7 TH DISTRICT ______



T: (614) 466-4895

Ohio General Assembly
House of Representatives Columbus

F: (614) 719-6957


REMARKS OF STATE REPRESENTATIVE MIKE DOVILLA ON HOUSE BILL 59 IN THE OHIO HOUSE OF REPRESENTATIVES THURSDAY, APRIL 18, 2013 As prepared for delivery. Thank you, Mr. Speaker. I ask leave to speak to the bill as well as the amendment. There exists an old proverb, “May you live in interesting times.” Although its origin as a Chinese curse may be apocryphal, its dubious nature as a good wish remains. For here in Ohio and the United States today, we most certainly live in interesting times. Two years ago, we faced an $8 billion structural imbalance in our state budget. Through a series of difficult policy decisions, we successfully eliminated that shortfall, lowered taxes, and began placing Ohio on a path toward prosperity that already has helped drive economic development, create more than 120,000 jobs, and lower unemployment by two percent. I have long believed that, while government cannot create jobs, the policies we advance in the public arena can have an impact that either spurs or stymies economic growth. Two years later, we continue to be confronted with difficult choices in the budget before us today. And in many ways this budget presents greater challenges than the last one. In 2011, the mission was clear: as required by the Ohio Constitution, balance a budget left incredibly out of balance by decisions made in the previous biennium, the use of one-time federal stimulus money, and other budgetary tactics. Now, with a rainy day fund replenished from 89 cents to over a billion dollars and our great state beginning to realize progress resulting from a more business-friendly climate, this General Assembly received from our governor a budget filled with creative ideas – and a challenge to play our part in the legislative process that moves from his proposing to our disposing. On our initial part of this process, I believe we have done a good job. And we each owe a debt of gratitude to Chairman Amstutz, Vice Chairman McClain, Ranking Member Sykes, and the chairmen of the Finance Committee’s various subcommittees for charting and navigating a course that allowed us to move deliberately through this large bill. I was particularly pleased with the bipartisan manner in which our Higher Education Subcommittee conducted its business. Our panel of five members, three Republicans and two Democrats, led by Chairman Rosenberger, worked in a collaborative manner, and I truly enjoyed the experience of serving with that team of legislators on an issue set that is particularly important to me as an adjunct professor and advocate for students.

In any budget or other bill of this complexity, there are always plenty of reasons to vote in favor of or against it. For my part, I am pleased that this amended substitute bill includes provisions I offered to create the Youth STEM Commercialization and Entrepreneurship Program for high school students, to increase funding for Adult Basic and Literacy Education that allows public libraries to assist adult learners in remedial coursework instruction, and that validates the use of the Motion Picture Tax Credit program fund. All of these provisions will continue our efforts to leverage our state’s existing strengths and prepare the workforce of the future. More broadly, this budget reflects our ongoing commitment to lower taxes; provide efficient, effective government that responsibly appropriates taxpayers’ dollars; and emphasize the important role primary, secondary, and higher education play in generating an economic development pipeline of Ohio’s greatest resource for the future – the people of our state. Arguably, the most vexing element of this budget was the Medicaid expansion proposal, and on that matter I do not believe we have had adequate time to reach the best public policy result for Ohioans. One of the key lessons from the passage of the Affordable Care Act in Congress and Senate Bill 5 here in the General Assembly is that process often is as important as the specific provisions or impacts of legislation, regardless of the topic and merits of what is enacted. And in that regard, I believe (1) the original proposal to expand Medicaid in the budget has not had adequate time for full vetting and (2) the insistence of some to remove those budget provisions with no viable policy alternative does not represent responsible public policymaking. Medicaid is not a simple program, and it cannot be reformed – with or without expansion – with a simple fix. In an e-mail I have been using to be a responsive representative to my constituents in the 7th District, I have laid out some of the facts. And thanks to our friends the Center for Health Affairs, each of your offices and those of our Senate colleagues received a copy of that constituent e-mail. I appreciate the efforts of that organization to share my fact-based analysis with each of you in this letter. For those who haven’t had the chance to read that letter or my e -mail, let’s consider those facts here:

