Ohio plans to add work requirements for some and red tape for others covered under the state's Medicaid expansion.
The move is expected to take health insurance from tens, if not hundreds of thousands of the lowest income residents in the state, a group that already has poor health outcomes.
Lawmakers are moving forward, even after hearing that efforts to take similar action in other states did not lead to more employment, just less access to health care.
Ohio Medicaid Director Maureen Corcoran gave state lawmakers a presentation at a March meeting of the Joint Medicaid Oversight Committee about the realities of adding the new administrative burden to Ohio's Medicaid system.
She said during Ohio's open comment period, there was only one reason people offered support of the move, a "belief that too many people are just getting benefits and can work and that work for benefits should be required."
But 90% of the nearly 700 comments filed were against the move. And there were a lot of different reasons.
"Administrative burden, concerns about the loss of coverage affecting people's health, the lack of efficacy of the requirements," Corcoran said. "The inconsistency between the requirements and the program goals, child care, challenges, finding work, cost to providers of health care, lack of transportation to the needed employment."
The people who've qualified for coverage over the past decade have income under or close to the federal poverty level, which is about $21,000 for one person between the ages of 19 and 64. Corcoran's data shows about 40% of them are already working at least part time. But this move would add the burden of proving they worked a minimum amount of hours.
Corcoran said people in the group already have worse health than the average person, with higher rates of cardiac conditions, diabetes and mental health needs.
Those who don't work would have to prove they're 55 years of age or older, in school, in treatment or have a mental or physical health issue that prevents them from working.
Participants would lose coverage if they don't get the paperwork in to document why they aren't working. The more frequently the state requires people to verify their information, the more it will cost, Corcoran said.
Corcoran told lawmakers only two states have used work requirements recently. And the evidence from the programs in Georgia and Arkansas wasn't promising.
"This is the debate really going around the country about the effectiveness of this as a tool," Corcoran said.
The programs cost more than predicted. Many struggled to meet the reporting requirements. And the states failed to meet their goals of increasing employment.
That’s supposed to be Ohio’s goal too. "Promoting economic stability and financial independence (and) improving health outcomes by encouraging individuals to be engaged with their health and healthcare," the state's application states.
Georgia predicted 25,000 people would sign up, but fewer than 5,000 did. If the state had just allowed the full Medicaid expansion, more than 350,000 would have been eligible for coverage.
“The state indicates that it was an administrative nightmare," Corcoran said.
Ohio Sen. Beth Liston, a doctor and a Democrat, said the outcomes are predictable.
"There was no association with employment increase when the work requirements were put in place. Although, I'm not completely surprised, because I don't fundamentally feel like people losing health insurance is going to address barriers to employment," Liston said.
And, the uninsured rates skyrocketed.
"The uninsured rate among low-income Arkansans ages 30-49 rose from 10.5% in 2016 to 14.5% in 2018 after the 'community engagement' requirement took effect," Corcoran's presentation states.
Ohio's uninsured rate is at 6%, but was in double digits before the state expanded Medicaid under the Affordable Care Act.
Corcoran said when the uninsured rate is high, providers like hospital systems, end up footing the bill for the eventual emergency care the uninsured need.
"People will not get preventative care. People will go to the emergency room. You know, we will still end up paying for it in certain other ways. So, you know, I think there is concern among the hospitals about that," Corcoran said, adding that she can't speculate about what that dollar amount might be.
The state predicts at least 60,000 people will lose coverage. But opponents say hundreds of thousands is a more realistic number. There are 800,000 people currently in the program.
The state predicts it will save $7 million a year, after spending $700,000 the first year, but fewer health care dollars will be spent in the state, because the state will also see less federal match money.
Liston said she did the math, and that the state will save a little, but will feel the effects of having fewer people insured.
"So at a cost that's basically $100, $112 a year is what, per person, we're saving. On the other hand, 62,000 people are still going to have health issues," Liston said. "We, in this country, still treat people when they come to the emergency room. They have a car accident, they suddenly can't breathe. And so I'm concerned about the cost of uncompensated care and what that looks like for our safety net hospitals and for those that would bear the brunt so that we can save the $100 a year."
Ohio Democrats are asking the federal government to reject the state's application.
Federal public comments close Monday. Click here to file a comment.
