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00:00:01>> SUPPORT FOR THE STATEWIDE
BROADCAST OF THE STATE OF OHIO
00:00:08COMES FROM THE LAW OFFICES OF
PORTER, WRIGHT, MORRIS AND
00:00:10ARTHUR, LLP. HELPING BUSINESS
AND INDIVIDUAL SOLVE COMPLEX
00:00:17LEGAL PROBLEMS IN OHIO, ACROSS
THE COUNTRY AND AROUND THE
00:00:21WORLD.
AND FROM THE OHIO EDUCATION
00:00:23ASSOCIATION, REPRESENTING
120,000 MEMBERS, WHO WORK TO
00:00:24INSPIRER THEIR STUDENTS TO THINK
CREATIVELY AND EXPERIENCE THE
00:00:28JOY OF LEARNING.
KAREN: THE MARCH 15 PRIMARY IS
00:00:33MORE THAN THREE WEEKS AWAY, BUT
VOTING IS UNDERWAY.
00:00:38AND A PROPOSAL TO REQUIRE AS
MANY AS A MILLION PEOPLE ON
00:00:41MEDICAID IN OHIO TO PAY SMALL
PREMIUMS FOR THAT COVERAGE IS
00:00:43BEING TOUTED AS BOTH A GREAT
IDEA TO BUILD RESPONSIBILITY AND
00:00:47SAVE MONEY, AND A RISKY AND
UNFAIR BURDEN ON SOME OF OHIO'S
00:00:49POOREST PEOPLE. WE'LL TALK OVER
THE PROS AND CONS.
00:00:52ALL THIS WEEK IN "THE STATE OF
OHIO".
00:00:59THE MARCH 15 PRIMARY IS UNDERWAY
WITH THE START OF EARLY VOTING
00:01:06THIS WEEK.
OHIOANS CAN VOTE BY MAIL OR IN
00:01:10PERSON UP UNTIL ELECTION DAY,
THAT INCLUDES TWO SATURDAYS AND
00:01:11A SUNDAY. REPUBLICAN SECRETARY
OF STATE JON HUSTED SAYS VOTERS
00:01:15IN 82 OF THE STATE'S 88 COUNTIES
WILL HELP DECIDE THE OUTCOME OF
00:01:22465 LOCAL ISSUES.
THERE HASN'T BEEN ANY POLLING IN
00:01:25THE PRESIDENTIAL CAMPAIGNS IN
OHIO SINCE LAST FALL.
00:01:27SPEAKING OF PRESIDENTIAL
CANDIDATES, BOTH OF THE
00:01:32DEMOCRATIC LEADERS WILL BE AT
THE SAME EVENT TWO DAYS BEFORE
00:01:34THE PRIMARY. THE OHIO DEMOCRATIC
PARTY SAYS HILLARY CLINTON AND
00:01:36BERNIE SANDERS WILL HEADLINE THE
ANNUAL LEGACY DINNER ON SUNDAY,
00:01:39MARCH 13.
A LAWMAKER SAYS HE WANTS TO
00:01:44PROTECT STUDENTS OF ALL FAITHS
WITH A BILL THAT WOULD PUT
00:01:47FREEDOM OF RELIGIOUS EXPRESSION
IN SCHOOLS INTO STATE LAW. THE
00:01:50BILL WOULD REQUIRE SCHOOLS THAT
ALLOW SECULAR CLUBS AND
00:01:53ACTIVITIES ON CAMPUS TO PROVIDE
THE SAME OPPORTUNITIES TO ALL
00:02:02STUDENT RELIGIOUS GROUPS.
AND REPUBLICAN REP. BILL HAYES
00:02:03OF GRANVILLE SAYS IT WOULD
PROTECT STUDENTS WHO WANT TO
00:02:05WEAR RELIGIOUS CLOTHING AND
JEWELRY, AND USE RELIGIOUS
00:02:07EXPRESSION IN HOMEWORK, ARTWORK
AND OTHER ASSIGNMENTS.
00:02:12HAYES SAYS HE'S WORRIED THAT
SOME STUDENTS MIGHT BE SUFFERING
00:02:16BECAUSE SCHOOLS FEAR LAWSUITS.
THERE ARE PROTECTIONS FOR
00:02:17RELIGIOUS EXPRESSION IN FEDERAL
LAW, BUT HAYES SAYS THIS STATE
00:02:19LAW WOULD CLARIFY STUDENTS'
RIGHTS.
00:02:21THE BILL COULD GO TO THE HOUSE
FOR A VOTE NEXT WEEK.
00:02:23ANOTHER BILL UNDER CONSIDERATION
WOULD GIVE TOWNSHIPS THE POWER
00:02:27TO MAKE LAWS TO REQUIRE
SIDEWALKS TO BE SHOVELED.
00:02:31REPUBLICAN REP. TIM BROWN OF
BOWLING GREEN SAYS IT'S NOT FAIR
00:02:33TO TOWNSHIP RESIDENTS WHEN LOCAL
LEADERS CAN'T REQUIRE HOMEOWNERS
00:02:42SHOVEL SNOW OF THEIR SIDEWALKS
SINCE PEOPLE WHO LIVE IN
00:02:45, TOWNSHIPS HAVE THE SAME NEEDS
AS THOSE WHO LIVE ON A CITY
00:02:46BLOCK.
