The Republican governor told reporters Wednesday that he’s being patient with state lawmakers as they continue to review the federal-state health care program for the poor and disabled.

House Republicans dropped Medicaid expansion from the state’s two-year budget before sending it to the state Senate last month. The Senate’s leader has said his chamber’s version of the spending plan won’t include expansion.

Still, a group of lawmakers is studying possible changes to the Medicaid program.

Supporters of extending Medicaid coverage are exploring whether the issue could be put to a statewide vote.

Kasich says he’s for “whatever it takes” to get Medicaid expansion in Ohio.

Republican Gov. John Kasich is expected to decide soon whether Ohio should opt for the Medicaid expansion under the federal Affordable Care Act.

He plans to reveal the decision in his budget proposal on Monday.

In the meantime, a coalition of expansion supporters called the Ohio Alliance for Health Transformation has been encouraging lawmakers to back expanded coverage through face-to-face meetings, phone calls and emails.

The coalition’s regional partners are making the pitch locally with letters to the editor and public meetings.

Should Kasich go for the expansion, he’ll need backing from the GOP-controlled Legislature.

The association’s president Deepak Kumar says it is in the best interest of all Ohioans to help provide health care coverage for more than 700,000 people who currently receive inconsistent patient care.

The U.S. Supreme Court last year left it up to each state whether it would expand Meidcaid. The Medical Association says the move could mean an additional $19 billion  from the federal government to bolster the state’s health care system.

The group’s endorsement follows similar statements of support from the Columbus Chamber of Commerce and the CEO’s of Nationwide Childrens’ Hospital, Mt. Carmel Health System, The Ohio State University Wexner Medical Center and OhioHealth Corp.

In part two of the series, WOSU looks at why it’s easier for hospitals to expand and why some areas are still underserved.

Fifteen years ago, it was up to state regulators to determine if hospitals could expand. Hospital executives had to prove the projects were necessary before construction could begin.

The Ohio Department of Health was in charge. If it deemed the projects were financially feasible and did not duplicate services the hospitals would be given the green light in the form of a certificate of need – or a CON as it was called. But CONs for hospitals disappeared by the late 1990s when the state legislature failed to renew the law that put them in place. Only long-term facilities, like nursing homes, are still required to obtain a certificate of need.

State Senator Ray Miller of Columbus tried twice to bring back CONs for hospital projects, but to no avail. Cathy Levine directs Ohio’s Universal Health Care Action Network. She’d like to see the CON return because she thinks it would help curb excess medical spending.

“One of the things that Ohio did that was a step backward was to do away with the certificate of need process,” Levine said.

But some say the certificate of need requirement was not working. John Callender is the senior vice president for the Ohio Hospital Association. He said the certification process was filled with loop holes. Outpatient surgery and imaging centers could build as long as they did not add beds. But competing hospitals still had to get approval to expand.

“A whole unregulated section of the market was popping up all over the place which was putting great financial pressure on hospitals because people weren’t building these things unless they were profitable and so they were taking the profitable services away from the hospitals,” Callender said. Levine said some specialty physicians supported CON’s abolishment because of investment opportunities in the outpatient sector.

“We’ve moved toward making health care decisions on the basis of generating revenues rather than on the needs of the community,” Levine said.

Politics also clouded CON’s effectiveness. Callender said often times when the health department turned down a hospital’s project, a local legislator would override the health department’s decision.

Still Callender said individual hospital boards are a much better judge of whether expansions are needed.

But Levine said the lack of state oversight has left vulnerable areas of the community without easy access to health care.

“In a good certificate of need process the hospital would have to address how they’re going to address those community disparities and those community barriers,” Levine said.

In Columbus the community barrier seems to be Route 70. While there are many hospitals north of I-70 there is not one major hospital on the south side of Columbus. The last one – Mercy Hospital – closed in 2001.

Rita Brown lives near Obetz. When needs to go to the emergency room, her closest option is Mount Carmel West, a 20 minute drive without traffic.

“It’s par for the course just like everything else. People are pretty poor in this end of town. I’ve lived in the South End almost all my life. We had Mercy Hospital which wasn’t the best in town. I would avoid it at all cost,” Brown said.

South side resident Elaina Shipp wishes hospital execs would expand in her neighborhood.

“If there was hospital here that would be more convenient. It would. Maybe OSU could have something here? Could they have a part of their hospital over here this way? That would be nice,” Shipp said.

It’s unlikely the south side will see a new hospital. The Hospital Association’s John Callender offers a simple explanation.

“The economics make it almost impossible for a hospital to go to the south side of Columbus and be successful. If you do that you’re going to end up with three kinds of patients: Medicare patients, Medicaid patients and no pay. And you can’t operate a hospital that way,” Callender said.

Callender said a hospital on the city’s south side would need some kind of government funding to operate an acute care facility. He said he’s unsure of an answer for the South Side of town.

“Unfortunately until we figure out how to deal with the uninsured people we have. There’s only so much an individual institution can do and maintain viability,” he said.

Meanwhile hospital construction and planning continues on the north half of town.

