Medicaid expansion at risk: 'My life was saved by the citizens of Ohio'

Apr. 10—As state and federal lawmakers pursue initiatives and possible cuts to Medicaid, those who have been on the program say it saved their lives and helped them get back on their feet.

Nearly 770,000 Ohio Medicaid members are at risk of losing their health insurance as state lawmakers seek the implementation of work requirements and federal lawmakers seek budget cuts. The Dayton Daily News spoke with those who have been on the program to see how it impacted them.

"My life was saved by the citizens of Ohio, and my life was saved by an appropriately compassionate structure of governance," said Karen Jeffers-Tracy, of Fairborn.

Jeffers-Tracy and others say Medicaid gave them access to life-saving treatments, kept them in the workforce or able to return to the workforce, as well as allowed families to have more flexibility in caregiving. This also frees up state and federal tax dollars with family members taking on unpaid roles in taking care of loved ones unable to care for themselves, preventing the state from having to take on those costs.

About 61,000 Ohioans could lose their health insurance coverage in 2026 if the U.S. Centers for Medicare and Medicaid approves Ohio's proposal for work requirements, according to estimates from the Ohio Department of Medicaid.

"As part of our work to empower people reach their full potential, we have a responsibility to make sure as many Ohioans as possible are on a pathway toward financial independence," Gov. Mike DeWine said after the state submitted the request to CMS.

The larger question is whether federal lawmakers and the Trump administration will end Medicaid expansion, which covers 770,000 Ohioans. The president and congressional leaders have said Medicaid will be protected, but experts say ambitious federal spending reduction goals are nearly impossible to meet without impacting Medicaid.

Even a modest reduction in federal Medicaid spending could trigger the end of Medicaid expansion in Ohio under a proposal in the state budget that would terminate Medicaid expansion in Ohio if federal funding falls under 90% for that program. That measure was in the state budget draft passed by the Ohio House Wednesday.

Cutting back on the availability of Medicaid could walk back the progress Ohio has made in the number people who have health insurance and increase medical debt, experts say.

"Medicaid has played a crucial role in helping vulnerable households achieve greater economic security while improving access to necessary health care services," said Amy Rohling McGee, president of the Health Policy Institute of Ohio, a nonprofit focused on researching health policies.

A lifeline

"I had cancer for five years and didn't know it because I had no medical care," Kim Smith, of Dayton, told this news outlet.

Smith would go to the emergency room if she got sick, but if doctors there gave her a prescription, she couldn't afford the cost to buy the medication, she said. She was occasionally able to get assistance, but Smith could only get a limited amount per year.

"I had to choose (between) feeding my kids or getting my medicine," Smith said. "So I chose to feed my kids."

The uninsured rate for people living below 138% of the federal poverty line dropped by 62% between 2012 and 2023 due to the expansion of Medicaid in 2014, according to the Health Policy Institute of Ohio, as Medicaid membership increased by 61% between 2012 and 2023.

When Smith eventually found out she had thyroid cancer, she was able to get on Medicaid, which paid for her surgery and cancer treatments.

"I went through all that, and then they found out that my heart, I was going into a heart failure for not having any kind of medical (care)," Smith said. "And so after that, I got a case manager with CareSource, and they've been helping me ever since."

Medicaid, which she gets through a managed care plan with the Dayton-based health insurer CareSource, provides her access to annual visits with a nurse and access to medication she has to take consistently in order to treat her heart conditions, she said. Smith was also able to get a wheelchair through Medicaid, as well as physical therapy after she had a heart attack.

Smith, who wouldn't be subject to work requirements due to being over 55 years old, still maintains a job. She avoids going on disability through Social Security due to the amount of work it takes to get on disability and maintain access, despite her doctors wanting her to pursue disability coverage.

"They (Smith's doctors) want me to get Social Security disability ... and I told them when I'm in a coffin, I'll apply," Smith said.

If Smith were to work more and earn more money, commercial health insurance through an employer would be too expensive for her to get access to treatment and her medications with monthly premiums, copays and deductibles, she said.

Work requirements

To qualify for Medicaid, a family must be at the federal poverty level ($32,150 for a family of four) and meet other qualifying conditions. Medicaid expansion expands eligibility to up to 138% of the federal poverty level ($44,367 for a family of four).

Ohio Republican leaders want to require everyone covered under the expansion to be employed or be in school or job training. The proposal has exceptions such as age, disability and being in a drug treatment program. Individuals with household earned income will be presumed to be employed, the state said in its final application to the federal government.

In 2023, an estimated 46.8% of Ohioans 19 to 65 years old living up to 138% of the federal poverty level were employed, according to the most recent data available from the Ohio Medicaid Assessment Survey.

"I believe that reinstating the work requirements instead would mean that at least 61,000 Ohioans will gain the work experience and/or training they need to become financially independent and a contributor to Ohio rather than a burden to the system," said state Sen. Kyle Koehler, R-Springfield, in his sponsor testimony of Senate Concurrent Resolution 5, which is a resolution urging President Donald Trump to support Ohio's effort to install the work requirement.

"We are doing these individuals a disservice by providing health care services without asking them for at least a minimum of 80 hours of employment, education or job skills training as a condition of continued Medicaid eligibility," Koehler said.

The last time Ohio sought to implement work requirements was during President Donald Trump's first term before the Biden administration scrapped the proposal.

