Fearing that Medicaid could bankrupt the state, Gov. Bob Taft has proposed $468 million in Medicaid cuts.

This has some fearing that increased medical expenses could bankrupt the working poor and make the sick sicker.

In Lawrence County, 14,117 people receive Medicaid benefits, according to Buddy Martin, director of the Lawrence County office of the Ohio Department of Job and Family Services. Nursing homes throughout the county also receive $1,251,496 in reimbursements.

When many people lose their jobs, the economy slows down, resulting in cuts in programs such as Medicaid, Martin said. However, more people need assistance in times of economic downturn.

"It's a self-fulfilling prophecy," he said.

Taft's plan would include making 30,000 of the 400,000 adults who became eligible for Medicaid benefits when a state program for poor families began in July 2000. Their children would not be affected. The plan also includes freezing reimbursement rates for nursing homes, hospitals and in-home providers in Ohio over the next two budget years. It would also eliminate coverage for some services the state has the option of offering, including dental, vision, podiatry, chiropractic and psychological services.

Rick Heaberlin, administrator for Jo-Lin Health Center in Ironton, said he and other employees of the nursing home are playing a "waiting game."

"If they change the rules, we'll abide by them, and we'll make it," he said. "We'll adjust to meet budget cuts that come along and continue to provide quality care to our residents."

Martin said when former welfare recipients go to work, they usually take a low-wage, entry-level position which does not offer health insurance coverage. Having to have a lower income to receive Medicaid benefits could discourage welfare recipients from finding work, Martin said.

Working parents with a low income not receiving health care coverage could still be detrimental to their children, even if the children still receive benefits.

"If a couple works a job that pays them $6 to $7 an hour each, and they have no health insurance, suppose one had to have cardiac bypass," Kathy Lee, medical supervisor for the Ironton-Lawrence County CAO said. "Well, most places would just let them die, but if they do get it, they will pay on it for the rest of their lives. They'll live less healthy because they'll be stressed out over the medical bills, they won't have the means for necessary items, they'll miss work and it just goes on and on."

The couple's other alternative is living on public assistance.

"Children live what they see," she said. "When they get older, they will learn it is OK to be on welfare."

State Sen. John Carey, R-Wellston, of the 17th Senate District, said Taft's plan only consists of proposals. He plans to suggest other options in dealing with Medicaid cuts. In the case of the optional services such as dental and vision, he suggests a co-pay plan rather than completely eliminating coverage.

He also expressed concern about some working parents losing coverage. Currently, uninsured children 19 or younger must be at 200 percent of the federal poverty level to qualify for Medicaid benefits. That will remain the same, but parents with children 19 or younger would have to be between 70-90 percent of the federal poverty level when they now only have to be at 100 percent, Carey said.

"It's always a risk because part of welfare reform is encouraging people to work," he said.

Even with cuts, Medicaid expenses are expected to rise 14 percent due to health care costs, Carey continued. Without the cuts, the expenses are expected to rise 27 percent.

According to State Rep. Todd Book, D-McDermott, of the 89th District, the ones who will suffer the most if Taft's proposals are approved are the ones already struggling. During the mid-1990s, government agencies' "workfare" policies sought to get people off public assistance. This was needed, Book said, but those people who are now making sacrifices to work rather than be on public assistance would lose Medicaid coverage.

Book said he met with a member of Taft's staff last week to suggest starting a trust fund in which people can begin paying for their own nursing home care while they are still working. With the "baby boom" generation aging, it is critical that nursing home facilities are not forced to close because of cuts, he said.

"There are real problems with balancing the budget on the backs of the working poor," he said. "Everything is on the table right now. We have to live within our means, and in this slow time, we need to tighten our belts. But, we need to look at where we are tightening them."