From The Vaults

Ohio’s Medicaid Expansion Has Provided 700,000 Citizens Good Insurance And Has Made A Big Positive Impact On Recipients

In 2014, Ohio opted into the Medicaid Expansion made available to states through the Affordable Care Act. By May 2016, a total of 702,000 individuals were eligible for and received Medicaid coverage made possible by this Expansion. In 2016, at the request of the Ohio Assembly, The Ohio Department of Medicaid in cooperation with Ohio State University, conducted an in-depth study of the result of this Expansion. The information in this post comes from that study.

Medicaid expansion allowed most Ohioans age 19 through 64 with incomes at or below 138% of the federal poverty level (FPL) to become eligible for Medicaid. Prior to January 1, 2014, Medicaid eligibility for adults was limited to those with certain qualifying characteristics such as parenthood or disability, and the income limitation for most Medicaid eligibility groups was lower than 90% of the FPL

This Medicaid Expansion has made a huge difference in the number of low-income citizens in Ohio who have health insurance. In Montgomery County, 11.9% of all adults ages 19-64 are enrolled in the Medicaid Expansion. In total, 21.8% of adults in that age group are enrolled in Medicaid.

Ohioans who have insurance because of the Expanded Medicaid option provided through the Affordable Care Act

Most Expanded Medicaid enrollees were uninsured prior to obtaining Medicaid coverage, either because they had no prior insurance at all (75.1%) or they had lost employer-based insurance (13.9%). The study shows that most Expanded Medicaid enrollees were white (71.5%), male (55.8%), with a high school degree or less (58.1%), unmarried (83.8%), and without a child in the home (82.1%). Employment rates were similar for the Expanded Medicaid enrollees and pre-expansion enrollees (43.2% versus 41.5%)

Key Findings of the Study

  • More than one-quarter of Group VIII enrollees were diagnosed with a chronic condition after enrolling in Medicaid, suggesting a high level of unmet medical needs. Medicaid has enabled those with chronic conditions to obtain evidence-based care… Enrollees are showing improvements in the management of their chronic conditions, including reductions in high-risk levels of blood pressure and cholesterol.
  • Participation in Medicaid has made it easier for Group VIII enrollees to pay for basic necessities including food and housing. Medicaid coverage has enabled currently employed Group VIII enrollees to maintain their positions, and it has helped enrollees without jobs to seek employment.
  • Since Expanded Medicaid enrollment, more than one-quarter (27.0%) of participants have been diagnosed with at least one chronic health condition. Many of these chronic conditions would likely have remained undiagnosed and untreated without Medicaid expansion.
  • Nearly two-thirds of Group VIII enrollees (64.3%) reported that Medicaid improved their access to generalmhealth care. Similar improvements were reported for access to care in the areas of pharmacy, vision, and dental.
  • Of Group VIII enrollees with positive screens for anxiety or depression, 44.0% reported that access to mental health treatment had become easier since enrolling in Medicaid, while 5.0% indicated that it had become harder

The Ohio Assembly Has Mandated Work Requirement For Medicaid — Research Shows This Is A Bad Idea

Interesting report from Policy Matters Ohio concludes that mandating work requirements for Medicaid enrollees would drive down health coverage in Ohio and would be contrary to Medicaid’s stated goals.

Policy Matters says: “Rigid work requirements would not meaningfully improve work participation, but they would kick people off of insurance, many who are working, reversing hard-won progress in Ohio. Physicians groups like the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics and others oppose work requirements because they impose unnecessary barriers to health care.”

“New work requirements will not meaningfully increase work participation because most Medicaid recipients In Ohio are already working — or, they are eligible to be exempted from work requirements. 61 percent of working-age Medicaid enrollees are employed: 40 percent, full time and 21 percent, part time. Another 22 percent have an illness or injury that prevents them from working and 12 percent are caregivers. Five percent are not working for other reasons: some are students, some retired and some are looking for work.”

Another research group, Community Solutions has lots of good information on this issue. One thing their research shows is how a Medicaid work requirement will result in a big expense to government. They write: “Currently, eligibility is primarily a byproduct of income. With work requirements, all 700 thousand expansion enrollees would have to go through some level of adjudication on the state, local and/or provider level.”

In its petition to Health and Human Services (HHS), this is the list of categories that Ohio is requesting will be exempted from Medicaid work requirement:

  • 50 years of age or older
  • Physically or mentally unfit for employment
  • Participant in the Specialized Recovery Services Program
  • Caring for a disabled/incapacitated household member
  • Pregnant women
  • Parent/caretaker/residing in same house with minor child
  • Applied for or receiving Unemployment Compensation
  • In school at least half-time
  • Participating in drug or alcohol treatment
  • An assistance group member subject to and complying with any work requirement under the Ohio Works First
    (OWF) program
  • Applicant for or recipient of Supplemental Security Income (SSI)
  • Limit to counties that have an unemployment rate of more than 10% or do not have a sufficient number of jobs to provide employment for the individual.
Work Requirement Increases Cost And Size Of Government

Community Solutions states:

“The reality of this and other work requirement proposals is that it will increase the cost of the program as it will increase the size and operational requirements of government. Data from Virginia, Kentucky, and Pennsylvania demonstrates this, with governments in those states reporting that the operational costs for implementation would number in the hundreds of millions

In Cuyahoga County alone, it is estimated that nearly 30 percent of the expansion population will have to go through some level of appraisal by a county case worker before eligibility is granted. This new process, which subverts the efficiency of the current, data-driven system to one that is more dependent on human activity, will increase the variable costs of the state and county governments as well as the providers who rely on eligibility to ensure predictable revenue cycles.