BROWN SAYS HIS BILL WOULD ALLOW
00:02:50TOWNSHIPS TO PASS LAWS TO
REQUIRE RESIDENTS TO SHOVEL
00:02:51SIDEWALKS IF THEY DETERMINE IT'S
IN THE BEST INTEREST OF THE
00:02:52COMMUNITY.
TWO EMPLOYEES HAVE BEEN FIRED BY
00:02:57THE OHIO ENVIRONMENTAL
PROTECTION AGENCY AND A THIRD
00:02:58HAS BEEN DEMOTED OVER THEIR
HANDLING OF LEAD CONTAMINATION
00:03:00IN A VILLAGE'S DRINKING WATER.
THE STATE EPA SAYS THE
00:03:03DISCIPLINARY ACTION IS THE
RESULT OF AN INTERNAL
00:03:06INVESTIGATION INTO WHY IT TOOK
MONTHS FOR THE AGENCY'S TOP
00:03:09ADMINISTRATORS TO FIND OUT ABOUT
HIGH LEAD LEVELS IN SEBRING IN
00:03:16MAHONING COUNTY.
STATE ENVIRONMENTAL OFFICIALS
00:03:18HAVE SAID THE OPERATOR OF
SEBRING'S WATER PLANT WAITED
00:03:19MONTHS TO NOTIFY PEOPLE ABOUT
HIGH LEAD READINGS.
00:03:26MEDICAID IS THE BIGGEST THING IN
THE STATE BUDGET, AROUND $3
00:03:34BILLION.
SINCE GOV. JOHN KASICH EXPANDED
00:03:35MEDICAID TO PEOPLE UP TO MAKING
UP TO 138 PERCENT OF THE FEDERAL
00:03:37POVERTY LEVEL WHICH IS $27,310
, FOR THE AVERAGE FAMILY OF
00:03:44THREE, 650,000 PEOPLE HAVE
ENROLLED IN MEDICAID. THAT
00:03:46BRINGS TO JUST UNDER THREE
MILLION THE NUMBER OF OHIOANS
00:03:48WHO ARE ON MEDICAID.
THE REPUBLICAN CONTROLLED
00:03:51LEGISLATURE HAD SERIOUS CONCERNS
ABOUT MEDICAID EXPANSION, BUT
00:03:53DIDN'T TRY TO OVERRIDE IT IN THE
STATE BUDGET.
00:03:58INSTEAD, LAWMAKERS PUSHED A PLAN
TO DEMAND SMALL PREMIUMS FROM
00:04:00NON-DISABLED RECIPIENTS AS PART
OF THEIR PARTICIPATION IN THE
00:04:04PROGRAM.
IF IT'S APPROVED BY THE FEDS,
00:04:05THE PLAN WOULD REQUIRE PAYMENTS
INTO HEALTH SAVINGS ACCOUNTS
00:04:08THAT ADD UP TO 2% OF A HOUSEHOLD
INCOME, UP TO $99 A YEAR, WHICH
00:04:16COMES OUT TO ABOUT $8.25 A
MONTH.
00:04:17IF PREMIUMS ARE TWO MONTHS LATE,
COVERAGE WOULD BE SUSPENDED
00:04:19UNLESS THE RECIPIENT IS
PREGNANT.
00:04:21BUT NONE OF THIS GOES FORWARD
WITHOUT A WAIVER FROM THE
00:04:23FEDERAL GOVERNMENT TO ALLOW THE
STATE TO CHARGE THESE PREMIUMS
00:04:26AND MAKE CHANGES TO THE MEDICAID
PROGRAM.
00:04:30THE WAIVER SUBMISSION INCLUDES
THE ELEMENTS THAT STATE
00:04:32LAWMAKERS CAME UP WITH IN THE
BUDGET.
00:04:34AND IT'S ALMOST READY TO GO, BUT
IT WON'T UNTIL AFTER A 30 DAY
00:04:41PUBLIC COMMENT PERIOD.
AND THOSE PUBLIC COMMENTS WON'T
00:04:44--AND CAN'T -- MAKE MUCH OF A
DIFFERENCE IN THE STATE'S
00:04:52REQUEST TO THE FEDS.
A SPOKESMAN FOR OHIO MEDICAID
00:04:54SAID IN A WRITTEN STATEMENT, AS
IS REQUIRED BY LEGISLATIVE
00:05:00CHANGES INCLUDED IN LAST YEAR'S
BUDGET BILL, OHIO MEDICAID IS
00:05:02PREPARING THE WAIVER PROPOSAL
FOR SUBMISSION TO OUR FEDERAL
00:05:03COUNTERPARTS. THE LEGISLATIVE
LANGUAGE IS VERY PRESCRIPTIVE AS
00:05:04TO WHAT IS INCLUDED IN THE
WAIVER SUBMISSION, AND WE ARE
00:05:06FOLLOWING WHAT WAS SPECIFIED. WE
EXPECT TO HAVE ADDITIONAL
00:05:09UPDATES IN THE SPRING.
THE WAIVER IDEA CAME OUT OF
00:05:13REPUBLICAN CONCERNS ABOUT
MEDICAID EXPANSION.
00:05:14REP. JIM BUTLER OF DAYTON WAS ON
THIS SHOW IN SEPTEMBER TALKING
00:05:17ABOUT THE PROPOSAL TO REQUIRE
PREMIUMS.
00:05:23HE SAID THAT THE MEDICAID
PROGRAM NEEDS REFORM, AND
00:05:25POINTED TO SOME EVIDENCE THAT
REQUIRING PREMIUMS CAN CUT
00:05:30COSTS.
