More than 600,000 of Ohio poorest people could be without health insurance and would not qualify for subsidies or tax credits, if a Medicaid expansion isn't approved in the state.
The U.S. Supreme Court determined in June that individual states should be allowed to decide if their Medicaid programs should be expanded as part of the Patient Protection and Affordable Care Act.
That decision could leave Ohioans without coverage if Gov. John Kasich decides against expansion. The governor is currently among other Republican leaders who are likely waiting until November's election outcome-and GOP promises to repeal the law- to make a decision.
Tom Ballengee, director of the Washington County Department of Job and Family Services, said there are currently 4,778 families receiving Medicaid in Washington County and 2,083 households where only children receive Medicaid because the parents don't qualify. How many of those people would be impacted is not known at this time.
The decision whether or not to expand Medicaid would probably have more of an impact on those who don't qualify for Medicaid and can't afford private insurance, he said.
"We haven't gotten any numbers yet on how that would affect us, but we would follow suit with whatever the governor decides," Ballengee said.
The same people who visit the Washington County Free Clinic would likely be affected if Medicaid eligibility is not expanded to include those earning up to 138 percent of the federal poverty level, he said.
"We see people at the clinic with no health insurance, no Medicaid, no Medicare ... it is fair to say those people would be affected," he said.
A recent statistical study by Harvard researchers in the New England Journal of Medicine found that states that do expand their Medicaid programs could likely save thousands of lives.
The study found a 6 percent drop in the adult death rate in Arizona, Maine and New York, three states that have recently expanded coverage for low-income residents along the general lines of the federal health care law. It went on to say that for every 178 adults covered under expanded Medicaid, one death per year would be prevented.
An increase in the elderly population, with the inclusion of baby boomers, would mean more uninsured going to emergency rooms and entering nursing homes, according to Rick Hindman, director of the Area Agency on Aging 8 and assistant director of Buckeye Hills-Hocking Valley Regional Development District.
"The state government is worried about what it would cost to expand Medicaid but the numbers they are not looking at are those who go to nursing homes and emergency rooms without any insurance," he said. "That would end up costing the state more."
Hindman, who has been following the health care debate carefully, said expanding Medicaid would include those under the 100 percent poverty level who currently don't get any benefits and wouldn't qualify for the help available to access private health insurance.
"A good percentage of those people are elderly," he said.
Buckeye Hills and the Area Agency on Aging are already experiencing great need for services, such as their Senior Farmers Market Nutrition Program.
"We give coupons to low-income elderly to use at the farmer's market and we don't have enough," he said. "We are already seeing elderly going hungry. (To not expand Medicaid) would make the situation we already have much worse."
About 2.2 million Ohioans are enrolled in the Medicaid program, which serves the poor and disabled. Even without an expansion, officials say hundreds of thousands of people could sign up for Medicaid once the federal law requires that most people have health insurance. That is expected to cost the state $940 million more in 2014 and 2015.
The Associated Press contributed.