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Ohio’s expansion of Medicaid has been a success, in more ways than you think: Akram Boutros (Opinion)

August 26, 2018

Ohio’s expansion of Medicaid has been a success, in more ways than you think: Akram Boutros (Opinion)

CLEVELAND -- You might know Mary. Maybe you shop at the same grocery store, belong to the same church or have the same favorite Indians player.

Mary takes medication to control her diabetes. A few years back, she lost her job and could no longer afford her medicine or her regular visits to the doctor.

When her symptoms got bad, she got scared and went to the emergency room. It happened more than once.

Then, in 2014, Ohio expanded Medicaid, the government program that provides health coverage to low-income adults, children, pregnant women, the elderly and the disabled.

Mary qualified for the expansion and was able to find a primary care doctor at MetroHealth. She got back on her medication and regained her health. Then she found a new job.

We learned this past week that her story is not unusual. There are at least 290,000 people just like Mary in Ohio – folks who got coverage through Medicaid expansion and then unenrolled when they found a new job or saw their income rise.

That statistic is part of a new Ohio Department of Medicaid report measuring the impact of the 2014 expansion. The findings reveal lots of good news: Expanding the program has slashed the uninsured rate; it’s improved the health of enrollees;  and it’s eased financial worries for Ohio families.

But the most significant news from the report is that Medicaid expansion hasn’t done many of the things opponents predicted it would:

* It hasn’t become a lifelong entitlement. As Mary and the hundreds of thousands of people just like her show, coverage through expansion is often a temporary benefit. Since 2014, almost 1.2 million Ohioans have received coverage. Almost 500,000 of them are no longer on Medicaid.

* It hasn’t diminished recipients’ motivation to work. In fact, it’s increased it. Fifty percent of recipients are now employed, compared to 43 percent in 2016. Significant majorities of enrollees say coverage has either made it easier to work or easier to look for work.

* It hasn’t blown up the budget. During a presentation of the report’s findings on Wednesday in Cleveland, Ohio Budget Director Tim Keen revealed that each recipient of Medicaid expansion costs the state less than $21 a month. “Medicaid expansion is manageable and affordable,” he said, “now and into the future.”

MetroHealth saw how well expansion could work before almost anyone. In 2013, a year before the state expanded coverage, the federal government gave us permission to see how it might work in practice. The program, called CarePlus, offered health coverage to about 30,000 uninsured Cuyahoga County residents. The results were better than we expected: Enrollees saw significant improvements in care and outcomes, and the cost of caring for them came in about 30 percent below the government’s estimate.

Last week’s report is more proof of what we at MetroHealth have seen firsthand.  Medicaid expansion has proven to be a lot like a lifeguard: When members of the community start to splash and sink because of a lost job, a sick relative or a sudden crisis, expanded coverage is there to help them, to pull them onto solid footing, allow them to catch their breath – and then dive back into work and life.

We should all feel a bit more comfortable knowing that Medicaid expansion is protecting our community pool.

Lots of people deserve credit for the success of Ohio’s Medicaid expansion. Two of the most deserving are Gov. John Kasich and Department of Medicaid Director Barbara Sears. Both went against the wishes of many of their fellow Republicans and saw the true conservative benefits – controlled costs, personal responsibility, moral imperatives – of Medicaid expansion. Because of their courage and determination, life is better for hundreds of thousands of Ohio families. That’s quite a legacy.

I’ll speak for those families, for Mary and for those of us fortunate enough to have not needed Medicaid expansion: Thank you.

Let’s all work to make sure the next resident of the governor’s mansion knows the importance and success of this program – and that he keeps the lifeguard on duty.

Dr. Akram Boutros, a fellow of the American College of Healthcare Executives, is president and CEO of The MetroHealth System in Cleveland.

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