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The State of Ohio

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The State of Ohio is a weekly news program spotlighting the latest happenings at the Statehouse, in the Governor's office, at the Ohio Supreme Court and throughout the Buckeye State, hosted by the award-winning Karen Kasler.

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00:00:00	Support
00:00:00	for the Statehouse News Bureau
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00:00:03	dedicated to the health
00:00:03	and well-being of Ohioans,
00:00:05	offering health insurance
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00:00:12	More at Med mutual.com.
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00:00:39	Governor Mike DeWine,
00:00:39	state of the state speech
00:00:41	gets bipartisan applause
00:00:41	and pushback from Democrats
00:00:45	and from Republicans
00:00:45	in charge of the budget.
00:00:48	And the director of the agency
00:00:49	that spends the largest
00:00:49	chunk of the state
00:00:51	budget talks about changes
00:00:51	that could be coming.
00:00:54	That's this
00:00:54	week in the state of Ohio.
00:01:13	Just.
00:01:14	Welcome to the state of Ohio.
00:01:16	I'm Karen Kasler.
00:01:17	As expected,
00:01:17	there were virtually
00:01:19	no new proposals
00:01:20	announced by governor
00:01:20	Mike DeWine and his second
00:01:22	to last state of the state
00:01:22	speech,
00:01:24	though in his 71 minute
00:01:24	annual address,
00:01:27	he drew attention
00:01:28	to several ideas and programs
00:01:28	that are in his two year
00:01:31	budget that he introduced
00:01:31	last months.
00:01:47	DeWine last
00:01:48	used that line in 2022, in his
00:01:48	first post-pandemic address
00:01:52	this year.
00:02:08	But DeWine said
00:02:09	workforce is still the state's
00:02:09	most significant challenge.
00:02:12	He said his newly appointed
00:02:12	lieutenant governor, former
00:02:15	Ohio State football coach
00:02:15	Jim Tressel, will quarterback
00:02:17	what he's called
00:02:17	Ohio's work force playbook.
00:02:21	DeWine also noted
00:02:21	that Tressel will indeed lead
00:02:24	an effort that he talked about
00:02:24	on this show,
00:02:26	a coming statewide
00:02:26	initiative on physical fitness
00:02:29	in schools.
00:02:30	DeWine
00:02:30	waded into the discussion
00:02:32	on conservatives concerns over
00:02:32	what they've called
00:02:34	liberal indoctrination
00:02:34	on public college campuses,
00:02:37	introducing the heads
00:02:38	of the so-called academic
00:02:38	civic centers
00:02:41	that have been set up
00:02:41	at five public colleges
00:02:43	to promote constitutional
00:02:43	research and American history.
00:02:47	Senate Bill
00:02:47	one, the legislation to ban
00:02:47	diversity programs and faculty
00:02:51	strikes,
00:02:51	among other things, has passed
00:02:53	the Senate and is being heard
00:02:53	in the House.
00:02:55	It is strongly opposed
00:02:55	by faculty and student groups
00:02:58	as well as democratic
00:02:58	organizations, unions,
00:03:01	and the ACLU.
00:03:02	DeWine
00:03:02	also touted budget items,
00:03:04	some of which have not gotten
00:03:06	much enthusiasm
00:03:06	from his fellow
00:03:07	Republicans
00:03:07	in the legislature.
00:03:10	For instance, a $1,000 tax
00:03:10	credit for kids under seven,
00:03:13	funded by a $1.50 per pack
00:03:13	cigaret tax hike
00:03:17	and a sports facility
00:03:17	fund backed
00:03:19	by doubling the 20% sports
00:03:19	betting tax
00:03:22	that is paid by operators
00:03:22	to 40%.
00:03:25	DeWine noted his budget calls
00:03:26	for vision and dental services
00:03:26	programs for kids.
00:03:29	He encouraged
00:03:29	bringing driver's
00:03:31	ed programs
00:03:31	back to high schools
00:03:33	and a total ban on
00:03:33	cell phone usage.
00:03:36	After pushing last year
00:03:36	in that speech.
