.” The Columbus Business First reported that the presentation showed that “Ohio could actually save by expanding Medicaid.” These headlines and reports would have Ohioans believe expanding one of the largest and fastest-growing line items in the state budget can reduce spending. But this is not what the HPIO actually found.

The authors created three different scenarios. In the first scenario, Ohio does not expand Medicaid and the program grows at 7.2 percent annually, what HPIO reports as the average annual growth rate since 2004. It should be noted that in a report released earlier this year, HPIO expected future Medicaid growth to average 5.6 percent per year without expansion, based on Ohio’s most recent actuarial analysis of Medicaid. It does not explain why it now assumes 7.2 percent growth as the baseline (without expansion) moving forward.

In the second scenario, Ohio caps its annual Medicaid spending growth at 5 percent and also expands Medicaid eligibility. In the final scenario, Ohio caps its annual Medicaid spending growth at 4.5 percent while also expanding Medicaid eligibility. Capping Medicaid spending growth is not related to expanding Medicaid eligibility. If Ohio wished to impose such a cap, it could do so without expanding Medicaid. The only valid comparison is one in which the only changing variable is whether or not the state expands Medicaid eligibility.

For example, the presentation asserts that by capping annual Medicaid spending growth at 5 percent, Ohio can expand Medicaid and still save $2 billion between now and 2025, when compared to 7.2 percent annual growth. But, using that same data, Ohio could save more than $48 billion during the same time period by capping annual growth at 5 percent and not expanding Medicaid eligibility. So, when using an honest comparison, Medicaid expansion will actually increase taxpayers’ costs by $46 billion, even if the state is able to aggressively reduce annual growth.

Choosing not to provide any specific recommendations to reduce the annual growth in Medicaid, HPIO instead provides a listing of possible new revenues to offset higher costs. Of course, increasing revenues does not lower spending. But even at the assumed lower annual growth rates, Medicaid spending would still double within the next 15 years. For comparison, the U.S. economy is expected to grow only 4.9 percent during the next decade. Ohio can expect to see slower growth, as the U.S. economy has historically grown 1.5 times as fast as Ohio’s economy.  If this trend continues, Ohio’s economy will grow by just 3.3 percent during the next decade. The Ohio Department of Development also expects Ohio’s economy to grow slower than the national average in the coming years.

This means Medicaid will continue to consume more and more funding, crowding out resources for other state priorities, even under the HPIO’s assumed lower Medicaid growth rates. Worse yet, the HPIO spending projections are based on the same flawed designs highlighted in a  Foundation for Government Accountability-Opportunity Ohio report published earlier this year. For example, HPIO uses Medicaid managed care rates for current adult enrollees to estimate the costs of covering newly-eligible individuals. However, evidence from states that previously expanded Medicaid eligibility to cover working-age adults without children found this population to be much more expensive to cover than parents. Additional research published by the federal Centers for Medicare and Medicaid Services found that costs were an average of 60 percent higher to provide the same benefits package to childless adults as they were for low- income parents.

HPIO flawed analysis is also evident in its assumption that just 58 percent of all newly-eligible individuals will sign up for Medicaid after expansion. Even among the uninsured, HPIO assumes just 70 percent of newly-eligible individuals will enroll. These are much lower than other projections of participation, including projections by actuaries at the Centers for Medicare and Medicaid Services. States that have previously expanded Medicaid to cover working-age adults without children also relied on projections similar to those given by HPIO.  Those states experienced participation rates that far exceeded what was initially expected.

The HPIO presentation given to the Medicaid Subcommittee adds very little to the debate over Medicaid expansion in Ohio. It recycles old projections based upon faulty assumptions. The only “new” material is the conclusion that capping the annual growth in Medicaid spending will reduce total Medicaid spending, but this has no relevance to the debate at hand. Such a cap has nothing to do with Medicaid expansion, and conflating the two is intellectually dishonest. When comparing apples to apples, where the only changing variable is whether or not the state expands Medicaid, the only valid and fact-based conclusion is that Medicaid expansion will cost taxpayers much more.”