Metal and other scrap materials fall into a large bin near the edge of the Children’s Hospital construction site on Parsons Avenue.

Children’s is spending $840 million to renovate and expand its campus – including the construction of a 12-story, 750,000 square-foot inpatient tower.

It won’t be long before construction sites like Children’s become semi-permanent fixtures at hospitals around the city.

Ohio State University Medical Center recently announced a $1 billion expansion. OSU will build a new James Cancer Hospital and a critical care building. Mount Carmel plans to build a new cardiovascular center that would allow for open heart surgeries at Saint Ann’s Hospital in Westerville. And Ohio Health has told city officials it plans an expansion to Riverside Hospital which could include a cancer hospital.

Combined the central Ohio hospital projects could cost as much as $2.4 billion.

So, it begs the question, at a time when the country and lawmakers are trying to reign in health care costs, is all this hospital construction really necessary?

“We sure think it is.”

Doctor Steven Gabbe is OSU Medical Center’s CEO. Gabbe said OSU has to build a new hospital. He said the current James Cancer Hospital is 20 years old and the critical care facilities also are aging. Gabbe said the hospital is near capacity most of the time and critical care patients have been turned away because of a lack of room.

“It’s really a challenge for us to meet the needs of the patients and their families and of the referring physicians,” Gabbe said. OSU’s story is not unique. Children’s Hospital’s Senior Vice President for planning Patty McClimon said its current buildings are almost 50 years old.

“Those buildings do not support the technology, the air quality and the types of systems that a modern patient care building would support,” McClimon said.

And Mount Carmel Saint Ann’s CEO Janet Meeks said area doctors and EMS workers have said for years the Westerville hospital needs to expand its cardiovascular capabilities.

“Inpatient discharges at St. Ann’s have grown by 25 percent which is a huge increase in our volume,” she said.

The projects will boost employment. Executives predict the expansions will produce more than 17,000 new jobs.

But someone has to pay the $2.5 billion construction bills and critics fear the costs will show up in patient bills and health insurance premiums.

Cathy Levine directs Ohio’s Universal Health Care Action Network. It’s a consumer health advocacy group. Levine said she’s troubled by the projects

“There’s a growing body of research that shows the more you build, the more health care treatments you do. That areas that have two hospitals provide more procedures to patients than areas with one hospital because they’ve got to pay for the buildings,” Levine said.

And critics worry about duplication of services. Columbus already has two heart hospitals – Saint Ann’s unit would be a third facility catering to cardiovascular care. OSU’s James Cancer Hospital is nationally renowned. If Ohio Health chooses to expand its cancer facilities it would compete with the James for patients and doctors.

“We do know that if you spread specialty care over a larger number of facilities the quality of care at each facility is going to go down,” Levine said. Kelly Devers is a senior fellow at the Urban Institute in Washington, an economic research firm. Devers said many hospitals feel they have to expand because aging baby boomers – and to keep up with market competition.

“For fear that they will be seen as out-of-date or perhaps not offering the kinds of technological options and amenities…sort of comfortable patient rooms,” Devers said.

Comfort is a big part of the building plans. Some of the expansions will feature large green spaces and gardens. OSU’s new hospital will have all private rooms with windows, many overlooking the so-called grand concourse and what it touts as an aesthetically pleasing landscape. And its new critical care unit will offer apartment-like rooms. Children’s will also feature a park, garden and larger patient rooms to be more comfortable for family members who stay overnight.

Both OSU’s Gabbe and Children’s McClimon say such features are proven to speed up patients’ recovery. McClimon said having the green spaces will reduce the length of stay and in theory reduce costs for patients.

“The co-pay would be based on how long the patient stays, and if the patient stays for a shorter period of time the co-pay would go down,” McClimon said.

Both hospital executives also say the new facilities will be more energy efficient – further reducing costs.

As for the keeping up with the Doctor Joneses argument…OSU’s Gabbe said they are not trying to one up each other.

“It’s not competing with hospitals in the communities. It’s meeting the needs of patients and their families. It’s being one of the highest quality and safety hospitals and some of that comes with new facilities,” Gabbe said.

Kelly Devers said it’s difficult to predict a community’s heath care needs 10 to 20 years in the future.

“Guess what, a lot of planners get it wrong because it’s tough to do. It’s like reading a crystal ball. And if you guess wrong you pay a heavy price,” she said.

But Central hospital executives are confident they have got it right.

In part two of the series, WOSU looks at the changes in state law that made hospital expansion easier. And WOSU profiles an area of Columbus still under served despite all the new construction.

The agency’s Scarlet Bouder says planned expansions will provide health care for pregnant women up to 200 percent of the federal poverty level and give medical benefits to children living in foster care until they are 21 years old.

Bouder says the state will also extend benefits to disabled Ohioans in a special work program and to children whose family income is between 200 and 300 percent of the federal poverty level. She says those expansions meet the priorities set forth by Governor Strickland.

The plan to expand Medicaid to provide dental care to some low income adults remains on hold. Governor Strickland is still looking at economic figures and caseload data to determine whether there will be enough money to fund that expansion.