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State Controlling Board will take up Medicaid expansion



Published: Sat, October 12, 2013 @ 12:05 a.m.

Ohio residents earning up to 138 percent of federal poverty level would be covered

By Marc Kovac

news@vindy.com

COLUMBUS

The state Controlling Board will take up an expansion of Medicaid eligibility at its meeting later this month, bypassing a vote of the entire Ohio House and Senate on the matter and leaving it in the hands of six lawmakers and Gov. John Kasich’s appointed panel president.

The official notice of the move is included on the Oct. 21 agenda, released Friday in advance of the Columbus Day holiday.

The announcement came a day after the federal government OK’d the state’s request to expand Medicaid to cover residents earning up to 138 percent of the federal poverty level.

Federal officials have said they will cover 100 percent of the costs of the expansion during the initial years, with support dropping to 90 percent by 2020.

“We think as of June 2015, we would have a net increase enroll- ment of 275,000 Ohioans,” said Greg Moody, director of the Governor’s Office of Health Transformation.

Expansion

Kasich sought the Medicaid expansion in his biennial budget proposal earlier this year, but GOP lawmakers blocked the attempt, with some viewing it as an endorsement of President Barack Obama’s signature health care law and out-of-control federal spending.

Separate legislation to expand eligibility has stalled in the House and Senate. Earlier this week, Senate Republicans offered their own Medicaid reform package, with an eye toward controlling costs and improving health care for the needy.

Absent the passage of law changes by the general assembly, a group has started circulating petitions to force the issue before lawmakers and potentially onto the November 2014 ballot.

But the Kasich administration is moving forward with the Medicaid expansion, turning instead to the state Controlling Board for approval of authority to spend federal funds provided to the state for that purpose.

“We commend that administration for seeking to move this issue forward with the state plan amendment and move to the Controlling Board,” Jon Allison, a Columbus attorney serving as spokesman for Healthy Ohioans Work, the group behind the petition effort, said in a released statement. “We will be focused on getting the necessary legislative votes for Controlling Board approval.”

Controlling Board

Controlling Board members sign off on contracts, spending authority and payments requested by state agencies.

The Medicaid request seeks an increase in spending authority of $562 million in the current fiscal year and $2 billion in the next. All the money would come from federal sources.

The board includes three members from each chamber, with four Republicans and two Democrats currently serving. Randy Cole, a Kasich appointee, heads the board and is a voting member.

The Medicaid item will require four affirmative votes.

The Republican leaders of the Ohio House and Senate, through their spokesmen, declined to comment Friday.

The decision to move Medicaid expansion via the Controlling Board drew praise from Statehouse Democrats.

“I encourage the members of the Controlling Board to ensure 275,000 Ohioans gain access to health care by approving Medicaid expansion,” said state Sen. Capri Cafaro of Liberty, D-32nd. “Expanding Medicaid will be a win-win for Ohio by providing health care coverage to more Ohioans while also lowering costs over the next decade.”

But the move drew jeers from conservative groups.

“Expanding Medicaid is the wrong policy decision for Ohio — one which provides poor health outcomes for participants, drives down workforce participation, and will cost Ohioans billions of dollars,” Robert Alt, president of the Buckeye Institute for Public Policy Solutions, a conservative think tank, said in a released statement. “To circumvent the Legislature to ram through this bad policy is what we have grown to expect from the dysfunction in Washington, but Ohioans expect and deserve better from their state officeholders.”

Tom Zawistowski, head of the Portage County Tea Party, added in a released statement, “We are disappointed that the governor has chosen to take this course of action. He is going against the wishes of his own state party, 75 percent of registered Republicans in Ohio who do not want it. Worst of all, it is a betrayal of the 66 percent of Ohioans who voted for the Ohio Health Care Amendment.”


Comments

1seinfried(19 comments)posted 11 months, 2 weeks ago

about time someone votes with their own conscience and not party..

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2CompManRetired(29 comments)posted 11 months, 2 weeks ago

Funny how we are told that Social Security and Medicare, that has been paid by participants and employers portions all their working lives is running out of money; yet welfare programs have a never ending spigot of money.