AFP-Ohio says Rep. Sears and Pres. Obama are the same when it comes to Medicaid expansion

Press release from Americans for Prosperity - Ohio:

Americans for Prosperity-Ohio: No Difference Between Rep. Sears’ and President Obama on Medicaid Expansion 

COLUMBUS - Americans for Prosperity – Ohio is expressing their strong opposition to proposed legislation aimed at expanding Medicaid in the state of Ohio.  According to a recent Columbus Dispatch story, Rep. Barbara Sears (R-47) plans to introduce roughly a dozen Medicaid bills in the next few weeks with the end-goal of expanding Medicaid in the state.  The expansion of Medicaid is made possible through Obamacare.

“Rep. Sears and President Obama are both calling for the expansion of the Medicaid system.  How many blank checks and empty promises are we going to allow Washington to pass onto the states before we stop falling for it?,” said Eli Miller, State Director of Americans for Prosperity – Ohio. “The federal government can barely meet its current financial obligations.  We cannot allow Ohio families and businesses to be left holding the bag when, not if, the federal government realizes they cannot meet the financial obligations promised surrounding Medicaid expansion.”

According to the Columbus Dispatch story, Medicaid expansion legislation would need to pass the Ohio General Assembly in October of this year so that enrollment could begin in January 2014.

“At a time when even the Obama Administration is essentially admitting defeat by delaying key provisions of Obamacare, Rep. Sears should not recklessly and irresponsibly tie our state’s finances and the physical health and well-being of our most vulnerable citizens to this eventual disaster,” continued Miller. “We call on all members of the Ohio General Assembly to support Ohio families, stand up for fiscal responsibility, and oppose Rep. Sears and President Obama’s Medicaid expansion.”

Americans for Prosperity (AFP) is a nationwide organization of citizen-leaders committed to advancing every individual’s right to economic freedom and opportunity. AFP believes reducing the size and intrusiveness of government is the best way to promote individual productivity and prosperity for all Americans.  For more information, visit www.americansforprosperity.org

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Kasich, new TV ads, Obamacare and Medicaid expansion in Ohio

Despite the fact that it's summer when political things usually slow down, there's a lot of activity going on when it comes to Medicaid and Obamacare...

At a rally yesterday in Columbus, Ohio Gov. John Kasich continued his push for an expansion of Medicaid and enrolling up to 366,000 new members by the end of the year.

The General Assembly rejected this expansion as part of the state's two-year budget which they passed last month.

Jason Hart at MediaTrackers has good coverage of the event starting with:

Governor John Kasich stuck to his practiced Medicaid expansion pitch – a mix of progressive pseudo-Christianity and outright falsehoods about the program’s funding – during a speech at a July 9 Statehouse rally for socialized medicine.

As his administration has done for months, the Republican governor conflated Medicaid coverage with “health care,” though 28 percent of Ohio’s office-based physicians were already refusing new Medicaid patients in 2011 and a recent study found that Medicaid coverage does not improve physical health.

Americans for Prosperity - Ohio, one of the leading critics of expanding the state's Medicaid rolls (as allowed under law), argues that expanding Medicaid rolls will push thousands of low-income Ohioans into a shoddy system at enormous cost.

"AFP will continue to educate Ohioans about the problems with Medicaid expansion. Ohioans need more health care choices, not more sub-par, bureaucrat-controlled health care and higher taxes," Eli Miller, State Director of AFP-Ohio, said.

Also yesterday, in conjunction with the AFP-Ohio efforts, broadcast and cable networks in Ohio started airing a new ad from Americans for Prosperity. The goal of the ad is to "expose the major problems with the Pres. Obama's health care law, the Affordable Care Act also known as Obamacare."

