Big Decisions: How Medicaid Expansion Would Affect Ohioans


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The purpose of the webinar is to learn more about the value of the Medicaid expansion and how it could impact Ohio. We will also share resources to help you talk about the issue in your community.

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Big Decisions: How Medicaid Expansion Would Affect Ohioans

  2. 2. TODAY’S WEBINAR SPEAKERS Col Owens Gene King Cathy Levine Senior Attorney for Director of the Ohio Executive Director of Legal Aid of Poverty Law Center the United Health Southwest Ohio and Care Action Network co-chair of Ohio of Ohio (UHCAN Consumers for Health Ohio) and co-chair Coverage of Ohio Consumers for Health Coverage 2
  4. 4. CHILD COVERAGE ON PARENTS’ POLICY UNTIL AGE 26 Pre-ACA, children lost coverage on parents’ policy at 18 or college graduation Under ACA, children can stay on until age 26. As of 2011, 97,000 children in Ohio gained coverage under this provision of the ACA 4
  5. 5. HIGH RISK POOL FOR THOSE WITH PRE- EXISTING CONDITIONS Pre-ACA, no coverage available for persons denied insurance because of pre-existing conditions Under the ACA pre-2014, a federally-funded high risk pool provides coverage to those with such conditions who qualify As of 2012, 3,000 persons in Ohio have had coverage under this provision of the ACA 5
  6. 6. ABOLITION OF LIFETIME COVERAGE CAPS Pre-ACA, insurance companies could impose lifetime and/or annual caps on insurance coverage Those with serious chronic health conditions could exhaust coverage early in life and be without insurance The ACA abolishes lifetime caps and limits annual caps In 2011, over 4,000,000 people in Ohio are protected under this provision of the ACA 6
  7. 7. SMALL BUSINESS TAX CREDITS Pre-ACA, small businesses received no help from the government for providing coverage to their employees The cost of coverage has increased dramatically in recent years Under the ACA, qualifying small businesses are receiving tax credits for providing coverage In 2011, 107,000 small businesses in Ohio qualified for a tax credit covering up to 35% of the cost of coverage 7
  8. 8. MEDICARE PREVENTIVE CARE ANDPRESCRIPTION DRUG COVERAGE Pre-ACA, persons on Medicare paid cost-sharing for preventive care and paid full cost for prescription drugs in the “donut hole” Under the ACA Medicare participants get free preventive care and the donut hole is eliminated over time In 2011, 937,000 Medicare beneficiaries in Ohio received free preventive care services. In 2012, 117,000 Ohio Medicare beneficiaries received a 50% discount on drugs in the donut hole, for a total savings of $82 million. 8
  9. 9. Speaker: Gene KingMEDICAID: OVERVIEW 9
  10. 10. MEDICAID Medicaid is a public health insurance program for certain low-income people – 2.2M Ohioans Not all low-income Ohioans are eligible for Medicaid It is administered by the Ohio Department of Job and Family Services (ODJFS) Medicaid is funded jointly by the state and federal governments. Most services are provided at no cost to patients, but some services have a small co-payment. 10
  11. 11. MEDICAID Today, Medicaid eligibility is a two-step (or more) process. The first step is what category the person fits. The second step is income eligibility for that category. Different categories have different income limits. 11
  12. 12. MEDICAID INCOME LIMITS Children - - 200% of the federal poverty level Parents - - 90% Pregnant women - - 200% Aged, Blind or Disabled - - 64% For additional information, see: 12
  13. 13. Affordable Care Act: Federal Income Eligibility Levels in 2014 Private Insurance $92,200* (family of 4) Health Benefit Exchange Optional ACA Medicaid Expansion to 138% $31,809* (family of 4) MedicaidCurrent Ohio Medicaid Eligibility Federal Exchange Eligibility * The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four. **Over age 65 coverage is provided through Medicare, not the Exchange. 13
  14. 14. MEDICAID–COVERED SERVICESMedicaid provides comprehensive coverage, including: Doctors Inpatient Hospital Prescription medications Dental Vision Mental Health Laboratory tests & X-Rays Nursing Home & Hospice Care 14
  15. 15. Speaker: Cathy LevineBIG DECISIONS: CHOICES FOR OHIO 15
  16. 16. POST-ELECTION ANALYSIS Affordable Care Act is here to stay! • Expands Coverage • Protects Consumers • Promotes Market Fairness 16
  17. 17. MEDICAID EXPANSIONAffordable Care Actexpands Medicaidcoverage to everyoneunder age 65 with incomes below138% Federal PovertyLine (FPL) 17
  18. 18. SUPREME COURT DECISION Removed penalty for not implementing Some states consider it optional 18
  19. 19. COSTS OF MEDICAID EXPANSION Year Ohio’s Federal Cost Government’s Cost 2014 0% 100% 2015 0% 100% 2016 0% 100% 2017 5% 95% 2018 6% 94% 2019 7% 93% 2020+ 10% 90% 19
  20. 20. BENEFITS OF MEDICAID EXPANSIONBoosts our economyCreates jobsPromotes healthier Ohioans 20
  21. 21. IMPACT ON HEALTH CARE SYSTEMStabilizes hospitals and health centers serving uninsuredReduces cost-shifting of uncompensated care onto insurance premiumsReduces state spending on health care (includes uncompensated care)Funds ongoing preventative care – reducing health care costs in future  75% of health care costs is chronic health conditions 21
  22. 22. CONSEQUENCES OF NOT EXPANDING MEDICAIDWithout expansion, at least 600,000 Ohioans will be uninsured without ability to pay for health insurance • Premiums up to 2% of income, “modest” cost sharingProblems with only • Private insurance benefit lessexpanding coverage to comprehensive; non-covered benefits100% FPL (dental, vision, etc.) unaffordable • Doesn’t save state money 22