00:03:38	For a law to require districts
00:03:40	to have policies on
00:03:40	cell phone usage,
00:03:42	which
00:03:42	took effect over the summer.
00:04:04	DeWine did have one new school
00:04:04	related proposal
00:04:07	to put forward,
00:04:08	saying kids should be learning
00:04:09	about how to create a budget,
00:04:09	perform basic first aid,
00:04:12	cook simple meals,
00:04:12	and to vote.
00:04:38	The speech got audible cheers
00:04:38	from both sides of the aisle.
00:04:41	But some of DeWine's biggest
00:04:43	state budget priorities fell
00:04:44	flat among members
00:04:44	of his own party,
00:04:47	including that thousand
00:04:47	dollar child
00:04:48	tax credit funded through
00:04:48	a cigaret tax increase,
00:04:51	and the Sports Facilities
00:04:51	Fund paid
00:04:53	for with the doubling
00:04:53	of the Sports Betting Tax
00:04:56	you have to be careful
00:04:56	about basing any spending
00:05:00	historically or long term
00:05:00	spending on a cigaret tax,
00:05:04	because there's going to be
00:05:04	a declining source of revenue.
00:05:06	It's been a declining source
00:05:06	of revenue for years.
00:05:08	And I would suggest that
00:05:08	if the cigaret tax
00:05:11	were increased even more,
00:05:13	above what it is,
00:05:14	it's probably
00:05:14	going to be even more rapidly
00:05:16	declining source of revenue.
00:05:17	I don't think it income tax
00:05:19	credit for many Ohioans
00:05:19	is really the way to go.
00:05:23	And I think
00:05:23	some of the other things
00:05:24	that the governor
00:05:24	has proposed,
00:05:26	especially regarding
00:05:26	childcare, we have to,
00:05:30	be careful
00:05:30	about what we're doing here.
00:05:32	Are going to help
00:05:32	people get back to work.
00:05:34	So I guess I'd like to see
00:05:34	some modeling on whether
00:05:38	this particular income tax
00:05:38	credit would really, promote,
00:05:42	the, the ability of people
00:05:42	to have children.
00:05:46	House Finance Committee Chair
00:05:46	Brian Stewart
00:05:48	told me on Thursday
00:05:48	he does not support
00:05:51	those tax increases,
00:05:52	along with DeWine's proposed
00:05:52	increase in the marijuana tax,
00:05:56	and that most of the House
00:05:57	majority caucus does not,
00:05:57	either.
00:06:00	So Stewart
00:06:00	said it's very unlikely
00:06:02	that those tax increases
00:06:03	will be included in the House
00:06:03	version of the budget.
00:06:06	Democrats have their own
00:06:06	critiques of DeWine's address,
00:06:09	noting that he didn't make
00:06:09	any mention of property taxes,
00:06:12	though
00:06:12	lawmakers of both parties
00:06:14	have said that constituents
00:06:15	have long been reaching out
00:06:15	about skyrocketing valuations.
00:06:19	We can be both
00:06:19	fiscally responsible
00:06:22	while also
00:06:22	being morally compassionate.
00:06:26	But for all the good
00:06:26	that this budget does, there
00:06:29	is still so much more work
00:06:29	that can be done.
00:06:33	Nothing.
00:06:34	And the governor's
00:06:34	proposed budget addresses
00:06:34	the fact that prices are still
00:06:38	too high at the grocery store,
00:06:38	at the pharmacy,
00:06:41	and for Ohioans
00:06:41	who are hurting,
00:06:44	who are struggling
00:06:45	to afford quality
00:06:45	housing and higher education,
00:06:48	we have bipartisan solutions
00:06:48	to address property taxes
00:06:52	in both chambers
00:06:52	that we could enact today.
00:06:56	It is a choice that they have
00:06:56	not been enacted, and Ohioans
00:07:00	deserve better.
00:07:01	And Democrats also shot
00:07:01	back at the recent debate over
00:07:03	Senate Bill one, the higher
00:07:03	education bill, saying
00:07:06	lawmakers should instead focus
00:07:06	on the state's increasing
00:07:09	brain drain
00:07:09	and rising tuition costs.
