After Ohio’s Department of Medicaid and the Controlling Board granted Governor John Kasich’s request to use $2.56 billion of federal funding to expand Medicaid’s accessibility in Ohio, changes to the cost and structure of residential health care plans have became apparent in more remote residential areas. In Lorain County, 44,000 people are now eligible for Medicare and Medicaid benefits.

Clients served by Oberlin Community Services, a local non-profit, are largely eligible for these assorted welfare programs.

“I know people [for] whom it’s almost unaffordable now to get healthcare. They have to do something, because starting next year there’s going to be pretty hefty fines [for failure to enroll in the new marketplaces established under the Affordable Care Act],” said Kathy Burns, director of Client Services at OCS. “I saw the breakdown of some of the fines — just the first-tier fine was $700 for next year.”

According to Lorain County Commissioner Ted Kalo, a new statewide computer enrollment program for Medicare and Medicaid beneficiaries should make the expansion as accessible as possible for those who need it. The cost of the expansion is managed at the state level, which issues monthly reports to counties. The program itself is administered through the Department of Child and Family Services.

“I think it will take us three to five years to see the overall impact of what those changes might be. Health care [costs] always go up, it seems; we’ve been able to hold ours at about 12 percent or 13 percent from last year,” said Kalo. “Actually it was a little bit higher than that, about 18 percent but because of our cash reserves we’ve had, we’re able to only implement about a 12 percent increase,” he added.

Lorain County Commissioner Lori Kokoski did not mention rising costs. She highlighted the increased coverage for residents under the expansion implemented by Governor Kasich.

“I think [there are] a lot of people who have fallen between the cracks [who] will now be covered,” said Kokoski.

Rule changes under the ACA have begun to take place in Lorain County, including the requirement that insurance plans must now cover children.

The county spends $26 million a year on its health plan. According to Kalo, the new rules will cost the county an additional $260,000.

The county itself is self-insured: The government accepts a percentage of the risk associated with insuring its residents, instead of simply leaving insurance to the marketplaces. Because of this system, most of the changes mandated under the ACA have not affected the county as dramatically as the rest of the country.

Many of the costs and changes from the ACA in Lorain County remain unclear. As the final date for enrollment nears, residents will either enroll or face the fines imposed by the law.