AND SUPPORTERS SAY SINCE HALF OF
00:05:31THOSE WHO ENROLLED THROUGH
MEDICAID EXPANSION ARE WORKING,
00:05:33IT'S NOT OUTRAGEOUS TO SUGGEST
RECIPIENTS PAY SMALL PREMIUMS.
00:05:35THE PRACTICE, THEY SAY, CAN HELP
RECIPIENTS GET USED TO PAYING
00:05:40FOR THEIR HEALTH INSURANCE,
WHICH THEY WOULD HAVE TO DO WHEN
00:05:42THEY ARE NO LONGER ON MEDICAID.
BUT OPPONENTS SAY PEOPLE WHO ARE
00:05:46IN THESE FINANCIAL CIRCUMSTANCES
ARE ALREADY STRUGGLING WITH THE
00:05:49BILLS THEY HAVE, AND THE PREMIUM
REQUIREMENT COULD MEAN
00:05:51ENROLLMENT WOULD DROP BY AS MUCH
AS 15%.
00:05:56AND THEY SAY SUSPENDING MEDICAID
FOR THOSE WITH LATE PAYMENT
00:06:00WOULD MEAN INTERRUPTIONS IN CARE
FOR PEOPLE WHO NEED TO DEAL WITH
00:06:01CHRONIC HEALTH CONDITIONS AND
MENTAL HEALTH ISSUES.
00:06:06HERE TO GO OVER THE PROS AND
CONS OF THIS PLAN ARE TWO
00:06:09EXPERTS IN MEDICAID.
JOHN CORLETT WAS THE STATE
00:06:11MEDICAID DIRECTOR UNDER
DEMOCRATIC FORMER GOV. TED
00:06:14STRICKLAND.
HE NOW IS THE PRESIDENT AND
00:06:16EXECUTIVE DIRECTOR OF THE CENTER
FOR COMMUNITY SOLUTIONS, A
00:06:17RESEARCH ORGANIZATION
HEADQUARTERED IN CLEVELAND.
00:06:21GREG LAWSON WRITES EXTENSIVELY
ABOUT MEDICAID AS THE STATEHOUSE
00:06:23LIAISON AND POLICY ANALYST AT
THE BUCKEYE INSTITUTE, WHICH
00:06:24DESCRIBES ITSELF AS A FREE
MARKET THINK TANK.
00:06:32THANK YOU BOTH FOR BEING HERE.
I APPRECIATE IT VERY MUCH.
00:06:33LET ME START WITH YOU, JOHN.
THIS WAIVER NEEDS TO BE APPLIED
00:06:39FOR, THERE'S A PROCESS THAT GOES
WITH THIS IN TERMS OF GETTING
00:06:43PUBLIC COMMENT AND APPLYING FOR
IT WHICH HAS NOT STARTED YET.
00:06:46THE FEDERAL GOVERNMENT HAS
UPLOAD -- APPROVED SIMILAR PLANS
00:06:53IN OTHER STATES.
MEDICAID IS THE PAC-MAN OF THIS
00:06:59BUDGET.
WHAT IS THE PROBLEM WITH ASKING
00:07:11PEOPLE WHO ARE BENEFITING FROM
IT TO START PAYING INTO THAT AND
00:07:13HELPING TO FRY SOME OF THE COST
OF THAT?
00:07:14JOHN: WHAT WE KNOW FROM
EXPERIENCE IN OTHER STATES IS
00:07:19THEY HAVE SEEN LARGE NUMBERS OF
PEOPLE DROP OFF THE PROGRAM.
00:07:22SOME OF IT IS BECAUSE -- THIS IS
A BUREAUCRATS DREAM IN TERMS OF
00:07:27WHAT THIS PROPOSAL ENTAILS.
IT CREATES THESE ACCOUNTS, IT
00:07:32REQUIRES A CERTAIN PERCENTAGE OF
THE ACCOUNT TO GO FOR THIS, TO
00:07:34GO FOR THAT.
THEY GET POINTS, ALMOST LIKE A
00:07:39GROCERY REWARDS CARD.
FROM MY PERSPECTIVE, WHAT THE
00:07:45GOVERNOR PUT FORTH ORIGINALLY IN
TERMS OF MEDICAID EXPANSION
00:07:50REALLY HAS WORKED VERY WELL.
THE COSTS HAVE COME IN UNDER
00:07:54BUDGET.
WE HAVE COVERED A LARGE NUMBER
00:07:56OF PEOPLE.
IT HAS STABILIZE THE HEALTH CARE
00:08:00MARKET.
WE'VE HAD GOOD RESULTS IN TERMS
00:08:04OF PEOPLE'S HEALTH.
I WOULD ASK THE QUESTION, WHY
00:08:10ARE WE DOING THIS.
IF IT IS TO SAVE MONEY, I THINK
00:08:15THERE'S OTHER THINGS WE MIGHT
THINK ABOUT THAT MIGHT HAVE THE
00:08:17EFFECT OF SAVING NORMALLY.
THIS PROGRAM WOULD COST MORE TO
00:08:20IMPLEMENT.
ARKANSAS AT ONE POINT WAS
00:08:25COLLECTING PREMIUMS FROM THOSE
BELOW 100% AND STOPPED DOING IT
00:08:29BECAUSE IT COSTS THEM MORE MONEY
TO COLLECT IT.