00:07:12	instead of
00:07:13	taking any meaningful action
00:07:13	to invest in our kids
00:07:16	or lower property
00:07:16	taxes, the legislature,
00:07:19	through Senate Bill one,
00:07:21	has prioritized
00:07:21	an egregious attack and plan
00:07:24	to dismantle our world
00:07:24	renowned institutions
00:07:28	of higher learning.
00:07:29	Then they ignore
00:07:29	the will of Ohioans
00:07:31	by overhauling
00:07:32	the marijuana law approved
00:07:32	by a majority of voters.
00:07:36	There's a lot that we and the
00:07:38	governor, as I said, agree on.
00:07:39	We absolutely should be
00:07:41	focusing on our kids,
00:07:41	our economy, our workforce,
00:07:45	higher education institutions
00:07:45	in a positive way.
00:07:49	But we have much work on
00:07:49	how we do that.
00:07:53	A deadline was set a Friday,
00:07:53	March 14th, for House
00:07:56	budget amendments.
00:07:57	That deadline
00:07:58	was also a focus of the newly
00:07:58	formed House Doe's caucus.
00:08:02	Nearly half of GOP Republicans
00:08:02	are part of that government
00:08:05	cost cutting group,
00:08:06	which says it wants the state
00:08:06	to focus on core functions
00:08:09	of education, public safety
00:08:09	and infrastructure.
00:08:12	Chair freshman Tex
00:08:12	Fisher says he knows
00:08:15	Republicans have run Ohio
00:08:15	state government
00:08:17	for the better part
00:08:17	of three decades.
00:08:19	But quoting here, I think
00:08:21	wasteful spending and mission
00:08:21	creep of what government does
00:08:24	is a bipartisan issue
00:08:24	and, quote,
00:08:27	the largest single item in
00:08:27	the state budget is Medicaid.
00:08:30	With nearly half of state
00:08:30	spending going toward it.
00:08:33	More than 3 million Ohioans
00:08:33	receive Medicaid
00:08:36	to cover health care.
00:08:37	39% of those
00:08:37	Ohioans are kids under 18.
00:08:40	As of this week, 769,869
00:08:40	Ohioans are getting Medicaid
00:08:46	benefits through expansion
00:08:46	of the program done
00:08:48	in 2013 under Republican
00:08:48	former Governor John Kasich.
00:08:52	Following the passage
00:08:52	of the Affordable Care Act,
00:08:55	federal funding for
00:08:55	that population is uncertain,
00:08:58	and the proposed budget
00:08:58	has trigger language
00:09:00	that could end state
00:09:00	funding for it.
00:09:02	And the DeWine administration
00:09:02	has gone
00:09:04	to the Trump administration
00:09:04	for a second time
00:09:07	to ask for permission
00:09:07	to implement an 80 hour
00:09:10	a month work requirement
00:09:10	for people who are under 55,
00:09:13	are not enrolled in a school
00:09:13	or training program,
00:09:17	who aren't working
00:09:17	a recovery program
00:09:19	or don't have a serious
00:09:19	physical or mental illness.
00:09:22	I talked about all of that
00:09:23	and more with Ohio's Medicaid
00:09:23	Director, Maureen Corcoran.
00:09:26	So the state asked
00:09:26	to implement work
00:09:29	requirements in 2019.
00:09:30	It was granted.
00:09:31	Then the pandemic hit,
00:09:32	and the Biden administration
00:09:32	overturned the original order
00:09:36	allowing work requirements
00:09:36	to be implemented.
00:09:38	So the idea is back.
00:09:39	Why is it back
00:09:39	now is seen as a way
00:09:41	to save the state money,
00:09:41	though,
00:09:43	in the only state that's
00:09:43	successfully implemented.
00:09:46	Work requirements.
00:09:47	Georgia there wasn't
00:09:48	actually an increase
00:09:49	in costs per enrollee
00:09:49	through work requirements.
00:09:52	Why do it?
