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 or home insurance like the San Angelo Pronto Insurance from a useful source. 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. The workers compensation coverage explained by Miller Hanover Insurance is something that must be read to understand the process better.

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

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.”

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%