00:08:30THAT MAY BE A REFLECTION OF HOW
GOVERNMENT WORKS, THAT -- I
00:08:36GUESS I WOULD ASK THE QUESTION,
WHY ARE WE DOING THIS AND ARE
00:08:40THERE OTHER THINGS WE COULD DO
THAT MIGHT ENCOURAGE MORE
00:08:44PERSONAL RESPONSIBILITY, THE MAY
ENCOURAGE MORE PERSONAL
00:08:47ENGAGEMENT WITH A PERSON'S
HEALTH CARE.
00:08:48KAREN: LET ME START WITH THE
GREG, THIS BUREAUCRATS NIGHTMARE
00:08:53YOU JUST HEARD FROM JOHN, THIS
HAS THE POTENTIAL TO BE AN
00:08:57ADMINISTRATIVE DISASTER IN SOME
RESPECTS BECAUSE THERE ARE SO
00:09:00MANY MOVING PARTS HERE.
THERE WOULD NEED TO BE PEOPLE
00:09:04WHO MANAGE THE COLLECTION,
MANAGEMENT WHERE IT GOES.
00:09:06WHY DO THIS IF IT COULD
POTENTIALLY COST MORE MONEY THAN
00:09:09IT IS WORTH?
GREG: IT IS COMPLICATED.
00:09:12WE HAVE A CONCERN ABOUT THAT
TRADE WHENEVER YOU DEAL WITH
00:09:19SOMETHING LIKE THIS -- AND THIS
IS PROBABLY MORE COMPLICATED
00:09:22THAN ANYTHING THAT HAS BEEN
TRIED IN THE OTHER STATES IN
00:09:26TERMS OF HOW IT IS OPERATIONALLY
DONE AND SOME OF THE
00:09:29RAMIFICATIONS THERE.
BUT WE BELIEVE VERY STRONGLY
00:09:32THAT THERE HAS TO BE THAT
ELEMENT OF PERSONAL
00:09:35RESPONSIBILITY.
THERE'S ALSO ASPECTS WHERE THEY
00:09:38WILL BE TRAINED TO DIRECT
INDIVIDUALS WHO MAY NOT BE
00:09:40EMPLOYED TO EMPLOYMENT OFFICES
AND THINGS LIKE THAT TO TRY TO
00:09:44GET THEM BETTER CONNECTED TO
OPPORTUNITIES.
00:09:45THIS WAS OUR CONCERN DURING THE
MEDICAID EXPANSION DEBATE.
00:09:50WE DISAGREED WITH IT.
WE WERE VERY VOCAL ABOUT THAT.
00:09:55WE ALWAYS MAINTAIN WE WOULD HAVE
SUPPORTED -- I THINK WE MAY
00:10:03TALKED ABOUT IT AT SOME POINT ON
THIS SHOW.
00:10:08THIS ISN'T THAT, BUT IT GETS US
CLOSER TO SOMETHING IN THAT
00:10:10WHEELHOUSE AND IT BRINGS ABOUT
THAT RESPONSIBILITY.
00:10:15IT ISN'T A GREAT AMOUNT OF MONEY
FOR INDIVIDUALS TO BE ABLE TO
00:10:17PUT ASIDE, EIGHT DOLLARS A
MONTH.
00:10:18IT IS THE LESSER OF 2% OF THE
INCOME OR $99.
00:10:23IT CAN BE LESS THAN THAT.
BUT THERE IS TEETH.
00:10:29I FIGURE THAT JOHN PROBABLY
ISN'T A BIG FAN OF THAT AND I
00:10:37KNOW THERE ARE CONCERNS OVER THE
QUALITY OF CARE AND CONTINUITY
00:10:40OF CARE THAT IS THERE.
WE ARE A FREE MARKET
00:10:45ORGANIZATION.
WE BELIEVE WE HAVE TO HAVE
00:10:46RESPONSIBILITY AND FOLKS WHO
HAVE NEVER BEEN IN THIS BEFORE,
00:10:50WHEN THEY START MOVING UP AND
OUT OF THE MEDICAID SITUATION,
00:10:55THEY ARE GOING TO BE GOING INTO
AN EXCHANGE.
00:10:57THEY WILL PROBABLY BE GETTING A
HEAVILY SUBSIDIZED PRODUCT IN
00:11:02THE EXCHANGE, BUT AT SOME POINT
THERE ARE GOING TO BE PEERMAN --
00:11:05THERE ARE GOING TO BE PREMIUMS.
THIS TRAINING ASPECT TO SOME
00:11:11EXTENT OF GETTING PEOPLE TO
UNDERSTAND WHO MAY HAVE HAD THAT
00:11:13EXPERIENCE BEFORE WE THINK
POTENTIALLY HAVE A BENEFIT.
00:11:18YOU SEE SOME STATES SAVING
MONEY.
00:11:22IS IT PARTLY BECAUSE OF
DISENROLLMENT?
00:11:23YES.
I THINK WE HAVE TO ASK OURSELVES
00:11:28THE QUESTION IN PARTICULAR
RELATED TO THE EXPANSION
00:11:30POPULATION, ALTHOUGH THIS IS
BROADER THAN THE EXPANSION
00:11:33POPULATION.
AND WE ARE WAY OVER WHAT WE
00:11:35INITIALLY ANTICIPATED.
WE ARE WELL OVER IN TERMS OF THE
00:11:39EXPENSE OF THAT PORTION.
THERE'S A LOT OF NUANCE TO THAT.