00:09:54	Well, actually,
00:09:54	the reason we're doing it
00:09:57	now is that our legislature
00:09:57	in the last budget
00:10:01	put in a requirement
00:10:01	that in February of this year.
00:10:04	So just this past month,
00:10:04	we were to submit a waiver,
00:10:09	hoping or assuming that
00:10:09	that President Trump
00:10:12	would be president
00:10:13	and that there would be
00:10:13	a little more receptivity
00:10:15	to that at the federal level.
00:10:16	And certainly
00:10:18	all the indications we're
00:10:19	getting from the leadership
00:10:19	and key policy
00:10:22	people in Washington is a
00:10:23	is a receptivity and openness
00:10:23	to work requirements.
00:10:27	And, so what we're seeing
00:10:27	or what in our budget,
00:10:31	what we're planning for,
00:10:32	it will cost us a little bit
00:10:32	more in the first year,
00:10:36	primarily serve start up
00:10:36	in administrative money.
00:10:39	And then we're expecting,
00:10:41	more significant savings
00:10:41	in the second year and beyond.
00:10:45	So the idea is really
00:10:45	to give people,
00:10:49	an incentive to,
00:10:52	as there are with people
00:10:52	that have regular jobs,
00:10:55	that if I need to work
00:10:55	and or to engage
00:10:59	in community activities
00:10:59	or go to school
00:11:01	in order to have
00:11:01	my health care covered,
00:11:03	that will provide
00:11:03	a little bit of incentive
00:11:05	for them to do that.
00:11:07	Why are work requirements
00:11:07	a good thing, though
00:11:08	most people in the Medicaid
00:11:08	population are working.
00:11:11	Why are these work
00:11:11	requirements
00:11:13	something
00:11:13	that you think are important?
00:11:16	it's a it's a great question.
00:11:16	Well,
00:11:18	When we look
00:11:18	at the requirements
00:11:20	that our legislature
00:11:20	put in the law
00:11:23	with a certain exemptions,
00:11:25	more than two
00:11:25	thirds of the people
00:11:27	that are currently in this
00:11:27	target group, eligibility
00:11:31	group, more than two
00:11:31	thirds will be exempted.
00:11:34	So they'll and we do know
00:11:34	that many people on Medicaid
00:11:37	are working 1
00:11:37	or 2 jobs, low income jobs.
00:11:41	So and and then some of
00:11:41	the other exemptions include
00:11:45	if you're going to school,
00:11:46	if you have a serious
00:11:46	mental illness
00:11:48	or you're getting drug
00:11:48	and alcohol treatment.
00:11:50	So based on our
00:11:50	our preliminary analysis,
00:11:54	more than two
00:11:54	thirds of people will qualify.
00:11:58	And then the remaining
00:11:58	individuals will need to be
00:12:01	further assessed.
00:12:02	Maybe we don't have
00:12:02	all the information etc.,
00:12:05	but it's a much smaller
00:12:05	number of people.
00:12:08	So we're assuming
00:12:08	we cover now about 745,000
00:12:13	or so Ohioans
00:12:14	in this particular expansion
00:12:14	group is referred to.
00:12:18	We're assuming
00:12:18	that about 62,000 over
00:12:21	the first 18 months
00:12:21	or so would fall off
00:12:26	or would not meet
00:12:26	those exemptions
00:12:28	and would be required
00:12:28	to increase
00:12:30	their work activity
00:12:30	in order to receive Medicaid.
00:12:34	The critics say work
00:12:34	requirements
00:12:35	are essentially cuts
00:12:35	to Medicaid,
00:12:37	because some recipients
00:12:37	have no control
00:12:38	over the irregular hours
00:12:38	that they're working,
00:12:40	so they can't really ensure
00:12:42	that they're going to be able
00:12:42	to work 80 hours a month.
00:12:45	There are people
00:12:45	who will lose Medicaid
00:12:45	if they get a job
00:12:48	because their incomes
00:12:48	will go up,
00:12:50	but then their employer
00:12:50	doesn't offer
00:12:52	health insurance coverage.
00:12:53	They may have transportation
00:12:53	issues.
