Nearly all Ohio Medicaid expansion enrollees would lose coverage if program is repealed

About 95% of Medicaid expansion beneficiaries in Ohio would have no insurance option available if repealing the Affordable Care Act eliminates Medicaid expansion, according to a new study.

The report, published in the American Journal of Public Health, found the overwhelming majority of newly enrolled Medicaid members in the state qualified because they didn't have private health insurance, lost their private insurance due to unemployment, or weren't eligible for their employer's health plan.

"Many of these people have nothing else to turn to," said Eric Seiber, lead author and associate professor of health services management and policy at Ohio State University, in a statement. "Their choice is Medicaid or medical bankruptcy."

Republicans have included limiting Medicaid expansion and federal funding in their efforts to repeal the ACA. The failed American Health Care Act proposed converting the $552 billion Medicaid program from an open-ended entitlement to federal per-capita payments to the states that would grow more slowly than actual Medicaid costs. The goal is to reduce federal spending growth and give states greater flexibility to design programs that serve beneficiaries cost-effectively. It's been high on the GOP agenda since the 1990s.

The study analyzed data from 42,876 households that participated in the 2015 Ohio Medicaid Assessment Survey, which asks participants questions about their enrollment.

About 712,000 Ohio residents have enrolled in Medicaid since the state opted to expand coverage in January 2014. Approximately 17.7% of enrollees had private health insurance prior to Medicaid enrollment, but 8.7% were unemployed at the time they enrolled and another 4.8% were not eligible for their employer's sponsored health plan.

The authors note that this refutes arguments from Medicaid expansion opponents who claim it has encouraged people to enroll in taxpayer-funded insurance instead of private insurance through an employer to save money.

"That's just not what the data show," said Micah Berman, co-author and assistant professor of public health and law at Ohio State's College of Public Health and Moritz College of Law.

The study also found that the majority of those on Medicaid in Ohio are white, have a high school education or less, and suffer from chronic conditions.

A limitation of the study was that the authors were not able to evaluate how many people enrolled in Medicaid were eligible for private insurance because their employment status changed.

"While it is possible that some portion of these enrollees have since been hired by an employer that offers (insurance), it is unlikely that this would meaningfully improve the insurance outlook for this population," the authors wrote.

Correction: April 26, 2017 This story has been updated to reflect the coverage losses would impact Medicaid expansion beneficiaries.