By Debra Jasper and Spencer Hunt
Columbus Enquirer Bureau

Linda Wilson of the West End talks about possible cuts in Medicaid as she waits for a dental appointment Thursday at the West End Health Center. (Gary Landers photo) | ZOOM |

COLUMBUS - Some 30,000 low-income parents, many of them single working mothers, must lose their medical benefits so the state can pull through its financial crisis, Gov. Bob Taft said Thursday.

And 800,000 poor and disabled Ohioans must lose coverage for visits to dentists, eye doctors, psychologists, chiropractors and podiatrists, the governor said.

"This is the last thing we want to do," Mr. Taft said. "But we have very few options, frankly."

One day after his grim State of the State speech, the governor proposed the cuts as a way to tackle a state budget deficit that in the next two years could be as high as $4 billion. Other cost-cutting measures would include freezing the rates paid to nursing homes, hospitals and doctors who treat Medicaid patients.

Mr. Taft said Ohio will go bankrupt if the state doesn't reduce billions of dollars in annual spending on Medicaid, the health care safety net for more than 1.7 million poor, elderly and disabled Ohioans.

"If we don't slow the growth rate of Medicaid, the result will be to decimate every other category of state spending - colleges, seniors, parks, public health and public safety," Mr. Taft said. "Our current growth rate is unsustainable."

Dismayed county officials responded that the cuts will force poor working parents, especially single mothers, to make heartbreaking decisions. In the case of a single parent, eligibility would be eliminated for anyone with income over $13,000 a year.

MEDICAID COVERAGE

1.7 million Ohioans in fiscal year 2001, including: • 1 in 8 Ohioans • 1 in 4 children • 1 in 4 seniors age 85 and up •1 in 3 births in Ohio • 70 percent of all nursing home care Source: Ohio Department of Job and Family Services

"They'll go back to choosing whether to put food on the table or see a doctor they need to see," said Laurie Petrie, spokesperson for the Hamilton County Department of Job and Family Services. "It's an awful choice."

Adrienne Brown, a 19-year-old single mother from Avondale, was devastated by the news that she might lose her benefits. Ms. Brown, who works as a full-time customer service representative at a Cincinnati research company, said that after paying her bills she's left with $100 a month.

There is no money to pay for medical care, she said. "What about the mothers that can't afford insurance, where are they supposed to go?" she asked.

Ms. Brown said that if she loses her health benefits, "I won't have a choice. I'll be behind on my bills. I won't be able to go to a doctor. I see myself sitting in an emergency room somewhere."

Jerome Kearns, assistant director of the Butler County Job and Family Services agency, said single moms and other working poor parents already feel beaten down. "They will see this as just another obstacle that keeps them from reaching self-sufficiency."

He added that cutting payments for visits to psychologists, dentists and other medical treatment to all the poor and disabled will have a crushing impact. In 2001, Medicaid helped more than 160,000 poor or disabled people in Hamilton, Butler, Warren and Clermont counties.

He said many poor people already can't find dentists or doctors willing to accept Medicaid payments. Now they will have to do without. "It's really, really disheartening," he said.

Officials with the Department of Jobs and Family Services, which oversees the Medicaid program, say they want to cut payments for dental care and other medical services for 800,000 poor and disabled by Jan. 1.

Mr. Taft needs legislators to sign off on his other proposals, including cutting all medical benefits to 30,000 low-income parents by October and freezing Medicaid payments to nursing homes for the elderly and mentally retarded starting in July. Medicaid pays for 70 percent of all nursing home care in Ohio.

Peter Van Runkle, president of the Ohio Health Care Association, the lobbying arm for nursing homes, said the governor's plan would force some homes to close and others to cut critical services.

He said the cuts could eliminate about 12 nursing assistants from each nursing home. Most have 34. "It will result in less care provided to the frail elderly," Mr. Van Runkle said. "You're pushing some folks off the cliff."

Not so, said Mr. Taft. He noted that Ohio pays for beds and health care services many older Ohioans never use. In 1999, more than one out of every 10 beds the state tracked in Ohio's 980 nursing homes went unused on any given day.

But while fewer citizens are using beds - opting instead for at-home care - payments to nursing homes that averaged $47,000 a year per bed went up, not down.

Greg Moody, Mr. Taft's executive assistant for human services, provided data showing Ohio has 25 percent more nursing home beds per capita than the national average and has a reimbursement rate 20 percent higher than 10 states similar to Ohio.

The Taft administration has lobbied the legislature to spend less on nursing homes and more on Passport, a program that provides at-home care to the elderly. But lawmakers ignored those requests.

"Today, far more people prefer to be cared for in their own homes," Mr. Taft said. "Yet in the current formula we are paying for empty beds."

Hospital officials and doctors warned that if the Taft plan passes, more physicians are likely to refuse Medicaid patients and some hospitals may have to close. Nearly eight of every 10 doctors who responded to a 2002 Ohio Academy of Family Physicians' survey said they lose money when they care for Medicaid patients because of low reimbursement.

"You certainly can't see Medicaid patients when it costs you money to do it," said Ann Spicer, the group's vice president. "Doctors are, essentially, small businesses."

A Medicaid freeze would cost hospitals $180 million over two years, said Tiffany Himmelreich, a spokeswoman for the Ohio Hospitals Association.

"Down the road, some hospitals may have to make the difficult decisions to close, depending on how bad the situation gets," she said.

Mr. Taft said such drastic measures are necessary, in part, because the federal government is refusing to address the need to pay for prescription drugs for seniors through Medicare, the health care program for the elderly.

Because Medicaid pays for such drugs for low-income people, he said the state is footing the bill for Congress' inaction.

"The real solution to this problem lies in Washington," he said. "Without real reform the Medicaid system will crash and the entire medical safety net in this country, not just in Ohio but in every other state, will be shredded."

Until that happens, Mr. Taft wants the poor and disabled to pay $3 for prescriptions that aren't on a list of state-approved drugs.

Scott Milburn, spokesman for U.S. Sen. George Voinovich, a former Ohio governor, said the senator agrees the federal government must pass a prescription drug plan, although the costs could run as high as $500 billion.

"He (Voinovich) was very disappointed Congress didn't get its act together and pass it last year," Mr. Milburn said.

The state and federal governments will spend $8.8 billion this fiscal year providing medical coverage to Ohio's needy. Without cuts in spending, expenses are expected to jump 24 percent to $10.9 billion by 2005.

The federal government covers about 60 percent of that cost. The state picks up the rest.

Mr. Taft said Ohio must cut $1.1 billion in spending over the next two fiscal years to balance the budget. Several legislators on Thursday agreed that some cuts are necessary, but they say the issue faces a tough debate in the General Assembly.

State Sen. Jeff Jacobson, a suburban Dayton Republican, said lawmakers need to work out the details.

"I think we were very generous when we had the money. Perhaps overly generous," Mr. Jacobson said about recent expansions of the Medicaid program to include working-poor parents. "These were good things we did, but we exceeded our grasp."

Other lawmakers applauded Mr. Taft and said he wasn't going far enough.

"You got to do those kind of things. You've got to cut back the size of government," said Sen. Jim Jordan, R-Urbana. "Hard times require hard decisions and sacrifice for a whole bunch of folks."

E-mail djasper@enquirer.com and shunt@enquirer.com