Cuyahoga County, in fact, has testified that this activity of appraisal and adjudication will increase their costs in the millions. In its calculations, Ohio does not contemplate the cost of administration on the state or local level. The state also foregoes including how the increase in uncompensated care may increase disproportionate share payments to hospitals, which is also a Medicaid expense.”


In Montgomery County, Improving Voter Turnout In Strong Democratic Precincts Is Huge Challenge For MCDP

Low voter turn-out in strong Democratic precincts is an on-going challenge for the Montgomery County Democratic Party. The graph shows the percentage voter turnout in the Top 75 Democratic Precincts, the Top 75 Republican Districts, and the county as a whole for the 2012, 2016 and the 2014 elections. In each election, the 75 Top Dem precincts performed below the top 75 GOP precincts and below the Countywide average as well.

Of Montgomery County’s 360 precincts, I’ve identified the 75 precincts that had the highest percentage voting for Hillary Clinton. On average 90.8 % of votes in these precincts went to Hillary and the individual precincts ranged from an amazing 97.3% voting for Clinton to 75.9% voting for Clinton. Together these 75 precincts delivered 38,289 votes to the Democratic ticket.

I’ve also identified the 75 precincts that had the highest percentage voting for Donald Trump. On average 72.7% of votes in these precincts went to Trump and the range in individual precincts was from 83.7% for Trump to 67.2% for Trump. Together these top 75 precincts Republican precincts delivered 55,809 votes to Trump.

The Democratic turn-out in the top 75 Democratic precincts decreased from 66.5% in 2012 to 60.8% in 2016. This 5.7% decrease amounted to a gift to Trump of 3260 votes. This is painful to acknowledge, because Trump carried Montgomery County by 1,993 votes. If these 75 top Dem precincts had matched the average turn-out for the entire county, these 75 precincts would have produced an additional 5534 votes for Hillary.

Improving Democratic turn-out is a huge challenge for the MCDP. An equal challenge is to shore up Democratic votes in off years. There is always more voters at a presidential contest, rather than a governor’s contest. The top 75 Democratic Precincts crashed from a turn-out for Obama in 2012 of 66.5% to a turn-out in 2014 of 31.3%.

For the top 75 Dem precincts the decrease from 2012 to 2014 was 53.0%.

For the top 75 GOP precincts the decrease was 40.8%.

For the County as a whole decrease was 43.5%


The MCDP Must Transform Its “Political Boss” Organizational Structure — In Order To Engage And Empower Loyal Democrats

They say that how an enterprise is organized is the key to its success. I’ve been involved in three MCDP Reorganization Meetings — 2006, 2010, and 2014 — and in these meetings there was no reorganization. The status quo was simply ratified. I hope this year will be different, because the MCDP truly needs reorganization. This quadrennial Reorganization Meeting is scheduled for June 7.

With the rise of Trump, the polarization of politics, and the emerging majority of voters who identify as Independent, there is pressing urgency for the Democratic Party to discover how to become a stronger and more successful organization. For this Reorganization, 68% of precincts in Montgomery County had no Democrat to step forward to be elected to the MCDP Central Committee; this means that, going forward, 220 out of 360 precincts in Montgomery County will have no elected precinct leader. MCDP is falling far short of being the strong organization it could be.

MCDP Reorganization must address the fact that regardless that the county has about 60,000 Democrats — maybe 3% of whom periodically work for Democratic campaigns — only a tiny percentage of county Democrats are engaged in the party organization (maybe one-half of one percent). Many loyal Democrats have never been inspired to be engaged in the MCDP. How can MCDP be reorganized to engage and empower loyal Democrats?

Looking honestly at the present MCDP structure is to recognize the traditional “political boss” organizational structure that emerged from the nineteenth century — yes, the nineteenth century. At one time this system was effective, but now it is not working and has not worked for some time. What made it effective at one time was the elaborate system of patronage that empowered local party leaders to reward party workers with all kinds of government jobs. At one time, some Democrats were eager to work for the party because they hoped to get a patronage job. The power of patronage that supported the political boss system has largely vanished, but the system remains.

In addition to the loss of the patronage system, super PACs and candidate-funded and directed campaigns have changed the whole system. Parties are trying to adjust, but the“political boss” organizational structure that once delivered Democratic votes now is a major impediment to going forward. The MCDP should be restructured as a twenty-first century organization — transformed from a pyramidal to a more flattened grassroots structure, from a hierarchy to a community.