'I would have given up'

Bailey Miller, of Middletown, was working full-time when she experienced mysterious health symptoms.

"I had encountered difficulties working and had to move home with my parents and had, over the years leading up to that, kind of faced a lot of mysterious symptoms that were just interfering with my life and making it hard to work full-time," Miller said.

Miller, now 30, was doing well and working full-time in her early 20s, she said, before she started to have health complications at around 2018.

"I was in college, I graduated from Miami University and then I worked full-time at a tech company for three years and was insured by my company and was relatively healthy and capable," Miller said.

Miller applied for Medicaid in 2020, just before the COVID-19 pandemic, due to her health symptoms that ranged from neurological symptoms and changes in memory to back pain.

Miller later found out she an undiagnosed disease for about six years, she said, along with a cluster of other rare health conditions that weren't diagnosed until last year.

The symptoms Miller experienced went on for about six years, which took a lot of work to find the right explanations, diagnoses and treatments.

That took her from being an independent person in her 20s to having to rely on her family for food and to rely on Medicaid to help pay for the doctor visits and treatments, like neurosurgery.

"When people like me have a rare disease, it's very common to face those very long diagnostic processes," Miller said.

If Miller hadn't had access to health insurance through Medicaid, she would have had limited options to pay for her health care, such as relying on family members, paying for a Marketplace plan or going into debt, she said.

"I think I would have given up," Miller said.

The potential implementation of work requirements for the Medicaid expansion group is concerning to Miller. Even with an exemption for people with a disability, proving they are sick enough not to have a job could be time-consuming or burdensome.

"If we want people to have to earn Medicaid by working, that's only going to work for healthy people," Miller said.

Medicaid expansion

The federal government covers about 69% of Ohio's total Medicaid program, which provides health care to 26% of Ohioans, according to the Health Policy Institute of Ohio.

In state fiscal year 2024, federal and state expenditures on Medicaid were nearly $39 billion, according to Ohio Medicaid Budget Variance reports. The expansion group cost nearly $6.1 billion, which was about 15.7% of Ohio Medicaid's budget in fiscal year 2024.

Between 7.3% and 11.7% of residents in Montgomery and Clark counties are part of the Medicaid expansion group, according to estimates from the Health Policy Institute of Ohio. Butler County is estimated to be between 5.7-7.2%.

While politicians debate whether or not cuts to Medicaid will happen under the Republicans' goal of $4.5 trillion in tax cuts over the next decade, analysts say the math doesn't add up without cuts to Medicaid.

The U.S. House Committee on Energy and Commerce has to find a way to cut the deficit by at least $880 billion over the next decade, but, excluding Medicare, Medicaid accounts for 93% of the funds that committee manages, according to the Congressional Budget Office.

If the committee cuts all of its programs besides Medicare, Medicaid and the Children's Health Insurance Program (CHIP), those cuts only add up to $381 billion. If Medicare cuts are off the table, big cuts to Medicaid will be needed to achieve $880 billion in savings, according to KFF, health policy research organization.

Republicans in Congress have reiterated commitments to social services like Medicare and Medicaid, saying they believe they can make up for those cuts by cutting government waste.

"The White House has made a commitment. The president said over and over and over, 'We're not going to touch Social Security, Medicare or Medicaid.' We've made the same commitment," said House Speaker Mike Johnson last month on CNN.

'I'd be dead'

For many years, Jeffers-Tracy paid out of pocket for her health care and also used the Health Care Marketplace.

"When I got on the health care marketplace, I found out that what I was paying per month, the government was putting in twice that for me in addition to what I was paying," said Jeffers-Tracy. "So the for-profit insurance company was getting three times the amount I was paying total for me every month, and yet I still had co-pays and deductibles."

The deductibles and co-pays were disincentives to using the coverage she was paying for, she said.

When she was seeking help for chest pains one day, she collapsed at her doctor's office, who helped her find access to more affordable care through Medicaid.

"My heart stopped during the treadmill stress test. I had a near death experience — with visions and everything — and revived just as they were wheeling the crash cart up next to me," Jeffers-Tracy said. "I heard a nurse say, 'She's back!'"

Medicaid paid for Jeffers-Tracy's heart stents.

"I'd be dead. I wouldn't be here, for sure, if I had not been able to access it and if they (her doctor's office) hadn't found out that I qualified for it," Jeffers-Tracy said.

An investment

Jeffers-Tracy was able to get on Medicaid after Ohio expanded access. She was still working. She is a librarian at the Fairborn Community Library, as well as a climate science educator.

"I had to reduce my hours at work when the care of a family member with Parkinson's required more of my time," said Jeffers-Tracy, who was also a single mother and is now a grandmother. This means the state was not paying for the care of her family member.

"I benefited, but I also saved society money," Jeffers-Tracy said.

For Smith, Medicaid means she gets access to the care and medications that keep her alive so she can be in the lives of her children and grandchildren, whom she helps take care of and support.

"I know my life may not be important to other people, but I have six grandkids and two sons, and two of my daughters died from COVID three weeks apart," Smith said.

For some, like those in Miller's position, the ability to access Medicaid was a government investment into their lives, allowing them to pay back that investment with future contributions to society.

"The investment that was made in helping me get these answers, in this time period, even though it was a lot of work and a lot of money for what Medicaid paid for ... it paid off," Miller said.

Now, Miller is going back to graduate school.

"I'm working towards a career where I feel like I can really make a difference," Miller said.

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