With passage by the U.S. House of Representatives of what President Donald Trump described as his “big, beautiful bill,” it seems clear that Ohio is going to face some life and death decisions down the road.
The House bill, which now goes to the U.S. Senate, included new tax cuts and massive spending on border security. To help pay for that, about $625 billion was cut from Medicaid, KFF, formerly the Kaiser Family Foundation, estimated.
Budget hawks in Ohio and in Congress have long questioned whether the cost of expanded Medicaid was sustainable. But cutting the program would have consequences.
Experts say more than 7 million people would be pushed off Medicaid rolls nationally. Reporting by cleveland.com’s Sabrina Eaton laid out the impact quite starkly: More deaths. Late disease diagnosis. Increased costs to hospitals.
Gains recorded with expanded Medicaid would be reversed. Among those, 20 fewer deaths annually per 100,000 people aged 20 to 64 in states that expanded and nearly 2,600 fewer cases of late-stage cancer diagnoses in expansion states.
The conundrum for Ohio lawmakers will be deciding whether to pick up the tab and keep state programs funded, or cut Medicaid availability, leading to sicker people and more deaths.
Already Republican lawmakers are considering a plan to eliminate Medicaid expansion in the Buckeye State if the federal reimbursement rate is cut. That could threaten health coverage for 770,000 people.
We asked members of the editorial board for cleveland.com and The Plain Dealer to weigh in on what Ohio should do. Here’s what they said.
Leila Atassi, manager, public interest and advocacy:
Ohio should protect Medicaid expansion. Behind every number is a person—a parent with cancer, a child with asthma, a neighbor recovering from addiction. Cutting coverage for 770,000 Ohioans would mean more preventable deaths and suffering. Lawmakers should see this not as a budget line, but as a moral line we cannot cross. Lives are worth more than political wins or short-term savings.
Ted Diadiun, columnist:
Before we go all in on sky-is-falling mode, consider this: That $625 billion figure covers the next 10 years. Medicaid itself admits to $543 billion in improper or erroneous payments over the last 10. The cuts also rightly include decreased federal dollars for the 14 states (not Ohio) that fund health coverage for an estimated 1.9 million illegal immigrants. Improve efficiency, and citizens in desperate need won’t lose their coverage.
Mary Cay Doherty, editorial board member:
While Medicaid expansion has provided invaluable healthcare coverage for childless, non-disabled adults, the additional costs for Ohio taxpayers has been significant. Work requirements for the expansion recipients and frequent income verification requirements may help reduce some costs and prevent fraud. But sustaining the program would require the legislature to cut funding elsewhere or raise taxes. With no financially viable path forward, Ohio will have to eliminate Medicaid expansion.
Eric Foster, columnist:
The idea that someone (unless physically disabled) should have to work to receive public assistance is not an unreasonable one. Bill Clinton signed work requirements into law in the 90s. However, the idea is rooted in a false assumption that millions of people are abusing the system. Work requirements don’t increase job participation. They cause employed Medicaid recipients to lose coverage due to paperwork issues. They are paperwork requirements.
Lisa Garvin, editorial board member:
Waste, fraud and abuse is the latest catchphrase of Republicans trying to justify perhaps the largest upward distribution of wealth in history. They have yet to produce data to prove their claims, as studies show 90% of Medicaid expansion recipients are either employed or have legitimate disabilities. People who lose coverage will be innocent victims of a vicious, indiscriminate purge mentality while the nation’s overall health declines. How shameful.
Victor Ruiz, editorial board member:
Ohio’s Republican-led legislature is primarily focused on funding tax breaks and private school vouchers that disproportionately benefit wealthy families. This is done through marijuana and gambling taxes, while simultaneously cutting essential public services such as Medicaid and funding for public schools. Given their track record, I have no expectations that they will prioritize the health and well-being of our most vulnerable communities.
Thomas Suddes, editorial writer:
Medicaid expansion, OK’d at Republican then-Gov. John R. Kasich’s insistence, is one of the best things ever done for Ohio communities. Statistics don’t bring home the perils of Medicaid cutbacks: They’ll doom hospitals in rural and outer-suburban Ohio. If you’re OK with driving, say, 140 miles roundtrip to reach the nearest ER thanks to Medicaid cutbacks, then enjoy the ride: You’ll have no choice.
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