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376Ytown(1242 comments)posted 11 months, 2 weeks ago

The Medicaid expansion would subsidize incomes up to 133% of the federal poverty level. Attached chart shows what that may mean for your family. For a 1 person family = $15,282 and 2 person family = $20,628.

http://www.familiesusa.org/resources/...

If you are over the poverty level you will still be forced to buy insurance (without subsidy) or pay a penalty. Monthly premiums, deductibles and varying co-insurance make the out of pocket costs unaffordable for many. To keep your monthly cost down, you can purchase the Bronze plan, which pays only 60% of your cost after deductible and you pay 40% with an out of pocket maximum of up to $6350.00 for the year plus the monthly premiums.

For people with pre-existing conditions the cost for coverage may outweigh the cost of expenses. For others, they will still choose whether to put gas in their car, food on their table or pay the penalty.

Gone are the days of insurance premiums subsidized by our employers that amount to paying only $20 per pay check. Gone are the days when our deductible was only $100 or $200 per person. Gone are the days when insurance paid 80% and we paid 20%. Enter deductibles of $3800 - $5000 per person, and yearly out of pocket amounts of $10,000 - $20,000 per year. Affordable???

We need to change our health care COSTS not premiums. Bring down the COST of health CARE for all so that it is affordable. The drug companies profited by $85 billion last year alone. http://www.alternet.org/11-major-drug...

Subsidizing insurance premiums by the government is only causing employers to reduce hours, drop coverage and create more poverty in the US.

For people whose insurance is through their employer, most companies conduct their open enrollment period between October and December. Have your seen changes to your health plans for 2014?

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4SeriouslyNow(192 comments)posted 11 months, 2 weeks ago

@76Ytown,

I think that you are wrong about the subsidy and penalty levels.

As an example, let's use the example of a couple (2 adults, no children) who are earning 21,000 per year.

I agree that they are over the Medicaid ceiling (of 20,628) so may not be eligible for medicaid.

However according to the Kaiser Foundation
http://kff.org/interactive/subsidy-ca...

In Ohio that couple (non-tobacco users) would receive a 4,681 dollar subsidy for purchasing a Silver plan (70/30) with a maximum out-of-pocket of 4500.

The premium they would pay is 55.00/month, and notice no penalty.

In fact, they could have a Bronze plan at no cost and no penalty.

So maybe you could explain your statement, "If you are over the poverty level you will still be forced to buy insurance (without subsidy) or pay a penalty."

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576Ytown(1242 comments)posted 11 months, 2 weeks ago

seriouslynow: thanks for the link: http://kff.org/interactive/subsidy-ca... which provides a higher level of information than healthcare.gov

The law which contains thousands of pages is confusing to all including lawmakers who were told to just sign it and find out later what's in it.

per the website:
"Premium tax credits may be claimed at the end of the year, or you can apply for an advanced premium tax credit based on your estimated income for the up-coming year. If you elect to receive an advanced credit, the government will pay 1/12 of the credit directly to your insurance company each month and the insurer will bill you for the rest of the premium.

It’s important to keep in mind that when you apply for the premium tax credit this fall, during Open Enrollment, you won’t necessarily know for sure what your 2014 income will be, so you will apply based on your best estimate of your 2014 income. Later, when you file your 2014 tax return, the IRS will compare your actual income to the amount of premium tax credit you claimed in advance. If you underestimated your income and claimed too much premium tax credit, you might have to pay back the difference. If you didn’t receive all of the premium tax credit you’re entitled to during the year, you can claim the difference when you file your tax return. You should report any changes in your income during the year to the Marketplace, so your credit can be adjusted and you can avoid any significant repayments at the end of the year."

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6Cosmo19(53 comments)posted 11 months, 2 weeks ago

Dear 76Ytown:
Since you asked I have received my 2014 open enrollment.

Monthly premium increased 21 dollars from 573 to 594 for my family plan (my wife and I). 3.5% increase.