  24. 24. ECONOMIC IMPACT OF FEDERAL MEDICAIDDOLLARS Pre-ACA, Ohio Medicaid expenditures are paid roughly two- thirds federal, one-third state Under the Medicaid expansion, that ratio applies to persons eligible but un-enrolled Feds would pay 100% for 3 years for newly eligible persons under expansion Net effect of expansion on cost, feds would pay an average of 95% of cost for newly eligible persons over 6 years 24
  25. 25. ECONOMIC IMPACT OF FEDERAL MEDICAIDDOLLARS (CONT.) Past Ohio studies of economic impact of state Medicaid spending showed a 3.14 multiplier for state dollars invested This meant, for each state dollar spent, $3.14 of economic benefit was derived, including the receipt of federal match dollars Policymakers found these studies useful in determining the impact in their districts on economic activity and jobs created 25
  26. 26. ECONOMIC IMPACT OF FEDERAL MEDICAIDDOLLARS (CONT.) Ohio officials believe a full expansion to 138% FPL will bring into Ohio over $20 billion federal dollars in five years A current study by Bill Hayes and Anand Desai is determining both the economic impact of those federal dollars, including jobs created, and the amount of revenue they will generate that could be applied toward costs 26
  27. 27. ACA IMPLEMENTATION MEDICAID COSTS V.MEDICAID EXPANSION COSTS Confusion exists about the cost of the Medicaid expansion per se Many persons currently eligible will come on Medicaid because of the ACA itself: * mandate * penalty * ease of application * reduced stigma * publicity * better coverage * higher insurance rates due to lower variance 27
  28. 28. COSTS OF MEDICAID IN SFY 2014-15 BUDGET There are 250,000 Ohio parents and children eligible for Medicaid who are not enrolled There are 686,000 Ohio parents and children (mostly children) eligible for Medicaid with private insurance Ohio officials expect some number of both groups to come onto Medicaid because of the ACA implementation, and they will be covered at the current 2/3 federal – 1/3 state ratio 28
  29. 29. COSTS OF MEDICAID IN SFY 2014-15 BUDGET(CONT.) Difficult to determine for which reason these people – “woodwork” people – come on. POINT: cost of many/most of these people will be incurred with/without expansion In either case, challenge is how to pay for these people at normal match rate 29
  30. 30. MEDICAID EXPANSION PAYS FOR NEW ENROLLEES REGARDLESS OF CAUSE Hayes and Desai say $20 billion federal dollars moving through Ohio’s economy will generate sufficient economic activity and revenue to pay for state costs of expanded enrollment Sales taxes paid by Medicaid Managed Care Organizations will also be sufficient to help pay for enrollment costs, if needed Thus: Medicaid expansion is the solution, not the problem. 30
  31. 31. Speaker: Gene KingIMPACT OF EXPANSION ON OHIOANS 31
  32. 32. OHIOANS BENEFIT FROM EXPANDEDHEALTH COVERAGECommunities and people in every part of Ohio will seeimproved health outcomes and financial benefits if Ohiodecides to expand Medicaid for families and childless adults.Medicaid is a vital component of the health and human servicesystem in Ohio and across the nation. 32
  33. 33. EVERY OHIOAN Every Ohioan will benefit from the Medicaid expansion. As long as we have any uninsured Ohioans, every Ohioan will share the cost of their care, through cost-shifting, increased insurance rates, higher fees for health care, and the costs of emergency or episodic care rather than preventative care. 33
  34. 34. OHIO CHILDREN, ADULTS AND FAMILIES Childless adults Parents Parents of minor or dependent children Children whose parents are uninsured 34
  35. 35. OHIOANS WITH CHRONIC HEALTH NEEDS Ohioans with disabilities with income above 64% of the federal poverty level Ohioans with disabilities whose income is below 64% of the federal poverty levelOhioans who use county mental health servicesOhioans with chronic health conditionsOhioans currently in limited Medicaid coverage programs 35
  36. 36. WHO BENEFITS FROM EXPANSION?Every Ohioan, insured, underinsured or uninsured, whoneeds health care will benefit from the Medicaid expansion.As long as we have any uninsured Ohioans, every Ohioan willshare the cost of their care, through cost-shifting, increasedinsurance rates, higher fees for health care, and the costs ofemergency or episodic care rather than preventative care. 36
  37. 37. Speakers: GroupWHAT YOU CAN DO & TIMELINE 37
  38. 38. KASICH ADMINISTRATION DECISION Conducting cost/benefit analysis Receiving public input Will announce decision with biennial budget – February 4, 2013 Then, legislature considers 38
  39. 39. NEXT STEPS: WHAT YOU CAN DOSign your organization on to the sign-on letter supporting Medicaid expansion:  Go to or  email Betsy Johnson,Join local coalitions:  Northeast Ohio Medicaid Expansion Coalition  Southwest Ohio Medicaid Expansion Coalition 39
  40. 40. NEXT STEPS: WHAT YOU CAN DO Share your new expertise with your organization, your network, and your legislators. Shareable Resources: 1. Fact sheet on Medicaid expansion 2. Fact sheet on Ohioans affected by Medicaid expansion 3. How to find and talk to your legislators 40
  41. 41. QUESTIONS FOR OUR SPEAKERS Unmute your phone to ask a question by pressing *6 or type your question into the text bar. Speakers: Gene King, Col Owens, Cathy 41