00:11:45WE ARE GOING TO BE PICKING UP
COSTS OUT OF THE STATE TAXPAYER
00:11:52SHARE.
WE'VE GOT TO BE ABLE TO TAKE
00:11:56CONTROL OF THAT AND GET
COST-CONTAINMENT IN THAT
00:11:58POPULATION THE FOUR WE START
HAVING TO FOOT THE BILL.
00:12:00KAREN: I'M WONDERING HOW WE DO
THAT ON SUCH A LOW DOLLAR AMOUNT
00:12:03OR IT IT IS A LOW DOLLAR AMOUNT.
IT'S NOT A LOT FOR PEOPLE IN
00:12:10TERMS OF WHAT THEY RECEIVE FOR
THAT LOW DOLLAR AMOUNT.
00:12:12WHY NOT USE THIS AS AN
OPPORTUNITY TO TEACH PEOPLE WHO
00:12:18HOPEFULLY WILL EVENTUALLY NEED
MEDICAID TO GO INTO THE EXCHANGE
00:12:23OR FIND OTHER HEALTH INSURANCE?
>> MOST PEOPLE ARE NOT ON
00:12:30MEDICAID FOREVER, UNLESS THEY
ARE DISABLED.
00:12:35CHILDREN TEND TO BE ON THEM
LONGER UNTIL THEY ARE ADULTS.
00:12:37BUT PEOPLE ARE NOT ON MEDICAID
FOR A LONG TIME.
00:12:39THIS PREMIUM PAYMENT CAN ALSO BE
PAID BY A THIRD PARTY, UP TO 75%
00:12:47OF IT.
TO GREG'S POINT EARLIER, ONE OF
00:12:54THE THINGS THIS PROPOSAL WILL DO
-- THERE WILL BE A LOT OF
00:12:59CHURNING, FOLKS MOVING ON AND
OFF.
00:12:59IT DOESN'T DO ANYTHING TO
PROMOTE CONTINUITY OF CARE.
00:13:05IT CREATES A LOT OF
ADMINISTRATIVE COST, AND I'M NOT
00:13:10SURE THAT BECAUSE WHAT WILL
HAPPEN IS THAT PERSON WHO GOT
00:13:12LOCKED OUT OF THE PROGRAM SHOWS
UP AT OSU MEDICAL CENTER FOR A
00:13:17TREATMENT, THEY FIND OUT THEY
ARE MEDICAID ELIGIBLE, THEY WILL
00:13:21SAY, WE WILL HELP YOU PAY YOUR
BACK PREMIUM BECAUSE WE WANT TO
00:13:25MAKE SURE WE GET PAID BY THE
MEDICAID PROGRAM.
00:13:26I DON'T KNOW WHAT THAT
ACCOMPLISHES OTHER THAN IT JUST
00:13:30REQUIRES A LOT OF ADMINISTRATIVE
WORK.
00:13:31I'M NOT SURE IT ACCOMPLISHES
ANYTHING.
00:13:34WE DO HAVE TO FIGURE OUT WAYS TO
MAKE THIS PROGRAM MORE
00:13:40SUSTAINABLE.
WE ARE GOING AFTER THE EASY SIDE
00:13:45OF THE LEDGER ON THIS, AND IT'S
A TRUISM IN MEDICAID THAT IF YOU
00:13:49WANT TO SAVE MONEY YOU HAVE TO
GO WHERE IT IS SPENT.
00:13:51THAT IS IN HOSPITALS, SKILLED
NURSING FACILITIES, AND
00:13:57PHARMACEUTICALS.
WE SHOULD BE LOOKING TO FIND
00:14:00WHERE WE CAN FIND ECONOMY.
KAREN: YOU TALKED ABOUT
00:14:04CONTINUITY OF CARE.
POLICY MATTERS OHIO SAYS NEARLY
00:14:1070% OF THOSE ON MEDICAID HAVE
CHRONIC PHYSICAL DISORDERS.
00:14:1142% NEED BEHAVIORAL HEALTH
TREATMENT.
00:14:15IF THAT CARE IS INTERRUPTED, IT
CAN SET THOSE PEOPLE THAT TO THE
00:14:19POINT WHERE THEY WOULD NOT HAVE
THE BENEFITS OF MEDICAID
00:14:21EXPANSION IN TERMS OF THEY ARE
BACK TO HEALTH, BACK TO WORK.
00:14:25WHY PUT THAT AT RISK?
>> THE ISSUE COMES DOWN TO WHAT
00:14:29IS YOUR VIEW OF WHAT WE CAN DO
THROUGH GOVERNMENT.
00:14:31CAN GOVERNMENT PLAY THIS TYPE OF
A ROLE?
00:14:33THIS IS A RATHER PATERNALISTIC
TYPE OF APPROACH TO THINGS
00:14:39BECAUSE YOU ARE ESSENTIALLY
SAYING WE HAVE A GOVERNMENT
00:14:42BENEFIT OF SOME KIND THAT IS
THERE.
00:14:43WE RUN THE RISK OF TAKING AWAY A
BENEFIT.
00:14:46I THINK WE REALLY SHOULD HAVE
HOPEFULLY OVER TIME A HIGHER
00:14:50ASPIRATION FOR INDIVIDUALS, THEN
TO HAVE THAT TYPE OF A VIEW THAT
00:14:56ONLY GOVERNMENT CAN DO THIS.
THERE ARE OTHER THINGS.