00:12:55	There's a lot of things
00:12:55	involved in requiring people
00:12:58	to prove that they are working
00:12:58	80 hours a month.
00:13:01	Right.
00:13:02	And we as part of this
00:13:02	process, we, the federal,
00:13:06	process you have to follow
00:13:08	to put one of these waivers
00:13:08	together.
00:13:10	We have to engage
00:13:10	in a stakeholder
00:13:12	input process for 60 days,
00:13:12	which we we did,
00:13:16	and we got, 4 or 500 comments
00:13:20	and feedback from people
00:13:20	and many all the comments
00:13:24	reflected some of these kinds
00:13:24	of concerns or issues
00:13:28	or things.
00:13:28	Have we thought about this?
00:13:28	Thought about that?
00:13:30	So what we've
00:13:31	what we've been sharing
00:13:31	with the General Assembly
00:13:34	and with other stakeholders
00:13:34	as we talk to them is,
00:13:37	you know, this is
00:13:37	the first step in the process.
00:13:40	We have to go through.
00:13:42	It's a bit of a process
00:13:42	with the federal government,
00:13:45	and we'll see what
00:13:45	what other kinds of either
00:13:49	things
00:13:49	that the federal government
00:13:51	wants us to add
00:13:51	or what kind of considerations
00:13:53	we need to take into account.
00:13:55	But at the same time,
00:13:57	you know,
00:13:57	the county departments of job
00:13:59	and family services work
00:13:59	with all these individuals.
00:14:03	We're working
00:14:03	with our managed care partners
00:14:06	to be sure
00:14:06	that they can reach out
00:14:08	to people in advance,
00:14:08	that they can see
00:14:11	maybe it is transportation.
00:14:12	What can we do to help you?
00:14:14	We're we've been developing
00:14:14	a voluntary work
00:14:18	support program, which will
00:14:18	now turn into a resource.
00:14:22	So there is we've been working
00:14:22	with the job,
00:14:25	agencies across the state,
00:14:25	director Dan Schroeder and I,
00:14:30	in anticipation
00:14:30	of something like this.
00:14:33	So we know people are going
00:14:33	to need support.
00:14:36	Arkansas got permission
00:14:36	to implement work requirements
00:14:39	along with Georgia.
00:14:40	A judge actually halted that.
00:14:42	So there's just this one state
00:14:43	that's made work requirements
00:14:46	work in implementing them
00:14:46	successfully.
00:14:48	Does that suggest that work
00:14:49	requirements are not,
00:14:49	in fact, workable?
00:14:52	That's working 3 or 4 times.
00:14:54	You've said work in
00:14:54	the same sentence is getting
00:14:57	getting that in there. Well,
00:14:58	and that that is the point
00:14:58	of these kind of waivers.
00:15:02	These are what are referred
00:15:02	to as 1115 waivers.
00:15:06	They're a particular type
00:15:06	of demonstration waiver.
00:15:09	So we have to do fiscal
00:15:09	analysis
00:15:13	and reporting as we go along.
00:15:15	And the whole idea is
00:15:15	if it's a demonstration, let's
00:15:19	try it out.
00:15:20	Let's do the research.
00:15:22	And we have to do you know,
00:15:22	it's not just little reports.
00:15:25	We have to do formal research
00:15:25	as we go along
00:15:29	in order to demonstrate
00:15:30	whether, in fact,
00:15:30	it is saving money or not.
00:15:35	The Medicaid
00:15:36	expansion population includes
00:15:37	people who are dealing
00:15:37	with addiction,
00:15:38	people
00:15:38	who have mental illnesses
00:15:40	that they're dealing with more
00:15:42	so than the larger
00:15:42	Medicaid population.
00:15:44	So if those people leave
00:15:44	the existing
00:15:47	Medicaid population,
00:15:48	it makes the rest of Medicaid
00:15:48	sicker, does it not?
00:15:51	And does
00:15:51	that cost more money? So
00:15:55	so we
00:15:56	and you're right,
00:15:56	we've got two big issues
00:15:58	in front of Congress
00:15:58	right now.
00:16:00	One is the
00:16:00	at the federal level,
00:16:02	they're very supportive.