It's called “Questions,” and features the story of Julie, a mother of two who started paying close attention to her family’s health care options after her son began having seizures. The threat of shrinking options, higher premiums, and Washington bureaucrats making health care decisions leaves her with serious concerns about ObamaCare.



"The American people have serious questions and concerns about the negative impact of ObamaCare," Miller said."Ohioans are waking up to higher premiums and fewer choices, but are being told by President Obama and outside groups that everything is just fine. Well President Obama, everything isn't just fine. We feel it is important to educate Ohioans on the true consequences of government intrusion into the private health care decisions of families."

AFP-OH and state chapters across the nation plan to host events and meet-ups to further educate and provide information on the negative consequences of ObamaCare.

AFP describes itself as "a nationwide organization of citizen-leaders committed to advancing every individual’s right to economic freedom and opportunity. AFP believes reducing the size and intrusiveness of government is the best way to promote individual productivity and prosperity for all Americans."

The AFP ad competes with a national buy from the pro-Obama Organizing for Action, though both groups say the timing is coincidental.

Called "Better Coverage," the OFA ad features Stacey Lihn, who is also a young mom, and focuses on the Obamacare provision that eliminates a lifetime cap on benefits. “Thanks to Obamacare, we can now afford the care that Zoe needs. And for her, that’s a lifesaver,” she says.



Both ads are going after a key demographic in the health care debate, as this quote from a 2010 Time article explains:

Women make the primary health care decisions in two-thirds of American households. They account for 80 cents out of every dollar spent in drugstores and are likelier than men to choose the family's health insurance. Even when both parents work, wives shoulder 75% of domestic responsibilities, including making the kids' doctor appointments and getting them there on time. "Women are the main brokers of health care in the United States," says Dr. William Norcross, a family physician and faculty member at the University of California, San Diego, School of Medicine. "This has long been the case and is probably true elsewhere in the world too."

But be ready, Ohio, because the push for Ohio to expand the Medicaid program and the ad wars on Obamacare are just getting started.

Batchelder: House won't act on Medicaid bills before recess

Gongwer is reporting that the Ohio House will not act on any Medicaid overhaul bill before their recess. House Speaker Bill Batchelder said he doesn't think the House can pass the legislation before they take their summer break beginning June 30.

"My sense is that at this point in time, we cannot complete that work (before June 30) but we will continue the work,” he told reporters. “We can’t do anything before the break, in my opinion, just given the dynamics..."

Is new Sears bill another version of the Obamacare Medicaid expansion for Ohio?

I'll admit to not being an expert on the Medicaid expansion that Gov. John Kasich proposed for Ohio - as part of Affordable Care Act, also known as Obamacare - but this new bill introduced by Rep. Barbara Sears sure sounds a lot like it.

The House, after significant public pressure from conservatives and tea party groups, removed the Medicaid expansion from the budget bill (H.B. 59) earlier in the year. Rep. Sears was extensively criticized for her role in pushing the expansion and for what some considered was a violation of the Health Care Freedom Amendment overwhelmingly passed by Ohioans. She responded to those allegations, saying she did, in fact, support the Health Care Freedom Amendment, though she believed a pending bill would conflict with that amendment.

Speaker Bill Batchelder told reporters that a bill separate from the budget could be passed by the House before the end of June.

The press release below details some of the provisions of her legislation:

Rep. Sears Introduces Medicaid Reform Legislation

COLUMBUS—Today, State Representative Barbara Sears (R- Monclova Township) introduced legislation requiring the Director of Medical Assistance to implement Medicaid reforms that will identify ways to lower costs, reduce uncompensated care, and extend coverage to Ohio’s most vulnerable citizens.

The legislation would extend coverage to Ohioans under 138% of the federal poverty level and will provide critical health care services to Ohio’s poorest citizens. New enrollees in the Medicaid program will be fully funded by the federal government for the first three years. The bill provides protections for Ohio should the federal assistance percentage decrease below the specified amount after the third year.

Additional provisions of this legislation include encouraging personal responsibility through cost sharing, promoting employment-related services, and ensuring those who abuse narcotics receive proper treatment.