First, the cost of Medicaid to the State of Ohio is undeniable and unsustainable. The average

annual growth rate in the program has been 7.2 percent from 1992 through 2011. This is based on analysis provided by our non-partisan Legislative Service Commission. Clearly, Medicaid is not the only state expense on the rise in the past two decades; however, Medicaid is consuming an ever greater portion of the state budget. Spending on Medicaid over the last 20 years has grown faster than spending on infrastructure, education, and almost every other category of funds which are appropriated by this legislature. Which begs the question, what happens when the federal government chooses not to reimburse the state for 90 percent of expenses after three years? Will the advocates for immediate expansion now – without full hearings on this matter – support the retraction of Medicaid expansion if the costs are not covered? Or will they insist that the state continue to fund Medicaid expansion at the expense of public education and other budget priorities? The simple truth is that we have scarce taxpayer dollars to allocate. These dollars must be allocated in a way which respects taxpayers by providing government services that are efficient and effective.

Second, health insurance is not the same as heath care. I find it interesting that many

advocates for immediate expansion do not seem to have a position on this important topic. Medicaid has been insuring Ohioans for decades. Yet, insuring Ohioans is not the same as providing health care for Ohioans. Countless studies, including a recent peer-reviewed analysis by the University of Virginia, have found that individuals on Medicaid have worse health care outcomes than individuals with private insurance or with no insurance at all. In fact, that study, which some have summarily dismissed, controlled for over 30 variables, including co-morbidity, age, gender, and income. This allowed researchers to determine whether Medicaid patients have worse outcomes if other variables are held constant. Our current Medicaid system, and the originally proposed expansion, does not work for Ohioans in need. Everyone agrees that preventative health care is necessary to provide for better health outcomes at decreased costs, yet system wide we ignore this truth.

Third, Medicaid recipients need access to good physicians. In an ideal world, all physicians

would accept Medicaid. Yet, over 25 percent of physicians refuse to accept Medicaid patients. And why? We know definitively that Medicaid routinely underpays physicians and hospitals for the assistance they provide patients. We also know that these costs must be passed on to paying consumers – either those who are privately insured or uninsured by choice. Under the original Medicaid expansion proposal, these same doctors and hospitals are guaranteed a reimbursement rate considerably less than that which private insurers and uninsured individuals pay, and that rate would only be in effect for three years.

Under the proposed expansion, Ohioans will continue to fund a system which is broken. Ohioans will continue to fund a system which is unsustainable for physicians and hospitals, institutions which are critically important economic drivers for my region and our entire state.
The fact of the matter is that Medicaid is a state and federal partnership, not a program simply to be designed by Washington and forced on the states. Our state tax dollars are increasingly being used to support Medicaid in Ohio. Every additional state dollar utilized for Medicaid is one less dollar we can spend on schools, infrastructure, or other state services. Without a question, we must ensure that there is a social safety net, but providing health insurance is not the same thing as providing health care. Listening to my constituents – Democrats, Republicans, and Independents – has reinforced my belief that regardless of party affiliation the future of Medicaid in Ohio must not be a knee-jerk reaction subject to the whims of extremists on one side or healthcare lobbyists on the other.

That’s why remain committed to working with my colleagues in the General Assembly to evaluate all viable options for offering quality health care at sustainable costs to those most in need. And that is the process outlined in this amendment.

As I have shared over the past few days with the Speaker, Chairman Amstutz, and other members of our majority leadership, I maintain that this House can advance a responsible, comprehensive package of Medicaid reforms, but only by undertaking a thorough, rigorous process that brings all Ohio stakeholders, as well as national experts, to the table. Ohioans deserve a thoughtful analysis of the future of health delivery for our state that will result in the development of meaningful reform legislation to help solve Ohio’s solvency issues. Under this proposal, over the course of the coming weeks and months, the House of Representatives will schedule a series of hearings leading to legislative proposals to provide a real set of solutions. I advocate and encourage such a process. This House will lead the effort on this important issue. Our great state can and must lead the Nation in reforming healthcare delivery for those in need. Mr. Speaker and colleagues, I encourage adoption of the amendment and passage of the bill. ### Note: The House of Representatives passed by a unanimous vote of 97-0 the referenced amendment to initiate a rigorous, thorough legislative process leading to healthcare reform for Ohio. After over five hours of debate, the budget bill, as amended, passed the House on a bipartisan vote of 61-35.

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