00:14:57IF YOU WERE TO GET GOVERNMENT
OUT OF A LOT OF DIFFERENT AREAS,
00:15:05WE THINK THERE'S ALSO A ROLE FOR
NONPROFITS AND CHARITABLE
00:15:11ORGANIZATIONS AND THINGS LIKE
THAT.
00:15:12HOSPITALS, CONTRARY TO THEIR
PROTESTATIONS DURING THE
00:15:16MEDICARE DEBATE, THEY OFFER A
LOT OF CHARITY CARE.
00:15:20SOME NONPROFIT HAS TO OFFER A
CERTAIN LEVEL OF CHARITY CARE TO
00:15:24MAINTAIN THEIR NONPROFIT STATUS.
WE LOOK AT WHERE YOU CAN GET
00:15:28THOSE THINGS, AND IT IS STILL
AVAILABLE.
00:15:29THERE ARE OTHER MECHANISMS.
WE THINK THOSE SHOULD BE MADE
00:15:41MORE ROBUST SO THERE IS A
PRIVATE AND CHARITABLE SIDE OF
00:15:45THINGS RATHER THAN ALWAYS HAVING
THE GOVERNMENT STEPPING IN AND
00:15:47DOING IT ALL.
THE WAY THIS WAS STRUCTURED,
00:15:52THERE WERE A FEW FUNNY THINGS.
I CAN TOTALLY SEE THAT SITUATION
00:15:56EXACTLY AS YOU DESCRIBED.
THAT DOES RAISE THE QUESTION OF
00:16:01WHETHER OR NOT THAT WAS MAYBE
THE BEST ASPECT OF PROVISIONS TO
00:16:04PUT INTO THEIR.
I'M NOT SURE WE LOVE THAT
00:16:07PARTICULAR IDEA QUITE AS MUCH.
THAT REDUCES THAT THING WE WANT
00:16:11TO ACCOMPLISH BY GETTING PEOPLE
TO PUT SKIN IN THE GAME AND IT
00:16:13IS WHAT IT IS.
KAREN: I WANT TO TALK ABOUT
00:16:20INCENTIVE PROGRAMS.
YOU QUIT SMOKING, YOU GET AN
00:16:26INCENTIVE.
YOU LOWER YOUR BLOOD PRESSURE --
00:16:28IN THIS PROGRAM, IT WOULD ALSO
ADD POINTS IF YOU GO TO AN
00:16:32EMERGENCY ROOM FOR A
NONEMERGENCY PURPOSE.
00:16:33IF OTHER INSURANCE COMPANIES DO
THAT, WHY NOT THIS PROGRAM?
00:16:37>> IT OFFERS POINTS IF SOMEONE
SETS UP AN ELECTRONIC FUNDS
00:16:43TRANSFER ARRANGEMENT TO PAY
THEIR PREMIUM ELECTRONICALLY.
00:16:45IGNORES THE FACT -- A LARGE
PERCENTAGE DON'T HAVE BANK
00:16:50ACCOUNTS.
TO BE HONEST, I THINK ON THESE
00:16:57POINTS, THINK THE JURY IS OUT ON
WHETHER THOSE DO ANYTHING,
00:17:04WHETHER THEY IMPROVE ANYBODY'S
HEALTH OR LOWER COST.
00:17:06I DON'T THINK THERE'S A LOT OF
EVIDENCE TO SUGGEST THAT THEY
00:17:08DO.
KAREN: EMPLOYERS ARE TRYING TO
00:17:11DECIDE IF THEY ARE WORTHWHILE.
>> IF I CAN DO ONE THING ABOUT
00:17:20MEDICAID, ONE OF THE THINGS I
FOCUS ON IS REDUCING SMOKING.
00:17:25WHAT CAN WE DO TO REDUCE THE
NUMBER OF PEOPLE ON MEDICAID WHO
00:17:28SMOKE?
WHAT POLICY CHANGES CAN WE MAKE
00:17:32SO THAT WE ENCOURAGE PEOPLE TO
QUIT SMOKING, AND IT WOULD HAVE
00:17:38A SIGNIFICANT IMPACT ON COST AND
WELL-BEING?
00:17:40KAREN: WHAT ABOUT RAISING THE
CIGARETTE TAX?
00:17:43>> IT'S MORE IMPORTANT TO MAKE
SURE WE ARE PROVIDING THE
00:17:48SERVICES THAT WILL GET PEOPLE TO
QUIT AND GET PEOPLE OFF OF
00:17:50SMOKING.
KAREN: THIS SOUNDS LIKE NANNY S
00:18:01TATE TO ME.
>> IT IS.
00:18:06IN A PERFECT WORLD, WE WOULD NOT
BE HAVING THIS CONVERSATION BUT
00:18:12IS IT ANY MORE NANNY STATE OR
PATERNALISTIC -- PATERNALISTIC
00:18:19THAN A STATE THAT PAYS
EVERYTHING, WHICH IS THE CURRENT
00:18:21MEDICAID EXPANSION.
YOU GET IT, YOU ARE ENROLLED,
00:18:26YOU ARE RETROACTIVELY INVOLVED,
THERE IS MARKETING AND
00:18:28BILLBOARDS ENCOURAGING PEOPLE TO
SIGN UP FOR MEDICAID.
00:18:30THIS IS NOT FREE MONEY.
THIS IS FEDERAL TAX DOLLARS.
00:18:36IT IS EITHER FEDERAL TAX DOLLARS
, OR HE COULD BE FEDERAL DEBT
00:18:43MONEY THAT IS PAYING INTO THIS.