00:16:03	The Trump administration's
00:16:04	very supportive of work
00:16:04	requirements.
00:16:06	The other is
00:16:06	just this whole issue around
00:16:09	how states are being paid
00:16:11	to care for this
00:16:11	same group of individuals.
00:16:15	So in the work arena,
00:16:15	people who have a drug
00:16:17	and alcohol problem
00:16:17	or a mental health problem,
00:16:20	they would be exempt.
00:16:21	They would be able to continue
00:16:21	to be covered.
00:16:25	Now, what you're
00:16:25	also getting at, though, is
00:16:27	as we've
00:16:27	come out of the unwinding
00:16:30	from the public health
00:16:30	emergency, we have seen
00:16:34	quite a number of people
00:16:35	go back to work or go back to
00:16:35	some other kind of coverage.
00:16:40	And that's where your question
00:16:40	is particularly on point.
00:16:43	As you lose the healthier
00:16:43	people than those
00:16:48	who remain in the program
00:16:48	are more costly.
00:16:51	So, we've been having
00:16:51	a lot of that conversation
00:16:55	with the General Assembly
00:16:55	to help kind of understand,
00:16:58	you know, just because
00:16:58	you reduce by one doesn't mean
00:17:01	you save the full cost of that
00:17:01	one person because of this,
00:17:06	where you're getting
00:17:07	the overall group of people
00:17:07	then become sicker.
00:17:10	So there is a kind of
00:17:10	a balancing act
00:17:13	as we're looking at
00:17:13	how to set the rates.
00:17:16	You bring up the federal
00:17:16	funding
00:17:17	and there's
00:17:17	a lot of uncertainty around
00:17:18	federal funding.
00:17:20	And the federal budget
00:17:20	bill proposes $880
00:17:20	billion in cuts to Medicaid
00:17:24	and the Affordable Care Act,
00:17:26	which funds Medicaid
00:17:26	expansion.
00:17:28	There are discussions
00:17:28	about dropping the share
00:17:30	the federal government
00:17:30	would pay.
00:17:31	The federal government pays
00:17:31	90% for the Medicaid expansion
00:17:34	population, 65% for the
00:17:34	general Medicaid population.
00:17:38	A provision in the state
00:17:38	budget says that
00:17:40	if that funding
00:17:40	for the Medicaid expansion
00:17:42	population drops below 90%,
00:17:42	then that eliminates
00:17:46	the coverage
00:17:46	for Medicaid expansion.
00:17:49	That's 769,869 people
00:17:53	who would lose their Medicaid
00:17:53	expansion coverage.
00:17:55	Right?
00:17:56	The the trigger line is we
00:17:56	call it the trigger language,
00:17:59	which a number of states
00:17:59	have implemented.
00:18:02	And again, it's very simple
00:18:02	because we don't know
00:18:06	exactly what will happen
00:18:06	in Washington.
00:18:08	But yeah, the way that it is
00:18:08	currently framed,
00:18:11	it says that the state
00:18:11	must terminate the program
00:18:15	if the federal funding drops
00:18:17	below
00:18:17	the current expected amount.
00:18:21	And, you know,
00:18:21	we can all understand,
00:18:24	I mean, if they drop it by 5%.
00:18:27	So if they go
00:18:27	from just 90% to 85%,
00:18:31	that would cost the state
00:18:31	about $380 million.
00:18:35	And if they went all the way
00:18:37	down to 65, you're right,
00:18:37	our our regular amount,
00:18:41	then they'd be dropping it
00:18:41	by five times that.
00:18:45	So we're up,
00:18:45	you know, up near $2 billion.
00:18:49	And so the discussion
00:18:49	that we've been having with
00:18:51	the legislature
00:18:51	is really around.
00:18:54	Look, we need a clear
00:18:58	trigger
00:18:58	so that if this happens there
00:19:01	can be additional conversation
00:19:01	with the General Assembly.
00:19:05	They they would have to act.
00:19:07	They control the purse.
00:19:09	They would have to.