“Ohio’s Medicaid system has made substantial improvements over the past few years and this legislation furthers that effort,” Rep. Sears said. “By providing a ladder up and out of poverty through quality care, we are allowing for citizens to achieve greater self sufficiency and creating a healthier Ohio.”

The bill also includes requiring the Medicaid director to present a report to the General Assembly on the progress being made and specifies that the Joint Legislative Committee on Medicaid Technology and Reform consider and review the reforms implemented by this legislation.

-30-

The bill will be assigned a number Tuesday, but here is a link to the language submitted, as provided by her office.

Medicaid expansion out, ban on Internet cafes in, OH Senate President says

Gongwer is reporting:

Senate President Says Medicaid Expansion Off The Table For Budget, Promises Internet Cafe Ban

Senate President Keith Faber announced Wednesday that the Senate will not pursue an expansion of Medicaid as proposed by Gov. John Kasich for the biennial budget.

The Celina Republican also detailed his intentions for the Senate to quickly extend a moratorium on so-called Internet cafes in the state and to follow that legislation with a complete ban on the operations, which he said serve no public purpose.

His announcements came during a Statehouse news conference where Attorney General Mike DeWine and Franklin County Prosecutor Ron O’Brien expressed support for the cafe prohibition, and fellow lawmakers joined the Senate leader in discussing general plans for the budget.

Quote of the Day - a lesson on government vs. private charity

Perhaps Gov. John Kasich should pay attention to this, especially when he thinks expanding Medicaid is the 'charitable' thing to do...

"We are all doubtless bound to contribute a certain portion of our income to the support of charitable and other useful public institutions. But it is a part of our duty also to apply our contributions in the most effectual way we can to secure this object. The question then is whether this will not be better done by each of us appropriating our whole contribution to the institutions within our reach, under our own eye, and over which we can exercise some useful control? Or would it be better that each should divide the sum he can spare among all the institutions of his State or the United States? Reason and the interest of these institutions themselves, certainly decide in favor of the former practice." ~ Thomas Jefferson

Rep. Sears, Obamacare and Ohio's Health Care Freedom Act

Over the past 24 hours, many of us in this area (and around the country, for that matter) have been informed about actions and comments made by Rep. Barbara Sears in a House committee during the discussion of the Health Care Freedom Act, the Affordable Care Act (also known as Obamacare) and the proposal to accept the Medicaid expansion in Ohio.

The FreedomWorks article, cross-posted on RedState.com, says:

In early March, Ohio State Representative Ron Young and Rep. Andy Thompson introduced a bill known as, “The Health Care Freedom Act,” (HCFA) that proposed a new line of defense against the Patient Protection and Affordable Care Act, or, Obamacare. The bill, when passed, will prohibit health insurance companies in Ohio from accepting any federal funding that would trigger penalties for employers or individuals who aren’t compliant with Obamacare. Wednesday, when the bill was brought up in committee, opposition arose; but not only from the expected side of the aisle. While the Democrats did balk at the bill, Republican Majority Floor Leader Barbara Sears also took issue with HCFA. One needn’t look too deep to understand why Sears wouldn’t want the HCFA to pass in Ohio. Not only has she received a substantial amount of financial contributions from the health care industry, she currently works at a health insurance provider and recently passed her own bill which helps implement Obamacare.

Rep. Sears is not quoted in the article, nor does it say if they tried to contact her to get a comment or response.

I've known Barbara for a long time - we've worked on each other's campaigns and supported each other over the years. So I emailed her and asked for her response. Here is her reply:

Thank you - I can respond however I'm in Columbus with a full calendar of budget meetings today and tomorrow.

It would be helpful if they would read or call...Thank you for your reach out.

Barbara

When she does respond, I will post it here.

