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Medicaid Expansion Key Difference in Dueling Medicaid Reform Plans

Andy Chow
Senator Dave Burke

Two Ohio lawmakers are stumping for their plans to revamp Medicaid. Both want to set measures that control the cost, but the disagree when it comes to the big issue of expansion.

As he unveils his plan to overhaul Medicaid, Senator Dave Burke points to a graph showing the program’s costs slowly engulfing the rest of state spending.

“I think one would have a hard time arguing that that’s a stable growth environment for Medicaid. It technically puts the entire system at risk as it nears what eventually could be 100% of the state budget” said Burke.

The Republican senator from Marysville urges something must be done to slow down the growing expenses. He says his bill creates a path for the state to meet certain goals that will improve health outcomes while containing the costs.

One thing his proposal doesn’t address is Medicaid expansion. The senator says the bill tackles the much larger problem of spending, whether the state decides to expand Medicaid eligibility or not.

“Medicaid reform," Burke said  "is an issue I’ve been working on since 2009—that’s before the Affordable Care Act, that’s before President Obama—this a $30 billion issue in Medicaid and rather than focus $2 billion question I’m focusing on the things that I know are in front of me. The growth of Medicaid, the $30 billion ‘Pac-Man’ as it’s been referred to—is happening now—I’m working in the now.”

Senator Capri Cafaro, a Democrat from Warren, was a co-sponsor with Burke on previous legislation to reform Medicaid. However, she and Burke split to create two bills with similar goals. The biggest difference… Cafaro’s plan includes expansion.

“Any effort that does not include expansion will not fully achieve—I think—any kind of really significant results in the same way. The inclusion of that population does enable us to reduce the overall risk associated with the overall Medicaid population resulting in an overall reduced costs,

” said Cafaro.

One of the measures set by Burke’s plan would set the per member, per month spending rate at 3 percent. This means the amount of money the state pays for each Medicaid enrollee can’t exceed 3 percent growth or the medical inflation rate, whichever is lower.

With all the variables that come with health care, Burke says the three percent goal is something that can be established right now.

“We can’t control the economy. I can’t tell you how many people are going to be on Medicaid in a year because if the economy approves, we’ll have less people—if it doesn’t we’ll have more. But the Per Member, Per Month growth rate is something that we can set targets on, negotiate, and work towards.”

While Cafaro commends Burke for his work and thoughts on the issue, she believes setting the spending growth cap using a five-year weighted average of the medical cost inflation rate would allow the administration more flexibility.

“So that we were not setting up the administration nor policymakers for failure not knowing ultimately where the medical rate of inflation would land,” said Cafaro.

Burke says his bill does not include any penalties if this goal isn’t met.
But he says the bill ensures the administration and the General Assembly will be held accountable to keeping the state on a stable road.

“We’re looking for a policy path. This bill is the ‘what,’ there may be a lot of legislative ‘hows’, but this bill is the ‘what,’” Burke said.

The Republican senator says this plan lays out Ohio’s future long after he, the governor and the rest of the current legislators leave office.