00:19:10	And you,
00:19:11	you know,
00:19:11	you know, from
00:19:12	other situations
00:19:12	we've had in the state of Ohio
00:19:14	where there's been crisis and,
00:19:17	you know, people
00:19:17	have had to come together
00:19:18	in the General Assembly.
00:19:20	So, you know, without knowing
00:19:20	exactly what might happen,
00:19:24	you know,
00:19:25	the our view is we need
00:19:25	a clear kind of trigger
00:19:29	and then there will need
00:19:29	to be more discussion.
00:19:32	But the other thing
00:19:32	I've cautioned in,
00:19:34	in some of the hearings is,
00:19:35	you know, nothing like this
00:19:35	occurs overnight.
00:19:39	Okay.
00:19:39	So it's not
00:19:40	that you're going to show up
00:19:40	at the hospital the next day
00:19:43	and not have coverage.
00:19:44	You know,
00:19:44	it all takes guidance
00:19:46	from the federal government
00:19:46	to tell you,
00:19:48	you know, what you have to do.
00:19:48	And all that.
00:19:50	So we don't know how
00:19:50	much time, but there would be,
00:19:54	you know, some back and forth
00:19:56	in some time
00:19:56	that would be needed before
00:19:59	any kind of terminations
00:19:59	of individuals would occur.
00:20:03	So there is discussion
00:20:03	going on among
00:20:05	Medicaid and lawmakers
00:20:05	about that trigger language
00:20:08	to ensure that
00:20:09	maybe it wouldn't be 90%, 80%
00:20:09	something else like that.
00:20:12	Yeah.
00:20:12	Or or does it become,
00:20:12	you know, is it
00:20:15	does it get framed more as a,
00:20:17	you know, the administration
00:20:17	may is opposed to show.
00:20:20	So yeah,
00:20:21	there's there's been quite
00:20:21	a bit of discussion
00:20:23	about that already in
00:20:23	the hearings that we've had.
00:20:26	There are more people
00:20:26	on Medicaid
00:20:28	now than there were
00:20:28	before the pandemic.
00:20:30	Why is that?
00:20:32	Yeah, it's probably the
00:20:33	most common question
00:20:33	we get from the legislators.
00:20:36	We at the time, just before
00:20:36	the pandemic began,
00:20:41	Ohio was at its
00:20:41	strongest place economically.
00:20:46	We had
00:20:46	the greatest number of people
00:20:49	or percentage of people
00:20:49	employed.
00:20:51	We had seen some 36 months
00:20:55	of continuous decline
00:20:55	in the Medicaid population.
00:20:59	It was like the the opposite
00:20:59	of the perfect storm.
00:21:03	It was kind
00:21:03	of the perfect, perfect.
00:21:05	And so even as we began
00:21:05	our work on The Unwinding
00:21:10	two years ago,
00:21:11	we said to the General
00:21:11	Assembly, we will not get back
00:21:15	to the pre-pandemic level,
00:21:15	at least not right away,
00:21:19	because we know
00:21:19	and we see it today.
00:21:22	While the economy is doing
00:21:22	much better, we do not have
00:21:26	the degree of work
00:21:26	purchase of employment
00:21:29	participation
00:21:29	that we had before.
00:21:32	We have a lower percentage,
00:21:32	the economy is is not
00:21:37	I mean, not that there's
00:21:38	anything wrong with it,
00:21:39	but it's not where it was
00:21:39	when we started.
00:21:42	And so we have seen
00:21:44	a significant decline
00:21:44	in the number of people,
00:21:47	but there still are about
00:21:47	200,000 people.
00:21:50	We're still at about
00:21:51	200,000 people higher than
00:21:51	we were before the pandemic.
00:21:56	One of the biggest drivers
00:21:56	of your costs is drugs.
00:21:59	And in fact,
00:22:00	it was $6.2 billion
00:22:00	spent on drugs just last year,
00:22:03	not last budget,
00:22:03	but just last year.
00:22:06	There were some unusual
00:22:07	and expensive drugs
00:22:07	that are funded.
00:22:08	That's part of that.
