Ohio taxpayers barely afford the Medicaid program they have now, much less the vastly more expensive version envisioned under the national health care law.
Medicaid, serving about 2.2 million Buckeye State residents, eats up nearly one-third of the state budget each year. Though federal funding also is received for it, Washington's share is scheduled to decrease, possibly taking Ohio's Medicaid cost up by as much as 43 percent.
Gov. John Kasich's administration wants to reduce Medicaid spending, while at the same time improving the health of those who depend on the program.
A "health home" concept is envisioned and will be kicked off this fall in five counties. If all goes well, the state's remaining 83 counties will join within about a year.
The health home idea is to ensure Medicaid clients are linked to primary care physicians through a concept much like many Ohioans once knew as the family doctor. That single provider will work with other health care specialists, ranging from pharmacists to doctors in all specialties, to ensure Medicaid beneficiaries get the care they need.
Part of the idea is obvious. It is to focus care on a patient's overall needs. Proponents say it should lessen use of emergency rooms and hospital beds, thus lessening the cost of Medicaid - and, again, improving clients' health.
Under various names, the health home concept has been tried elsewhere, with some success.
But in some ways it will make those who rely on Medicaid more responsible for their own health - and that is an idea that sometimes is not popular.
Medicaid spending needs to be gotten under control, however. Merely managing - or, in a sense, failing to manage - the program through the same old failed strategies of the past won't work. Rapidly spiraling expenses have made that approach plainly unsustainable.
The Kasich administration's plan needs to be pursued to end the dual vicious cycles of burgeoning expenses that plague taxpayers and poor health that harms many low-income Ohioans.