Wendy Patton is a senior project director with Policy Matters Ohio.
A quarter of Ohioans get health insurance through Medicaid. Why? Because they’re too young, old, sick or disabled to work; because their jobs are low-paying and don’t provide insurance; or because they can’t find a job at all.
Ohio’s General Assembly wants to change the Medicaid program for adults who are not elderly and don’t have disabilities. They created what they’re – oddly – calling the “Healthy Ohio” plan for this group, which would impose premiums and caps on coverage and lock people out if they miss payments. The legislature directed the Ohio Department of Medicaid to ask the federal government to waive existing Medicaid rules and allow these changes.
Despite the misleading name, it’s not healthy for Ohio. It will disrupt care, endanger the financial stability of our health system and lead to poor health outcomes
Under the proposal, adults covered by Medicaid (people earning less than 138 percent of the federal poverty level, or $1,366 per month for a single person) would pay premiums of up to 2 percent of annual income, capped at $99 per year, into a modified health savings account to get access to health care services.
Imposing fees and complex health savings accounts is the wrong model for health care for people living in poverty. Over the past 30 years, repeated studies have found that even modest increases in cost prevent poor people from seeing a doctor for preventive care for chronic conditions like schizophrenia, hypertension and diabetes. People who barely make enough to cover rent, food and bus fare will skip a preventive appointment that they can’t afford, even if it’s necessary in the long run.
The conservative Rand Corporation found modest savings in the private market from health savings accounts – typically used by high-income families and paired with a high deductible health insurance plan – because participants ration their own care. But the problem with low-income families is underuse – not overuse – of health care. The same study found that for poor and sick people, the health savings account model may yield poor health outcomes.
Reducing barriers to medical services is good for everyone because it encourages preventative care. Regular checkups and appropriate, consistent medication promotes better health, which boosts productivity, reduces suffering and curtails overall costs. This is preferable in every way to treating medical crises in the emergency room – which becomes more common when policies create barriers like these.
The Ohio Department of Medicaid itself forecasts between 125,000 and 140,000 fewer people will be enrolled in Ohio’s Medicaid program under the “Healthy Ohio” plan. Some will choose not to participate because of increased costs, and some will be locked out of the program. If you miss a premium payment and can’t repay it within 60 days, you lose your coverage and cannot re-enroll until that debt is paid in full.
Not only does the “Healthy Ohio” program block access for individuals, it shifts the risk of emergency care to the medical service provider. Under the existing program, if you have a heart attack and are eligible for Medicaid, you can apply for coverage at the hospital and Medicaid can cover the emergency care. Under the “Healthy Ohio” plan, Medicaid would have to get a premium payment before coverage begins. Denial of coverage until a premium is paid could leave hospitals holding the bill for crisis and emergency care.
Lastly, the added red tape means “Healthy Ohio” actually will cost the state more. The health care consulting firm Human Arc estimates that the proposed changes could cost Ohio’s health care system billions over five years.
The state’s existing Medicaid expansion program has helped more than 650,000 Ohioans and strengthened hospitals and health care. The “Healthy Ohio” plan would diminish those benefits and hurt scores of thousands. Federal officials have to approve this proposal, and they pay attention to citizens. The state comment period is open until Monday. Send a simple e-mail to HealthyOhio@medicaid.ohio.gov to speak out against the plan.