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Possible Medicaid expansion cuts in second Trump term could upend Ohio finances, close rural hospitals: Thomas Suddes

Possible Medicaid expansion cuts in second Trump term could upend Ohio finances, close rural hospitals: Thomas Suddes

Among many things 16-year Republican Gov. James A. Rhodes is reputed to have said was that, “When Ohioans elect a governor, they’re electing a manager.”

On that front, Republican Gov. Mike DeWine and his appointees, especially state Budget Director Kimberly Murnieks and her staff, are drawing praise for Ohio’s rock-solid finances.

In an Oct. 30 statement overshadowed by Nov. 5′s then-looming election, Fitch Ratings, which evaluates the creditworthiness of states’ bonds, affirmed the high ratings of Ohio’s bonded debt. Fitch said the AAA rating given the state’s general obligation bonds and Ohio’s issuer-default rating “reflect [Ohio’s] high level of financial resilience and superior budget management as evidenced by robust fiscal reserves and cash and the state’s proven ability to absorb the effects of economic cyclicality and repeated tax policy changes. Ohio also has a low long-term liability burden and associated carrying costs.”

The better Ohio’s bond ratings are, the lower the interest the state must pay. As Ohio budget-writers gear up for 2025′s General Assembly debate on the state’s next operating budget, Fitch’s affirmation is excellent news.

Clouds on the horizon? There may be.

Noises emitted by President-elect Donald Trump’s transition team suggest that, to finance tax cuts, he may seek to slash federal Medicaid “expansion” money flowing to 40 states, including Ohio, which expanded Medicaid in 2013 – in Ohio’s case, with then-Gov. John R. Kasich’s ardent support. Result of this Medicaid expansion in Ohio: Single adults with annual income up to $20,780 are eligible for Ohio Medicaid coverage. In October, that was about 784,000 Ohioans in the Medicaid’s expansion group. The federal government pays 90% of the expansion group’s Medicaid costs.

If Trump cuts the federal share, Ohio will have to make up the difference — or cut services, or slash enrollment. (Meanwhile, Trump, in a preposterous move, has picked celebrity doctor Mehmet Oz to lead the federal Centers for Medicare & Medicaid Services, which, The New York Times reports, provides “health coverage to more than 150 million Americans.”)

The knee-jerk General Assembly might well think Medicaid expansion covers too many Ohioans, so no big deal. But that ignores the virtual certainty that pruning or ending Medicaid expansion would force some Ohio community hospitals to close. That’s why these hospitals lobbied so energetically to expand Medicaid when Kasich was governor.

Safe prediction: When a county seat’s hospital closes in small-town Ohio because of Medicaid rollbacks, that’ll imperil its General Assembly member. If legislators don’t realize that now, they eventually will.

Ka-ching!: Ohio’s 100-year-old-plus Controlling Board, which includes six General Assembly members (four Republicans, two Democrats, and a president representing (Republican) Gov. DeWine), tweaks the state budget.

The board’s legislative members get paid $150 a meeting-day, plus expenses, whether a meeting’s for five minutes or five hours. How that squares with the Ohio Constitution is a good question: It says “members and officers of the General Assembly shall receive a fixed compensation, to be prescribed by law, and no other allowance or perquisites. …” (This year, base pay for a rank-and-file Ohio House or state Senate member is $71,099.)

The Controlling Board’s legislative members periodically embarrass themselves – or would, if they were self-aware. Last week, for example, the often-unanimous board, in a 4-3 vote, accepted from Washington an additional $17 million for services offered refugees living in Ohio, cleveland.com’s Jake Zuckerman reported.

Most critics of both parties blame Washington, not Columbus, for Ohio’s growing number of refugees, so it seems paradoxical for three Controlling Board Republicans to try to reject the federal money.

But vote “no” the three Republicans did: State Rep. Jean Schmidt, of suburban Cincinnati’s Loveland, sometimes ungallantly called “Mean Jean”: As a U.S. House member, for example, Schmidt had questioned the bravery of a House Democrat, then-U.S. Rep. John Murtha, of Pennsylvania, a Marine Corps veteran.

Also voting to reject refugee aid was state Sen. Shane Wilkin, a Hillsboro Republican, who, as a House member, was prime co-sponsor of 2019′s scandal-laden House Bill 6, the proposed FirstEnergy Corp. bailout. The third “no”: Lame-duck GOP state Rep. Jay Edwards, of Athens County’s Nelsonville, who may run statewide in 2026.

Heartening, isn’t it, to see the Christmas spirit pervade the Statehouse? Attention Messrs. Currier and Ives: Meet Mr. Scrooge’s trio.

Thomas Suddes, a member of the editorial board, writes from Athens.

To reach Thomas Suddes: [email protected], 216-408-9474

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