Ohio Medicaid Expansion Exceeds Projections

Published November 10, 2014

Ohioans newly eligible for Medicaid under the Affordable Care Act are enrolling in much larger numbers than expected, reaching 401,307 in September, according to the Ohio Department of Medicaid’s latest caseload report. Earlier projections by Gov. John Kasich’s office predicted enrollment wouldn’t even reach 366,000 until July of 2015.

Based on an October 16 estimate from the Ohio Joint Medicaid Oversight Committee pegging monthly costs per enrollee at $630 for the 2015 fiscal year that began on July 1, Ohio’s Medicaid expansion ran $63.7 million over budget from July to September. The Obamacare expansion in Ohio cost more than $250 million in September alone, and has set federal taxpayers back $1.7 billion since January.

In response to the higher than expected enrollment and costs, Rea Hederman, executive vice president of the Buckeye Institute, an Ohio-based think tank, said, “We … know that many more people have enrolled due to expansion than the administration predicted. We have already surpassed the enrollment numbers the Kasich administration predicted for the summer of 2015. This means taxpayers are going to have to bear a great share of the burden.”

Meanwhile the “woodwork” effect, a term for signups by those previously eligible and seeking to avoid Obamacare penalties, has created less enrollment than the state expected.

Expansion Covers New Groups

Expanding Medicaid from a targeted entitlement program to one based on income alone was a key component of Obamacare when the law passed in 2010. Prior to the Obamacare expansion, Medicaid in Ohio was restricted to the elderly, physically disabled, pregnant women, children and low-income parents.

Detailed data regarding enrollment under the Obamacare expansion haven’t been released, but the left-leaning Urban Institute projected 90 percent of uninsured Ohioans newly eligible for Medicaid would be able-bodied adults without dependent children.

President Obama has pointed to Ohio’s implementation of Medicaid expansion as proof of his unpopular health insurance law’s success, but there are concerns about the long-term viability of the expansion.

“Ohio’s Obamacare expansion continues to run over budget, which will ultimately put Ohio’s most vulnerable citizens at risk,” Jonathan Ingram, director of research at the free-market Foundation for Government Accountability, said. “When it comes time to pay for those cost overruns and the state’s share of Obamacare costs, who will Gov. Kasich put on the chopping block first?”

“While more than 40,000 children and adults with developmental disabilities have been languishing on Medicaid waiting lists for years, Gov. Kasich is bragging about enrolling able-bodied childless adults and ex-convicts in Medicaid,” Ingram added.

Kasich Bypasses Legislative Process

A 2012 U.S. Supreme Court decision made the Obamacare expansion optional for states, and Kasich expanded Medicaid unilaterally in 2013 after vetoing a ban on expansion passed by both houses of the Ohio General Assembly.

Kasich, a Republican, warned Ohio rejecting Medicaid expansion would “send our tax dollars to another state to be spent,” and he assured Ohioans the new federal spending for Medicaid expansion was actually “Ohio’s tax dollars.”

Rea Hederman at the Buckeye Institute rejects that argument.

“Remember that all government spending ultimately results in taxation. If Ohio continues Medicaid expansion, that means higher taxes on citizens of Ohio to pay for Medicaid expansion at the federal and state level,” Hederman said.

Federal taxpayers are currently on the hook for 100 percent of Medicaid enrollment costs for those newly eligible under Obamacare, a matching rate set to drop to 90 percent by 2020 and remain at 90 percent thereafter. Assuming the federal match isn’t reduced, Ohio’s Obamacare expansion is projected to cost the state $600 million per year by 2022, according to the Urban Institute.

Neediest On Chopping Block?

With the national debt fast approaching $18 trillion, state lawmakers are expressing= serious concern the generous federal match will decline. Most notably, President Obama himself has proposed cutting the federal matching rate for the Medicaid expansion.

If the federal government makes such cuts at some point, Ohio will have to cut benefits for traditional Medicaid populations including needy children and low-income parents, or remove able-bodied childless adults from the Medicaid rolls. Because the latter receive more generous federal funding, the neediest may lose out.

“It’s time for the legislature to put a stop to Kasich’s unilateral Obamacare expansion, before it’s forced to make the kinds of devastating cuts we’ve seen time and again in other expansion states,” said Jonathan Ingram of the Foundation for Government Accountability. “Those states have been forced to cut treatment for late stage cancers and lifesaving organ transplants, all to protect a new entitlement for able-bodied adults.”

Jason Hart ([email protected]) writes for Watchdog.org. This article is based on previously published articles at Watchdog.org, and is reprinted with permission.