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‘We’re in an analytical mode': Ohio weighs the Obamacare Medicaid expansion

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition — and read all previous columns here.

You probably haven't heard of  Ron Amstutz. He was raised on a dairy farm in Ohio and now lives in the city of Wooster (Population: 26,139). He is on the board of the Orrville Area Boys' and Girls' Club and a member of the Wooster Rotary Club.

Turns out, though, that Ron Amstutz has one of the most important roles right now in implementing the Affordable Care Act: He leads a small committee that will get the first say on whether Ohio expands Medicaid to 684,000 residents.

Rep. Ron Amstutz is sworn in as a member of the Ohio House of Represenatives (

Eight Republican governors have endorsed the Medicaid expansion. While that's necessary for a state to participate in the Obamacare provision, it's by no means sufficient: State legislatures also need to sign off on expanding the program that, in many situations, is their biggest budget item.

In some states, this is moving forward smoothly: North Dakota legislators look set to go along with Republican Gov. Jack Dalrymple's plan to expand Medicaid. New Jersey and Nevada have Democratic-controlled legislatures, so Govs. Chris Christie and Brian Sandoval, respectively, are unlikely to face opposition.

But that has not been the case in Florida, where the two panels in the Republican-controlled House and Senate shot down Gov. Rick Scott's proposal. They are, however, considering an alternate approach where they would use the Medicaid expansion dollars to buy private insurance for the same population.

And that brings us to Amstutz, a Republican who chairs the Finance and Appropriations Committee in the Ohio House of Representatives. It's his committee that will get the first crack at approving, tweaking or rejecting the 2014 budget that Gov. John Kasich has proposed, which does include funding for a Medicaid expansion.

"Our top three problems are the issue of health-care delivery, followed by taxes and then a new school funding proposal," Amstutz told me when we spoke Wednesday. "Those are the top three things, and they give us plenty to work on."

Amstutz says he personally hasn't made up his mind on whether to support the Medicaid expansion, and thinks that many of his fellow legislators are in a similar place.

"I mean, there are people who are pretty set on their general view of Obamacare but I don't think they've figured out how we go forward," he says. "We’re in analytical mode."

What's most challenging, he says, is that the Medicaid expansion feels like a "moving target." The state has taken notice of what other states are doing (places like Arkansas and Florida, which considering privatizing the expansion) and now legislators need to take that into consideration as they weigh their options.

"We are evaluating a continuum of options that involve the expansion idea and its different components, its advantages and disadvantages," Amstutz says. "The exchange adds a whole other dimension to that."

Amstutz and his Finance Committee colleagues are the subject of aggressive lobbying from the Ohio Hospital Association, which supports the Medicaid expansion. Right now, they're agnostic on what approach they take to the program — they just want to make sure it actually happens.

"We have been in very active discussions with a lot of legislators, mainly the finance committee," says spokesman John Palmer. "We're moving through that process. A lot of it relates to the financial impact, or what if the federal government makes any adjustments. There are also discussions about the overall financial implications for the state, in regards to the Medicaid program."

As to how the legislature was leaning at this point, Palmer wasn't quite sure. He expects a vote in the next month or two. Ohio does not have to finalize its budget until June, so a decision could still be a long way off.

"I would stay tuned until about mid-May or April, when we're expecting a vote," he says. "I'd say we're somewhat optimistic at this point."

Scott Milburn, a spokesman for Ohio Gov. John Kasich, says he's seen huge diversity in how the legislature will handle the issue.

"Some people like it, some people like it but want to learn a bit more," he says. "Some people are against it. It runs the predictable gambit. There are some who have big concerns and some who are outright opposed."

That isn't unusual, Milburn says. Each year, legislators will have questions about the budget and its various components. "This is part of the budget," he says. "We've got a tax reform piece, a higher ed piece and a big highway part. All these things are in the mix. This is one of those issues."

When asked about the odds the legislature would sign off on this part of the health-care law, Milburn demurs.

"I'm not," he says, "going to handicap this one."

KLIFF NOTES: Top health policy reads from around the Web.

Here's why Obamacare's calorie labels still haven't turned up in restaurants. "Diners will have to wait a little longer to find calorie counts on most restaurant chain menus, in supermarkets and on vending machines. Writing a new menu labeling law 'has gotten extremely thorny,' says the head of the Food and Drug Administration, as the agency tries to figure out who should be covered by it." Mary Clare Jalonick/Associated Press.

Health reform is increasing medical costs for ... pets? "Pet owners, listen up: You may want to start saving more money for veterinarian care this year. The reason goes all the way back to Washington and an unintended consequence from medical reform. Why the increase? It's part of a new 2.3-percent federal excise tax on certain medical devices that just went into effect. The tax will help fund the Patient Protection and Affordable Care Act, commonly known as Obamacare, intended for people, not pets. Manufacturers pay the tax, but a recent survey found more than half plan to pass it along." CBS Miami.

Maine Gov. Paul LePage, a Republican, is reconsidering the Medicaid expansion. "Maine’s governor, Republican Paul LePage, has dialed back his staunch opposition to Medicaid expansion and entered discussions with the Obama administration over the possibility of accepting billions in federal funding to provide health insurance for the state’s poorest residents. 'We are in preliminary talks' with the U.S. Department of Health and Human Services, acknowledged Adrienne Bennett, LePage’s spokeswoman. 'It’s very preliminary at this point. It’s premature for us to talk about anything.'" Tracey Jan in the Boston Globe.



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