The coverage is 80/20, I can go to any licensed physicians, specialists or hospital. The yearly deductable is 600 (for the family) and the annual maximum out of pocket is 2000 (for the family).

The plan also covers prescriptions (can't go to Walgreens or Target) at 70%. There is is out of pocket maximum of 2500 for the family.

My employer contends that they pay 50% of our group premium, employees pay the remainder.

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776Ytown(1242 comments)posted 11 months, 2 weeks ago

Cosmo: Sounds like very good coverage.

Is your $594 premium your payroll ded cost or is that employee/employer cost? If just yours, that's $7128 per year. Having pre-tax premiums helps offset the cost but it is still a lot of money.

Our family has to pay for individual coverage. Our premiums for 3 people are $508 per month. Deductible is $5500 per person / $11,000 family max. Plan then pays 100% for the remainder of the calendar year. We pay everything including RXs until the deductible is met with the exception of preventive screenings. Yearly cost $6096. Beginning 1/1/14 the new premium will be $1099 per month for the same coverage.

Will be looking into other options, especially any possible tax credits come January 2014. I just can't help but wonder how they justify a 100% increase in premiums other than expecting to get a government subsidy which we taxpayers are ultimately paying for anyway.

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8Cosmo19(53 comments)posted 11 months, 2 weeks ago

Dear 76Ytown,
You neglected to mention what your co-insurance would be for 2014.

According to the KFF calculator an Ohio family of 3 (2 adults, 1 child, non-tabacco) should be able to purchase the Silver Plan for 555.00 per month, without any subsidy!

The Silver Plan is 30% co-insurance with a total out of pocket maximum of 12,700 (which I believe includes the deductable).

Subsidy for this plan exists for total incomes between about 24,000 to 72,000. After 72,000 there would be no tax credits.

Sounds to me like you ought to consider dropping your existing coverage and go to the exchange.

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976Ytown(1242 comments)posted 11 months, 2 weeks ago

Cosmo, I pay 100% (co-insurance) till I meet my deductible ($5500) then, plan pays 100% for the remainder of the calendar year.

So if I go with the exchange, I might be able to buy the Silver Plan for $555 per month which is $47 per month more than the $508 that I have been paying. The out of pocket is $12,700 with is $1,700 more than my current plan. Of course these premiums are assuming no subsidies.

The only way to get a government subsidy or to keep my costs close to what they were before ACA is to enroll in the exchange.

Why is the ACA a better deal for all Americans if the government has to subsidize premiums for everyone in order to get coverage at a lower cost? A true cost saving to all would have been reduce the COST of health CARE for all making insurance premiums affordable for ALL.

"There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.

That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive."

http://www.washingtonpost.com/blogs/w...

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10Cosmo19(53 comments)posted 11 months, 2 weeks ago

Dear 76Ytown,

A couple of things: I agree that the price of health care in the US is higher(much higher). I suggest to you that the underlying reason is that there has been no effective way of controlling prices.

In a truely Free Enterprise system, the only controls are supply, demand and competition. The demand (almost oblivious to the cost) for better and better health care is Insatiable and will always be there. Doctors and hospitals are unwilling to compete, largely because the volume of available consumers is unlimited.

The ACA "plan" is to get insurers to compete.

You ask the question: "Why is the ACA a better deal for all Americans if the government has to subsidize premiums for everyone in order to get coverage at a lower cost? The answer is the ACA is NOT subsidizing premiums for everyone.

Lets' take your situation. Assuming that you do not qualify for subsidy (meaning that your income for your family is greater than 75,000/year), then the exchange Silver Plan is a significantly better plan for you.

Yes, your premium would increase by 47/month, and yes, your out of pocket max increases by 1700/year, but that compared with 2013.

Comparing 2014, your premium difference is 6528 (13188 vs 6660), but for that difference your total exposure is increased by 1700.

Let's say that your family spends 17,000 in 2014 on health care.
Under your current plan your family's burden would be 24,188.
Under an exchange Silver plan your family's burden would be 19,360

On the other end of the spectrum say your family spends only 8,000 in 2014 on health care.
Under your current plan your family's burden would be 21,188.
Under an exchange Silver plan your family's burden would be 14,660.

