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Be Well: Who Are 'The Poor' Who Qualify For Medicaid Expansion?

About 2.2 million Ohioans currently receive Medicaid. Mostly, these are parents and children, plus some who qualify because they are aged, blind or disabled.

Now, under the expansion engineered by Ohio Gov. John Kasich, about 275,000 more people will qualify in Ohio.

Who are the newly eligible?

Medicaid was created to provide health insurance for the poorest of the poor. But, in Ohio, a lot of the poor have been excluded. It's primarily been for the poor who have families; more specifically, it has been for adults with children living at home But adults with no children haven't been able to qualify for the health coverage.

One could earn as little as $11,500 a year and still not qualify for Medicaid. Under the new Medicaid expansion, childless adults with incomes of $15,800 or less annually will now have access to Medicaid.

People who are poor haven't necessarily always been poor. I can imagine people who've done well but then lost a job and couldn't find work for a long time yet wouldn't get Medicaid.

When we talk about policy, it's always helpful to keep it real by talking about individuals. Let me introduce you to Doug Pfouts, who I met in Cleveland Heights earlier this year. I was struck by how he just didn't fit in any stereo type of "the poor."

He was doing some home construction work with a friend who had hired him as a sort of helper. He was way over-qualified for the job but needed whatever money he could make. He was in a very different economic situation than he had been in a few years earlier, before the recession.

"I have a degree in energy management with some grad school in geology and I have over 20 years in energy engineering and energy management. So I have the technical background. You'd think it would be a strong field. And, it's actually people are being laid off in that field," Pfouts said.

Pfout quit a $72,000 a year job a few years ago, thinking he had a better opportunity. That didn't pan out. He moved in with his brother out in Stark County this summer because the bills were just piling up.

"The tough thing is because you're used to living at the higher rate, and you know, my stupidity is I got myself in debt and things and now I just can't afford all the payments on things. I'm in the rear on trying to pay off everything and there's a lot of people trying to do that because you are you are taking the jobs that are lower paying so you have at least money come in to survive on and it's just a matter of figuring out what do you don't pay and what do you pay," Pfouts says.

Among the unpaid bills: A $5,000 visit to the emergency room.

Without insurance Pfouts also couldn't pay for all the insulin he needs to manage his Type 1 diabetes. He'd decrease the amount of food he was eating to offset the fact that he couldn't afford his medicine. That lack of insulin hampered the ability of his immune system to fight off colds and other viruses. He came down with pneumonia.

People like Doug would qualify for Medicaid in the future. Fortunately for Doug, his situation already has improved. He got married this summer, his wife has two children, so now the family…including Doug…qualify for Medicaid. And, a few weeks ago, Doug started a new full-time job that pays over $30,000 and will provide health insurance in the coming year.