00:22:09	But there's one
00:22:09	particular class of drugs
00:22:12	that you say there's
00:22:12	going to be a 459% increase
00:22:12	expected
00:22:15	over the next two years,
00:22:17	and that's these GLP
00:22:18	one drugs,
00:22:18	these diabetes drugs
00:22:19	that are also being used
00:22:19	for weight loss.
00:22:22	A lot of insurance companies
00:22:22	don't cover those
00:22:24	for weight loss.
00:22:25	Why do you expect
00:22:26	such a serious increase in
00:22:26	just that category of drugs?
00:22:30	It's a great question.
00:22:31	So the the Medicaid program,
00:22:31	under federal law,
00:22:36	if we participate
00:22:36	in the rebate program.
00:22:39	So today for our $6
00:22:39	billion of drugs,
00:22:42	we get about half of that
00:22:42	back in rebates.
00:22:46	So our
00:22:46	net spend is only about half.
00:22:50	But the the
00:22:51	in exchange,
00:22:52	what the federal law lays out
00:22:52	is that if a manufacturer
00:22:56	participates
00:22:56	in the rebate program,
00:22:58	they give us that
00:22:58	degree of rebate,
00:23:01	then we must cover any of that
00:23:01	manufacturer's drugs
00:23:06	if they are approved by the
00:23:06	Federal Drug Administration.
00:23:10	So what that means is today
00:23:10	we cover these drugs,
00:23:14	the GLP ones for obesity,
00:23:17	be not because they're
00:23:17	for obesity, but as you say,
00:23:20	because they're also
00:23:22	being used primarily because
00:23:22	the person has diabetes
00:23:26	and the weight loss
00:23:26	is a significant contributor.
00:23:29	We're covering them
00:23:29	for certain kinds of heart
00:23:32	conditions,
00:23:33	not because
00:23:34	the person is obese,
00:23:34	but because
00:23:35	the obesity is contributing.
00:23:38	And so we are seeing
00:23:38	a significant increase
00:23:41	in their use,
00:23:41	but we're also seeing
00:23:45	that there are a number
00:23:45	of additional,
00:23:48	what we refer to
00:23:48	as comorbidities
00:23:50	that the drug companies
00:23:50	are asking the FDA to approve.
00:23:54	So sleep apnea,
00:23:55	we even saw some things
00:23:55	recently about, you know,
00:23:58	our GLP ones are, helpful
00:23:58	in treating depression.
00:24:02	So as those go through the the
00:24:02	review process with the FDA,
00:24:07	if the FDA comes out and says
00:24:10	yes, GLP ones can treat
00:24:14	sleep apnea depression,
00:24:17	then we must cover it.
00:24:20	That's going to drive
00:24:20	those costs up big time.
00:24:22	Well, it is, it is.
00:24:24	However, we're also you know,
00:24:25	we've had questions
00:24:25	from some of the legislature
00:24:28	that there still though
00:24:28	is a push not
00:24:31	just for those comorbidities.
00:24:35	You know, diabetes,
00:24:35	sleep apnea,
00:24:37	but there's a push toward,
00:24:37	you know,
00:24:39	why can't we open them up
00:24:39	more broadly?
00:24:42	And and so that's where you
00:24:42	that's why
00:24:46	both in Medicaid programs
00:24:46	as well as in
00:24:49	commercial insurance,
00:24:49	as you mentioned,
00:24:51	there's been a lot of
00:24:51	nervousness about these drugs
00:24:54	because they the,
00:24:55	increase in utilization
00:24:55	is pretty dramatic.
00:24:58	And it's pretty.
00:25:00	It happens fairly quickly.
00:25:02	So we're trying to just be
00:25:02	a little bit more cautious
00:25:06	as we roll this out.
00:25:07	And there are serious
00:25:07	side effects.
00:25:08	So we're trying to be just
00:25:08	a little bit more cautious.
00:25:11	And that is it for this week
00:25:11	for my colleagues
00:25:13	at the Statehouse News
00:25:13	Bureau of Ohio Public Media.
00:25:15	Thanks for watching.
00:25:16	Please check out our website
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Note : Transcripts are compiled from uncorrected captions