Would Ohio Fare Better Without Expanding Medicaid?

The National Center for Policy Analysis (NCPA) suggests Ohio would fare better economically by opting out of of expanding its Medicaid program.

Instead, the Dallas-based think tank suggested that the Buckeye State encourage poor residents to purchase subsidized insurance through the state's insurance exchange.

The issue of expanding Medicaid remains unsettled in Ohio, where Gov. John Kasich has wrestled with lawmakers about passing an expansion bill. Expanding Medicaid would add as many as 700,000 Ohioans to the rolls. Under the Affordable Care Act, income limits would be raised to 138% of the federal poverty level.

“Ohio would be better served to free those earning above 100% of the federal poverty level to seek subsidized coverage in the health insurance exchange,” the study concluded.

According to the NCPA, providers would obtain higher payments from commercial insurers competing in the state's health benefits exchange. Altogether, Medicaid pays providers in Ohio 49% of Medicare rates, including 61% of fee-for-service Medicare. The study suggests that many of the state's physicians would be reluctant to treat patients at Medicaid rates, and that more Ohioans would be likely to enroll in private plans with more extensive provider networks.

The NCPA contends that Ohio would see a net economic gain of $4.4 billion over the next decade if it opted out of Medicaid expansion. That compares to the estimated net gain of $1.4 billion if the state expanded Medicaid. That's based on an estimate that Ohio would forego $5.5 billion in federal matching funds for the Medicaid expansion, but $9.2 billion would be spent on those enrollees in private plans.

The NCPA recommended that residents earning under 100% of the poverty level who would not qualify for a tax subsidy receive some for of limited benefits, and that some populations be covered over others.