Buckeye Institute shows how Blade is wrong on health care exchange

I was going to take apart the recent Blade editorial chastising Gov. John Kasich for not accepting federal monies for a health care exchange, but the Buckeye Institute has done a nice job already with "Obamacare, Politics and the Myth of Free Money," so why duplicate efforts?

Here's what they have to say specifically about The Blade's warped thinking:

Second, the underlying argument assumes that federal spending is somehow “free” money and that the offer of expansion is simply to good to pass up.

In a rather rich case of projection, Innovation Ohio accuses Governor Kasich of playing politics while Ohio loses millions. The ideologically sympathetic Toledo Blade follows a similar line, accusing Kasich of politics on the issue rather than taking the generous federal money and immediately implementing Obamacare in Ohio.

The irony is that this mindset is what has gotten us to where we are today. It is a belief that federal dollars are free and Ohioans should grab every penny lest they be scooped up by other states. The history of Medicaid is one of states getting hooked on federal dollars only to have the program gobble up their budgets even as it offers less and less flexibility and reduced quality of care.

But state taxpayers are federal taxpayers. These dollars don’t magically appear in Washington to be doled out to states, the money comes from individuals in those very same states. Ohioans are rightly concerned about the federal deficit and about paying higher taxes. Increased spending in Washington impacts Ohioans to pretend otherwise is to ignore fiscal reality.

The Blade casually tosses aside the fears of increased Medicaid enrollment through a woodworking effect as if the dollar amounts are not significant. But those numbers are big enough to give governors across the country, both Republican and Democrat, pause. And whose numbers should we trust, state experts or liberal think tanks who support Obamacare?

These governors understand that Medicaid is a deeply flawed system that hooks states on a process of expanded enrollment with the promise of federal funds. Once on this path any attempt to reign in spending or control costs means giving up not only the state’s share of spending but the feds as well.

And is it really realistic to assume the federal government will never attempt to roll back the amount it covers? Half the assumed savings of Obamacare comes from reducing Medicaid reimbursement rates. Facing a deficit beyond what many of us can conceptualize, will Washington continue to pay out vast sums to states already committed to expanded coverage for their citizens?

In reality, what underlies this debate is a mix of politics, policy disagreements and deep uncertainty about the future. Governors understand that what is good for Washington is not always (rarely?) good for the states. They understand that Medicaid is a failed program that has devastated state budgets, increasingly involves reduced flexibility, and carries with it perverse incentives.

I especially love the point that "state taxpayers are federal taxpayers. These dollars don’t magically appear in Washington to be doled out to states, the money comes from individuals in those very same states."

You'd think whoever wrote The Blade editorial would know that - and know that Toledoans know that as well.

Scary reality: $107 trillion in liabilities

An editorial in the Charleston Daily Mail spells it out in stark - but factual terms: we're in trouble because (t)he nation can't pay for Social Security and the health entitlement programs it has now.

$107 trillion in liabilities
Congress needs to fix existing programs if it creates new ones

AS Americans listened to people yammer on about "death panels" and other distortions of some of the health "reform" proposals circulating in Congress, larger and more important questions have gone unasked and unanswered.

First on the list should be: Are members of Congress out of touch with reality?

The nation can't pay for Social Security and the health entitlement programs it has now.

The Social Security and Medicare Trustees Reports for 2009, released in early May, laid out the situation plainly:

Social Security and Medicare have a combined unfunded liability of almost $107 trillion.

According to Pamela Villarreal, a senior policy analyst with the National Center for Policy Analysis, that's about seven times the size of the American economy, and 10 times as much as today's national debt.

Members of Congress have, over the decades, promised Americans $107 trillion more in benefits under these two existing programs over the next 75 years than they have provided for in taxes.

Medicare alone has an unfunded liability of almost $38 trillion.

By some people's reckoning, when today's college students reach retirement in about 2054, the burden of paying Social Security and Medicare benefits would consume one in three dollars of taxable payroll.

Yet some in Congress would create a costly new medical entitlement program to deflect attention from the fact that they don't want to deal with the problems they already face.