THAT'S NOT REALLY FREE.
00:18:49GOVERNMENT IS ALREADY SPENDING A
TON OF MONEY AND PEOPLE ARE
00:18:51ALREADY BEING GIVEN CERTAIN
THINGS.
00:18:52WE CAN ARGUE ABOUT THE MERITS OF
THOSE SERVICES, BUT THAT IS IN A
00:19:03CERTAIN SENSE PATERNALISTIC.
THE FACT THAT YOU CAN'T EXPECT
00:19:07ANYBODY TO PUT ANYTHING IN
THEMSELVES FOR FEAR THAT THEY
00:19:09MAY THEN DROPOUT, AND IF THEY
DROP OUT THAT'S TERRIBLE -- I
00:19:17UNDERSTAND SOME OF THE
CONSEQUENCES OF THAT, BUT IT'S A
00:19:20PHILOSOPHICAL QUESTION.
SHOULD PEOPLE BE ABLE TO PUT
00:19:22SOMETHING IN, EVEN IF IT IS THAT
MINIMAL AMOUNT, AND IS THAT THE
00:19:26PERFECT WAY OF DOING IT?
NO.
00:19:27IT'S A COMPLICATED STRUCTURE.
WE PROBABLY WOULD NOT HAVE
00:19:38CHOSEN TO DO IT THE WAY IT'S
CONSTRUCTED.
00:19:39IN THE CONTEXT OF HAVING
EXPANDED MEDICAID, WE THINK IT
00:19:43IS A BETTER OPTION THAN JUST
GOING WITH THE STATUS QUO.
00:19:45KAREN: GOVERNOR KASICH IN THE
LAST PRESIDENTIAL DEBATE SAID
00:19:51THE STATE MEDICAID PROGRAM IN
ITS SECOND YEAR GREW AT 2.5%,
00:19:56WHICH IS BELOW PROJECTIONS, AND
HE REALLY TOUTED WHAT HE HAS
00:20:00BEEN DONE WITH MEDICAID
EXPANSION.
00:20:01JOHN, ARE THE GOVERNOR'S NUMBERS
RIGHT?
00:20:04WHY MUST THIS BE THE CASE?
IS THIS WHOLE THING WITH THE
00:20:10WAIVER AND ENROLLMENTS THAT
COULD POTENTIALLY RESULT IN
00:20:14DISENROLLMENT -- IS THIS A WAY
TO KEEP MEDICAID NUMBERS LOWER?
00:20:16JOHN: THEY ARE DOING BETTER THAN
THEY PROJECTED IN TERMS OF
00:20:22EXPENDITURES.
THEY ARE FOCUSED ON THE RIGHT
00:20:26THINGS.
AS I SAID EARLIER, IF YOU WANT
00:20:29TO SAVE MONEY IN MEDICAID, YOU
HAVE TO SAVE IT WHERE YOU SPEND
00:20:33IT.
YOU SPEND IT IN HOSPITALS AND
00:20:36SKILLED NURSING FACILITIES AND
PHARMACEUTICAL.
00:20:37THEY WERE AWARDED THE STATE
INNOVATION MODEL GRANT
00:20:40NATIONALLY TO REFRAME OR RESHAPE
THE WAY THEY DO HOSPITALS.
00:20:45THAT WILL HAVE A MUCH MORE
SIGNIFICANT IMPACT ON THE BUDGET
00:20:49OVER THE LONG TERM THAN ANYTHING
PROPOSED IN THIS WAIVER.
00:20:52THAT'S WHERE WE SHOULD BE
FOCUSED.
00:20:53IT IS THE SAME IN MEDICAID, YOU
HAVE TO GO WHERE THE MONEY IS IF
00:21:01YOU WANT TO SAVE IT.
KAREN: WILL THIS BE A WAY TO
00:21:04KEEP THOSE MEDICAID NUMBERS
LOWER?
00:21:05>> I DON'T THINK IT'S
INTENTIONAL.
00:21:07THEY WANT TO ENCOURAGE
RESPONSIBILITY, ENCOURAGE PEOPLE
00:21:14TO BE COVERED.
IT WILL HAVE THAT EFFECT.
00:21:15I THINK 15% REDUCTION IS
PROBABLY CONSERVATIVE.
00:21:19THE EXPERIENCE IN OREGON OVER A
TWO-YEAR PERIOD WHEN THE IMPOSED
00:21:23PREMIUMS WAS AFTER THOSE TWO
YEARS, 73% OF PEOPLE HAD DROPPED
00:21:29OFF THE PROGRAM.
THAT IS A SIGNIFICANT NUMBER.
00:21:34WE HAVE EVIDENCE FROM LAST YEAR
OF THIS MIXUP, HOW MANY PEOPLE
00:21:39WERE TERMINATED FROM THEIR
PROGRAM BOTH PURPOSEFULLY AND
00:21:42ACCIDENTALLY.
KAREN: A LOT OF CONSERVATIVES
00:21:46HAD SAID THAT THIS MEDICAID
EXPANSION WOULD EXPLODE THE
00:21:49MEDICAID BUDGET.
THEY WERE EXPECTING 900,000
00:21:52PEOPLE TO ENROLL.
THESE NUMBERS ARE SUGGESTING
00:21:55THAT THOSE PROJECTIONS WERE OFF.
IS THIS WHOLE PROGRAM A WAY TO
00:21:59KEEP MEDICAID ENROLLMENT NUMBERS
LOW?
