Ohio

Plain Dealer Gets Medicaid Budget Amendment Backwards

Media Cleveland Plain Dealer

The Cleveland Plain Dealer has reported that a budget amendment which would prevent Medicaid expansion is great news for Medicaid expansion, in direct contradiction to the language approved by the Ohio House. Either Plain Dealer columnists are intentionally lying to promote a policy their editors endorsed, or they failed to read the April 18 amendment they have been writing about.

An April 18 news story written by Brandon Blackwell began, “Ohio’s Medicaid expansion is down, but not out.”

“House Republicans kept alive the possibility that Ohio may expand its Medicaid program to cover the working poor, approving an amendment to its budget that could open the door to changes later this year,” Blackwell wrote in the following paragraph.

Although the Ohio General Assembly could theoretically pass separate legislation to implement the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion or the state senate could jam the expansion back into the budget, the amendment introduced by Rep. Barbara Sears (R-Monclova Twp.) expressly forbids its called-for review of Medicaid from expanding the program.

Based on the language in the House Journal for the April 18 session, any legislation introduced as a result of the Sears amendment shall seek to “Lower net state and federal costs for the Medicaid program” and to “Reduce the number of individuals who enroll in Medicaid over time.”

Enacted as an outright broadening of Medicaid eligibility rules, the PPACA Medicaid expansion would violate all three of these requirements, increasing both state and federal Medicaid costs while dramatically increasing Medicaid enrollment. Any variation of the “private option” PPACA Medicaid expansion debated in the House would likely increase state and federal costs by even more than simply expanding Medicaid.

In other words, the amendment included in House Bill 59 (HB 59), the budget approved by the Ohio House on April 18, was written to prevent the policy which Blackwell reported it “kept alive.” The full text of the amendment is included at the conclusion of this story.

Blackwell added that the amendment “requires that legislation to reform the Medicaid program in Ohio be introduced in the House, but does not specify what shape that reform will take.”

While this statement is true to a certain extent, the premise of the story – that the Sears amendment “kept alive the possibility that Ohio may expand its Medicaid program” – is not.

On April 21, Thomas Suddes cited Blackwell’s inaccurate story in a Plain Dealer editorial whose opening paragraph falsely asserted that Republicans “have kept alive the discussion about Medicaid expansion in Ohio, a discussion that had looked dead.”

Building a narrative counter to the language of the Sears amendment to HB 59, Suddes opined that the amendment “represents a victory for Republican Gov. John Kasich and his aides.”

The amendment “seemingly envisions reform tailored to Ohio via negotiations between Kasich administration officials and federal Medicaid administrators,” Suddes wrote. This is completely false, for the reasons explained above.

Plain Dealer reporter Sarah Jane Tribble further built upon this theme in an April 22 news story, writing that the House “last week added an amendment that allows discussion of Medicaid ‘reform’ to continue, which has raised hopes that the legislature eventually will sign off on a compromise.”

Linking to Blackwell’s inaccurate April 18 story, Tribble reported that the Sears amendment to HB 59 “buoyed the hopes of Ohio’s advocates and health industry experts who had feared earlier in the week that Medicaid expansion would die in the Ohio House.”

The actual amendment, whose provisions contradict the central premise of two Plain Dealer news stories and one opinion column from the past week, follows.

Representative Sears moved to amend as follows:

Between lines 131812 and 131813, insert:

“Section 323.____. PROPOSAL TO REFORM MEDICAID AND OHIO’S HEALTH CARE DELIVERY SYSTEM

(A) Legislation shall be introduced in the House of Representatives to

reform the Medicaid program and Ohio’s health care delivery system. The

Director of the Governor’s Office of Health Transformation and the Medicaid

Director shall provide assistance in developing the legislation. The legislation

shall include, but not be limited to, all of the following:

(1) A focus on individuals who have the greatest potential to obtain the

income and resources that would enable them to cease enrollment in Medicaid

and instead obtain health care coverage through employer-sponsored health

insurance or the health insurance marketplace;

(2) Strategies to lower Medicaid caseloads by promoting

employment-related services available under Medicaid, including Medicaid

managed care, and promoting other programs that offer workforce readiness,

educational, and wellness services;

(3) Provisions that seek to do both of the following:

(a) Lower net state and federal costs for the Medicaid program;

(b) Reduce the number of individuals who enroll in Medicaid over time.

(B) The legislation may call for amending the state Medicaid plan,

obtaining a waiver under the “Social Security Act,” section 1115, 42 U.S.C.

1315, or a combination of the two. Subject to division (c) of this section, the

Medicaid Director may submit to the United States Department of Health and

Human Services a state Medicaid plan amendment, a request for a section 1115

waiver, or a combination of the two.

(C) Not sooner than September 15, 2013, and not later than October 1,

2013, the Directors shall submit to the General Assembly the terms of any

federal approval obtained for the reform. The Directors shall not begin

implementation of the reform unless the General Assembly enacts legislation

authorizing implementation. If the General Assembly does not enact such

legislation on or before December 31, 2013, the Directors shall cease any

activity regarding this reform, including pursuing a Medicaid plan amendment,

section 1115 waiver, or combination of the two.”

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