All responsible Americans should insist on better than that.

If corporations had such unfunded obligations, we'd have members of Congress demanding appearances and accountability in front of committees and lots of cameras. But they ignore their own house while complaining about others.

And these same people want to create a new government program based on the same pyramid scheme that puts non-elected people into jail?

Can you say stuck on stupid?

Insanity - thy name is government

Today's paper has an article about Carletta Huff, a widow on Medicaid and in assisted housing who won a $50,000 prize in the paper's Treasure Hunt contest.

The tone of the article is one of forewarning, but also sadness. What could be sad about winning $50,000? It's Ms. Huff's circumstances. The article details her spending habits which are frugal and appear wise. But under Medicaid rules, recipients must spend all of their prize money before the end of the month or lose their benefits. While she did spend a large amount of the funds, she didn't keep all the receipts and didn't spend it in the allotted time frame.

The insanity is that this government program encourages such spending in order to remain dependent on the system. But the real insanity is the decision made in the first place.

The main concern expressed in the article by Ms. Huff and her family is the $850 in monthly medications that are covered by Medicaid. She is in danger of losing that.

Perhaps I'm missing something. This woman has received $50,000. She set aside $10,000 for taxes, but that still leaves her enough money to cover her prescriptions for 47 months - nearly four years.

Why, instead of spending the money so she could remain Medicaid eligible, didn't she just forgo the Medicaid prescription coverage and use her winnings to cover the costs? I can understand making a few fun purchases with unexpected income, but considering the need, wouldn't she have been better off saving her funds for her necessary prescriptions?

That the government program penalizes her for thrift is no surprise. I've come to the conclusion that government really doesn't want to eliminate the need for programs, but does everything within its power to maintain dependency on the system. And Ms. Huff's thinking is the prime example of the 'training' government foists upon its dependents.

You see, there really wasn't a need for Ms. Huff to use the prize money for her needs because they are already being met by you and me through taxation for these government programs. As a result, knowing her housing and medication costs are being paid for by others, she spent the money on wants. And now she finds that the rules require such warped economic decisions.

This is insanity - and I cannot help but wonder how we've ended up with such a system.

More anti-logic from Columbus - SCHIP and Medicaid

Here's what I don't get:

Gov. Ted Strickland is upset because the U.S. Department of Health and Human Services rejected Ohio's plan to expand Medicaid eligibility to more families in Ohio. In fact, the state's plan would have increased the eligibility threshold from 200% of poverty level up to to 300%, meaning that families of four earning $62,000 per year would be eligible. In fact, he said he was 'appalled' by the decision.

He now plans to revise the request, increasing the eligibility threshold from 200% to 250% of poverty level. If the request is funded under SCHIP, the state would have a 30% match requirement. If the request is funded under Medicaid, the state would have a 40% match.

But then, there was today's Blade article in which the state's Medicaid struggles are detailed:

"...the governor who made expanded health care a priority angered supporters by delaying plans to restore promised dental Medicaid benefits to low-income adults that were eliminated two years ago.

As Medicaid rolls increase at a clip faster than expected, the governor also delayed promised fee increases for medical professionals providing Medicaid services.

And on Friday, the governor learned that the state likely will have to spend $207 million more for Medicaid than the budget anticipated, indicating that even more belt-tightening is to come."

So, if we've cut Medicaid services like dental benefits, delayed fee increases for medical providers and will have to spend $207 million MORE than budgeted, why are we asked the feds for permission to expand eligibility?

People making $62,000 per year are, according to IRS data, at the top end of the definition of middle class. Only 25% of wage earners make more than that - meaning that Strickland's rejected proposal was NOT covering 'low-income' families, but was, in fact, a request to cover all middle-class families - some of whom already have private insurance. And he wanted to do so while keeping cuts in services to people already enrolled in Medicaid.

The state cannot afford to meet its current commitments as budgeted, but they want to add more people onto the Medicaid rolls. Where is the logic in this?