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Column: Health reform has helped many Ohioans

Wendy Patton, Policy Matters Ohio

Thanks to Medicaid expansion, many Ohio families became healthier and better off financially over the past six years. If Congress repeals the Affordable Care Act (ACA) and restructures Medicaid, this progress could abruptly halt. In Ohio, many jobs pay poorly. For workers who don’t get health insurance through their job and are paid too little to pay for expensive coverage, Medicaid expansion and subsidies under the ACA are the only way to get care for themselves and their families.

The ACA helped almost a million Ohioans get essential health care. Built on America’s existing system of public and private insurance, it provides subsidies to help middle-income families buy private insurance. It also expanded Medicaid, a public program. Because the overall market for health coverage was broadened, many harmful practices in health insurance that affected everyone were eliminated.

For example, before the ACA, more than 4 million Ohioans had a lifetime limit on their insurance policy, meaning that the insurer capped benefits over the course of the person’s life. The ACA prohibits both lifetime and annual caps.

In 2009, more than 5 million Ohioans had a pre-existing condition that, prior to the ACA, would have meant insurers in the individual market could deny them a plan or quote them exorbitant premium rates. The ACA prohibited these practices.

Under the ACA, health plans must cover preventive services — including flu shots, cancer screenings and contraception — at no extra cost to consumers, benefiting more than 5 million Ohioans.

Medicaid covers a quarter of all Ohioans. The ACA’s Medicaid expansion extended coverage to people earning up to 138 percent of the federal poverty level, a yearly income of about $16,400 for an individual and $27,800 for a family of three. A full-time, year-round worker with a minimum wage job falls under this threshold. A single parent with two children would be at this income level with a $13.40 hourly wage. These are people employed in some of Ohio’s largest occupational groups, like food service, construction, retail or home health care. Employers in these sectors rarely offer health coverage.

About 700,000 people enrolled in Ohio’s Medicaid expansion. Governor Kasich’s program evaluation found more than 40 percent were working, and almost three quarters of the rest were looking for work. About 72 percent were white, more than half were male, and a majority had a high school degree or less. After a year with health care, enrollees felt better able to work or look for work, and their emotional, physical and financial well-being improved.

In Central Ohio, this was particularly important. In some central Ohio counties, Medicaid covers more than a third of the total population. Medicaid expansion helped more than 10 percent of people of working age.

Repeal of the ACA without a replacement would hurt thousands of low-income adults in every county. Changes to the Medicaid program could hurt many more, including people who are young, old, blind or disabled. Some in Congress want to change the structure of Medicaid from an entitlement, which you get if your income makes you eligible, to a federal block grant, which is a set amount of money the federal government gives to the state each year for the program. Under the current Medicaid program, help is there when need rises. Block grants don’t necessarily rise when there’s a national recession or a local plant closure. That leaves people out, just when need is highest.

Repeal of the ACA could mean an estimated $4 billion less in federal funds flowing to Ohio’s state budget, its health care providers and the many families benefiting from expanded coverage. An estimated 50,000 jobs would be lost as laid-off health care workers curtail spending at grocery stores and movie theaters, creating a downward economic spiral. Block granting of Medicaid funds to the state could cause even greater loss over time.

Congress’s shifting approach to Medicaid funding and the ACA places great uncertainty on families, employers and communities. There should be no major changes to health care without a comprehensive plan Ohioans clearly understand: so we can clearly compare what we had with what we are getting.

Wendy Patton is senior project director at Policy Matters Ohio, a non-partisan policy research institute, on the web at www.policymattersohio.org.