The choice is yours

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1176Ytown(1242 comments)posted 11 months, 1 week ago

Cosmo: To rebut your couple of things:

1. "In a truely Free Enterprise system, the only controls are supply, demand and competition." "Doctors and hospitals are unwilling to compete, largely because the volume of available consumers is unlimited."

True. doctors and hospitals are unwilling to compete. As long as our health plans continue to pay the costs which is supported by premiums paid by consumers, the costs will continue to rise.

2. "The ACA "plan" is to get insurers to compete."

Insurers are for profit. As cost rise, the consumer will continue to pay more because it is passed on to them through higher premiums. Unless we find a way to control medical care costs, the insurers competing with one another for market share of the premiums means nothing to us, they just pass on the cost of medical care and add their middleman cost for the service. Managed care implemented years ago creates a degree of control but we still need to contend with the fact that everyone wants the latest and best technology and care and we have an aging population that will continue to demand the greater portion of health care dollars spent.

Do I agree with you that I should be grateful for the ACA's Silver plan since my new 2014 costs skyrocketed? No.

http://www.ncsl.org/issues-research/h...

"Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey. During the same period, workers' wages and general inflation were up 1.8 percent and 1.1 percent respectively. This year's rise in premiums remains moderate by historical standards. Since 2003, premiums have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent). "We are in a prolonged period of moderation in premiums, which should create some breathing room for the private sector to try to reduce costs without cutting back benefits for workers," Kaiser President and CEO Drew Altman, Ph.D., said. Released Aug. 20, 2013.

For 2012, the previous report, annual premiums for employer-sponsored family health coverage reached $15,745, up 4 percent from 2010, with workers on average paying $4,316 toward the cost of their coverage. A single or Individual employee's coverage cost $5,615, with the worker on average paying $951 out-of-pocket. > See 2012 Kaiser/HRET Employer Health Benefits Survey (EHBS)

For comparison, In 2009, the average fully insured individual faced an employee share of $725 for 1-person coverage and a $3,354 annual share for family coverage. The total premiums to cover a family were up to $13,375 according to the 2010 annual Kaiser/HRET survey of Employer-Sponsored Health Benefits."

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1276Ytown(1242 comments)posted 11 months, 1 week ago

Cosmo: You say "The choice is yours"

I think that a better choice would be to not have to depend on our government to give insurance companies money paid for out of the pockets of working Americans. I would much rather not be reduced to depending on the government for money to pay my bills but to be able to maintain my dignity by being self sufficient. If we are increasing government dependency to extend to folks making 400% of the poverty rate, how far are we from a socialist government?

Yes, we will always have people who depend on the government for support, and we as a people should be grateful that if we are able, we can be productive members of society and take care of those in need. The direction of a bigger government utopia that provides for all while ignoring our debt and deficit is unsustainable.

Systematically we are being reduced to poverty. First, our stock market bubble wiped out 50% of wealth. Then the real estate bubble burst. Now employers are eliminating jobs, reducing hours and restricting insurance coverage due to rising health care costs. Employees are left to scramble for insurance on their own...but wait...Uncle Sam will take care of us...I sure hope so, because I'm sure going to depend on social security and medicare by the time I'm 66 1/2.

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13Cosmo19(53 comments)posted 11 months, 1 week ago

Dear 75Ytown,

I don't desire to get into a philosophical discussion with you over what should or should not have happened in the past (what got us to this point) or what should or should not happen in the future.

My only reason for responding to you was to answer you question as to my 2014 open enrollment. I now regret going beyond that point by discussing subsidies, for plainly you have made up your mind about ACA and no amount of factual information will change that.

You can deal with the situation either pragmatically or philosophically.

It's still your choice.
Best of Luck

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1476Ytown(1242 comments)posted 11 months, 1 week ago

Dear Cosmo,

Your participation in the discussion of this complicated issue was appreciated.

Thank you for sharing your experience.

Best of Luck to you as well, friend.

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