STEVE INSKEEP, HOST:
The future of the Affordable Care Act means a lot to the people we're about to meet in Ohio. Republicans in Congress are moving to repeal the law and have not said what they want to replace it. One part of the law known as Obamacare allowed states to expand Medicaid, the health insurance program for the poor. Some States declined that opportunity, but Ohio's Republican governor, John Kasich, took it. Nick Castele of WCPN Ideastream met people who were affected.
NICK CASTELE, BYLINE: It's lunchtime at a social services drop-in center in Cleveland. In the back of the cafeteria, a pair of health care navigators are making calls to help people sign up for Medicaid. Nearby, Evelyn Johnson says health insurance has really helped her.
EVELYN JOHNSON: So far, I've gotten a pair of glasses. And they're going to do my teeth.
CASTELE: Johnson is living with a friend, does not have kids and makes some money babysitting. She says without Medicaid, she would not be able to get the various prescription drugs she needs.
JOHNSON: If I had to pay for my medical costs, I wouldn't be taking no medicine. There's no way. I take too many pills.
CASTELE: Around 700,000 Ohioans have signed up for expanded Medicaid since January 2014. It used to be limited largely to low-income children, parents and people with disabilities. Now all individuals making at or below $16,000 a year for a single person can be covered. Ohio Governor John Kasich staked out an unpopular position among many Republicans. He fought his own party and then sidestepped the state legislature to get the expansion done. At an event with business leaders this month, Kasich argued it's been a good deal for the state.
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JOHN KASICH: If they don't get coverage, they end up in the emergency room. They end up sicker, more expensive, and we pay one way or the other. And so this has been a good thing for Ohio.
CASTELE: Also defending their decisions to expand Medicaid are such Republican governors as Rick Snyder in Michigan and Brian Sandoval in Nevada.
JOHN CORLETT: You pull on one thread, you topple the whole tower.
CASTELE: John Corlett ran Medicaid in Ohio under the previous Democratic administration. Now he runs a think tank in Cleveland called the Center for Community Solutions.
CORLETT: There's nothing to say that the program can't be improved - that it can't be, you know, made better. But to - just to say we're going to get rid of all of it and then we'll figure out how to make it better, I think, would be really disruptive. It'd be disruptive to health care providers, to patients.
CASTELE: Medicaid covers about 1 in 4 people here in Ohio. So if there are cuts, doctors and hospitals will see a financial impact. Last year, the state asked the federal government to require beneficiaries to pay into health savings accounts. The feds denied it. But with a new administration, there could be changes on the horizon.
GREG LAWSON: Well, I think that with the constellation in Washington the way that it is, that there's going to be an awful lot of opportunities.
CASTELE: Greg Lawson is a senior policy analyst with the Buckeye Institute, a conservative think tank in Ohio that opposed expansion. He'd like to see limits on federal spending per state. And he hopes Ohio will get more freedom to alter Medicaid, such as by adding a work requirement for some beneficiaries.
LAWSON: I don't think you're going to see the light switch, probably, just get turned and, you know, one day it's all going to just disappear. I think what you're more likely to see is major structural changes to the program that, over time, will have budgetary impacts.
CASTELE: But it's not clear yet what shape those changes will take or whether the governor who expanded Medicaid here will support them.
For NPR News, I'm Nick Castele in Cleveland.
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