Size matters. Vinton County has 13,435 citizens and although it is a strong Republican region, there is a Vinton County Democratic Party organization — with website, officers, a Central Committee, etc. The population of Montgomery County is forty times the population of Vinton County, yet the MCDP has pretty much the same structure as the VCDP.

In Vermont, known for its traditional “town halls,” political parties are organized at the town level. Democratic Town Caucuses in Vermont are reorganized every two years — officers are elected, new plans made. These Democratic Town Caucus deal with politics in the local town and work to nurture and empower new Democratic leadership. At their biennial reorganizations, they choose representatives to serve on the County Committee.

Democrats in Vinton County have the opportunity to act as leaders in a population that is less than 3% the size of Montgomery County. Democrats in Vermont have the opportunity to lead and to be meaningfully engaged with other Democrats in their local communities. I don’t have the statistics, but I’m betting that the percentage of loyal Democrats who are active in Vinton County and active in Vermont far exceeds the minuscule percentage of Democrats active in the MCDP. I’m betting a political party with a flattened organizational structure has much more success than a pyramidal one.

Montgomery County is divided geographically into five Ohio House Districts. In those districts are a total of sixteen political jurisdictions — each with a local board of education and a local city council. I’m developing a motion that calls for the formation of five district Democratic caucuses — one for each Ohio House District — a OHD-39 Democratic Caucus, an OHD-40 Democratic Caucus, etc.

The motion I am preparing for the MCDP Reorganization Meeting will call for approval of an Ohio House District Constitution. I’m working on a rough draft. The proposal will call for the elected precinct leaders in each OHD district to act as the Executive Committee for that District Caucus. It calls for the membership of each OHD Caucus to be all interested Democrats registered to vote in that Ohio House District. Each OHD Caucus, in turn, will have the discretion to form City Caucuses for the political jurisdictions (of the sixteen) within their Ohio House Districts

Key to the success of the Democratic Party in Montgomery County is inspiring many more loyal Democrats — young and old — to become actively engaged and to be leaders in the MCDP. There are tons of unused potential. We must make room and opportunity for leadership to emerge. We must provide a positive path for passion. The “political boss” system is out of date. We need to think through a twenty-first century organization structure that supports a vitalized MCDP. Between now and June 7, there is a lot of work to do, a lot of consensus to build.


Principles Of Improvisation Can Empower Strategic Change — Andy Eninger of Second City Gives Lecture At Wright State

This morning I had the pleasant experience of participating in Wright States’  “Organizational Effectiveness Lecture Series” offered by Wright State’s Business Department. The speaker, Andy Eninger, presented a lot of good information and got participants to interact with each other to develop that information. Eninger has a long history of working with improvisation at Second City in Chicago. He showed how practicing the principles of improvisation helped him act as an effective leader. He told of being appointed to head the writing program for Second City when its beloved founder, Mary, died. (Her name is “Mary,” but I didn’t get the last name.) It was a huge challenge to replace such a person. He did a good job of explaining how principles of improvisation he had practiced in his work at Second City helped.

In improvisation, actors practice working together, practice building each other up, practice saying “yes” to each other in order to construct a story. The Wright State announcement advertising this lecture said: “Great leaders build a story that builds trust, gives purpose and inspires.” An even greater leader, I guess, builds the story with the help of his or her listeners so that everyone has ownership. I thought Eninger gave some good insight into how that process works. It’s not enough to have facts and data and well prepared bullet points, a successful leader — through a connecting story, through effective metaphors — will engage listeners in understanding and caring about this information

Eninger talked about the importance of finding the right metaphor. He cited one study where one group was given crime data and was given information that described crime in terms of a dangerous animal in need of control. A second group was given the same crime data, and information that described crime in terms of a virus, a public health issue, that was in need of control. The participants’ responses were telling — the first group calling for harsher punishment, the second group calling for more broad-based solutions. The study showed the power of metaphor to shape judgement.

The title of the presentation was “How To Use Storytelling To Lead To Strategic Change.” During the presentation I kept wondering how the information I was hearing could apply to our local Democratic Party organization, The Montgomery County Democratic Party. The MCDP quadrennial Reorganization Meeting is scheduled for June 7. The 141 Democrats who will be elected to the Central Committee at the Democratic Primary on May 8 are empowered by the Ohio Revised Code to make big changes in the MCDP organization. A big change, of course, requires a big consensus. To develop a consensus, a shared story, is the challenge. As I explained in a previous post, in terms of reorganizing the MCDP, I’m hoping that the individuals elected to the Central Committee will come together and agree on a Big Hairy Audacious Goal (a BHAG) — a six year plan for transformation. I’m pondering what I learned today from Andy Eninger.

This lecture was held at the Nutter Center in the Berry room and included a nice breakfast. It was a first class event. I enjoyed Mr. Eninger, I enjoyed the morning, and I’m glad I attended.