00:22:01GREG: I AGREE WITH JOHN.
I DON'T THINK THIS MODIFIED HSA
00:22:06THING IS THAT.
I DON'T THINK IT IS INTENDED TO
00:22:10GIVE -- GET PEOPLE'S SKIN AND
THE GAME, HAVE THEM MOVE UP AND
00:22:16OFF.
THAT IS SOMETHING YOU HEAR A LOT
00:22:17OUT OF THE LEGISLATURE, AND THAT
INVOLVES THESE HEALTH CARE
00:22:23DISCUSSIONS AS WELL AS
EMPLOYMENT OPPORTUNITIES AND
00:22:24EMPLOYMENT TRAINING.
I WANT TO ALSO POINT OUT, THIS
00:22:28ADMINISTRATION DESERVES A GREAT
DEAL OF CREDIT FOR MANAGER IN --
00:22:31FOR MANAGING THE OVERALL BUDGET.
I CAN TELL YOU FIRSTHAND FROM
00:22:39BATTLES IN THAT INDUSTRY WHAT
HAPPENED IN THE LONG-TERM CARE
00:22:41INDUSTRY VERSUS HOME CARE, AND
THE DIFFERENTIAL OF THE PRICES.
00:22:43WHAT GOVERNOR KASICH HAS DONE IS
REMARKABLE.
00:22:48WHAT THE DIRECTOR OF HEALTH
TRANSFORMATIONS HAS DONE IS HER
00:22:53MARKABLE.
A LOT OF THOSE SAVINGS ARE
00:22:55COMING IN FROM THE AGE, BLIND,
DISABLED CATEGORY, WHICH ARE THE
00:23:01FOLKS WHO HAVE ALWAYS BEEN ON
MEDICAID.
00:23:03THERE WAS NEVER REALLY DEBATE
ABOUT THE FACTS THAT THESE FOLKS
00:23:07NEED TO BE ON THEIR.
THAT IS ONE OF THE GREAT THINGS
00:23:13THIS ADMINISTRATION HAS DONE.
THAT HAS BEEN ABLE TO ALLOW THEM
00:23:19TO GROW THE SPENDING OF THE
MEDICAID BUDGET LESS THAN THE
00:23:21PROJECTIONS.
THAT SAID, IT IS COMING IN UNDER
00:23:24WHAT THEY PROJECTED GREAT IT
STILL AN INCREASE IN SPENDING.
00:23:28WE WILL HAVE TO PICK UP A SHARE
ON THE EXPANSION POPULATION OF
00:23:32PURE STATE DOLLARS, AND THAT
WILL BE AN ISSUE.
00:23:35YOU HAVE $375 MILLION OR SO IN
ONE MONTH IS THE EXPANSION
00:23:42POPULATION.
ONCE WE GET TO THAT 10% A YEAR,
00:23:52YOU CAN SEE THAT WILL BE ALMOST
HALF $1 BILLION IN STATE DOLLARS
00:23:56FOR THE EXPANSION POPULATION.
WHAT DOES THAT MEAN FOR YOUR
00:23:58COMPETITIVENESS?
WHAT WILL THAT MEAN WHEN YOU
00:24:01HAVE THESE TWO FREIGHT TRAINS?
AND, EDUCATION POLICY, WE WANT
00:24:10TO KEEP SPENDING MONEY ON
PRIMARY, SECONDARY EDUCATION.
00:24:13NOW MEDICAID HAS SUPERSEDED IF
YOU LOOK AT FEDERAL AND STATE
00:24:20FUNDS.
THESE THINGS WILL CONFLICT AT
00:24:21SOME POINT.
WE HAVE TO UNDERSTAND THAT THAT
00:24:24IS A PROBLEM, AND THINGS COULD
HAVE BEEN WORSE, BUT THAT
00:24:29DOESN'T MEAN THEY ARE
NECESSARILY ROSIE EITHER.
00:24:31>> I THINK WE HAVE MADE GREAT
PROGRESS IN OHIO.
00:24:37THE FACT WE HAVE BEEN ABLE TO
ENROLL SO MANY PEOPLE IS A GOOD
00:24:39THING.
PEOPLE ARE HEALTHIER AS A RESULT
00:24:42.
I THINK IT'S A POSITIVE
00:24:43.
KAREN: THANK YOU FOR BEING HERE.
00:24:46AND THAT'S IT FOR THIS WEEK.
FOR MY COLLEAGUES AT OHIO PUBLIC
00:24:49RADIO AND TELEVISION, THANKS FOR
WATCHING.
00:24:50IF YOU'D LIKE TO ASK QUESTIONS,
MAKE COMMENTS, OR WATCH THIS
00:24:52WEEK'S SHOW OR EARLIER EPISODES,
PLEASE VISIT OUR WEBSITE AT
00:24:55STATENEWS.ORG, OR WATCH ON THE
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00:24:58IDEASTREAM.ORG/OHIO.
AND YOU CAN FOLLOW JO INGLES,
00:25:02ANDY CHOW AND ME ON TWITTER.
AND PLEASE JOIN US AGAIN NEXT
00:25:05TIME FOR "THE STATE OF OHIO".
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00:25:21?
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00:26:37120,000 MEMBERS, WHO WORK TO
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00:26:39CREATIVELY AND EXPERIENCE THE
00:26:39JOY OF LEARNING.
Note : Transcripts are compiled from uncorrected captions