As 2013 came to a close, thousands of Ohioans began signing up for Medicaid as the Affordable Care Act made nearly 300,000 who were not previously eligible qualify for the low-income health care service.
Locally as well as throughout the state and nation, the expansion and Medicaid itself now has plenty of opponents as well as advocates.
"This is a whole new wave of people we're getting with this expansion," said Tom Ballengee, director of Job and Family Services in Washington County. "The expansion is aimed to help more single, working adults who did not previously qualify because of their age or lack of dependents."
Medicaid is a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.
Both Medicaid and Medicare, which is for older Americans, were created when President Lyndon B. Johnson signed amendments to the Social Security Act on July 30, 1965.
The Patient Protection and Affordable Care Act committed the federal government to pay for any states through the year 2020 who chose to participate in expansion. Ohio's expansion was pushed by Republican Gov. John Kasich from his declaration that veterans, the mentally ill and hard-working but poor adults needed health coverage.
"I don't think the expansion of these entitlement programs is good for anyone," said Leslie Haas, the chairwoman of the Washington County Republican Party.
Haas said she believes in the "Give a man a fish, and you feed him for a day; show him how to fish, and you feed him for a lifetime," principle, believing that it is local and community support that helps people, not federal government assistance.
"Local charities no longer have the kind of power to help people anymore," Haas said. "The federal government has usurped that spirit of generosity in us."
Haas said she thinks Medicaid creates too much dependence, a dependence that in the long run does not help anyone.
Bobbi Jo Horton, a Marietta resident, said she and her husband are both covered by Medicaid, but have some family members, like her aunt, who do not quite qualify because of family or income reasons.
"If this expansion means that more people can have it that really do need it, I see it as a good thing," Horton said. "These are tough times everyone is going through and people need it now more than ever."
Haas said she thinks although the governor justified the expansion because it was to be funded by the federal government, she believes the burden will eventually shift onto the state and local taxpayers.
"Eventually they'll have to realize that there's no money left, and they'll make states cover the costs," she said.
Ballengee did not want to comment on whether he saw the expansion as positive or not, but said his department is working toward preparing for it as much as possible.
Washington County has sent one of its agents to Union County for training throughout the fall and winter to be better educated and ready for a spike in participants they would never have normally seen.
After enrollment for Medicaid under Ohio's expansion opened in November 2013, Ballengee said a spike of about 12,000 sign up in Washington County. He said they expect a possible 2,000 to 3,000 more, a total that he said is a bit shocking.
"That's 15,000 out of about 61,000 in the county, so it's quite a lot of people that are on it just here," he said.
A total of about 6.3 million people became eligible for Medicaid under the federal expansion, which could add large numbers to the previous count of 60 million utilizing the service before the Affordable Care Act took effect.
Medicaid was first enacted in 1965, along with Medicare for people over 65, by President Lyndon B. Johnson.
Medicaid Requirements under Ohio expansion
Adults falling within 138 percent of federal poverty level(Yearly income of less than $15,856).
Nationally: 6.3 million uninsured Americans expected to qualify.
Ohio: 275,000 uninsured Ohioans expected to qualify for Medicaid.
Washington County Department of Job and Family Services, 373-5513.