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Ohio bill would extend Medicaid, add cost sharing

COLUMBUS, Ohio (AP) — A Republican state lawmaker submitted a bill Wednesday to expand Medicaid to thousands more low-income Ohioans, with the hope that by adding changes such as copayments for some of the newly eligible that she could sway more of her GOP colleagues to back the idea.

The plan from state Rep. Barbara Sears would go beyond the expansion put forth by Republican Gov. John Kasich, which GOP leaders scrapped from the state budget.

Sears, of suburban Toledo, said her bill would encourage more personal responsibility and cost sharing for new enrollees. She's also proposing to link those in the expansion to state job training services in an effort to ultimately reduce the need for participation in the program.

Sears said her plan would also impose barriers on so-called "doctor shopping," where patients get prescription drugs from multiple health care practitioners without the prescribers' knowledge of the other drugs.

She said those on Medicaid with substance abuse problems would get needed prescriptions from one pharmacy and one provider.

"It really, quite frankly, protects both the recipient and the system," Sears said.

Her proposal also would let the state require a co-payment for certain Medicaid enrollees who sought more expensive services. For instance, a small fee could be levied against those who visited the emergency room instead of a primary care provider for non-emergency treatment, or wanted a brand name drug instead of a generic one.

Roughly 366,000 Ohioans will be eligible for coverage beginning in 2014 by expanding Medicaid, the health program for the poor that already provides care for one of every five residents in the state.

The Medicaid expansion is one of the key components of Democratic President Barack Obama's federal health care law.

Opponents of Medicaid expansion fear being stuck with the long-term costs of the program, which now is being paid for mainly by the federal government.

Many conservatives in the Legislature also are philosophically against the idea of expanding government programs and opposed to Obama's law, which calls for mandated health coverage.

The federal law expanded Medicaid to cover low-income people making up to 138 percent of the federal poverty level, or about $15,400 a year for an individual. The provision mainly benefits low-income adults who do not have children and can't get Medicaid in most states.

The federal government will pay the entire cost of the Medicaid expansion for the first three years, gradually phasing down to 90 percent — still well above Ohio's current level of 64 percent.

Similar to Kasich's plan, her proposal also calls for a so-called trigger that would dis-enroll the new Medicaid participants, should the federal government not pick up its share of expanded coverage.

A broad group of Ohio's doctors, hospitals and health providers back expansion, as does AARP Ohio. Supporters have continued to call on the Legislature to take action through rallies and lobbying events at the Statehouse.

A coalition of Medicaid backers praised the bill's introduction Wednesday evening, saying they remained hopeful Medicaid changes could come by July 1.

"We are hopeful that Rep. Sears' responsible and balanced bill will immediately receive its committee assignment, and that hearings start on the bill next week," Jon Allison, an attorney working on behalf of the Ohio Alliance for Health Transformation.

Sears, who is the No. 3 Republican in the House, said others on the GOP leadership team were involved in the process and the speaker has seen the bill.

Still, she acknowledged the plain might be a tough sell.

"Any kind of expansion is going to be difficult with a Republican caucus," she said. "But what we're hoping to do is put enough guardrails in there do it in a responsible and conservative way."

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