COLUMBUS, Ohio – A new bill in the Ohio Senate would require Medicaid expansion enrollees to pay premiums and make copayments on some medical services.

Senate Bill 60, which would start a program called in the bill the Medicaid Personal Responsibility Initiative, doesn’t have specific dollar amounts for co-pays and premiums. That’s purposeful, said sponsor Sen. David Burke, a Union County Republican.

“It’s meant to start a discussion,” he said.

However, he said that co-pays would be “nominal,” such as $5.

Copayments would be required under the bill when patients see specialists -- unless they received a general practitioner’s referral first -- and if they visit an emergency room. Medicaid patients are technically currently required to pay co-pays, such as $3 each time they visit the dentist, however there are exceptions, and most recipients do not pay anything.

The bill requires premiums to be on a sliding scale.

Burke said they could be maybe 2 to 3 percent of someone’s income. For instance, if a person earns $10,000 a year, a 2 percent premium charge would be $200 yearly.

Loren Anthes of the Cleveland-based health care think tank the Center for Community Solutions said the requirements “usually result in people being confused and dis-enrolling."

“If the goal is to save money through dis-enrollment, these policy ideas will be very effective,” he said. “If the goal is to encourage greater workforce participation and cost-sharing, I don’t think this accomplishes it. I think the opposite will happen.”

Anthes said SB 60 brings back some of the Medicaid cost-sharing ideas that existed in Healthy Ohio, a different Medicaid program that the state asked the federal government to OK. The federal government determined it was not legal.

Just under 3 million Ohioans receive Medicaid. Of those, the Ohio Department of Medicaid says approximately 633,000 people are part of the expansion group – adults aged 18 to 64 with incomes of up to 138 percent of the federal poverty level. That is $12,140 for individuals and $25,100 for a family of four.

Medicaid expansion is part of the Affordable Care Act. It began in Ohio in 2014, under Gov. John Kasich’s administration.

Burke, who is a pharmacist in Marysville, said that if expansion enrollees leave Medicaid, due to a higher income or a new job with health benefits, they will most likely have to pay premiums, deductibles and co-payments. Medicaid should prepare them for that, he said.

“Unfortunately, with the cost of health care, to shelter someone from the costs of the real world is an act of disservice,” he said.

In addition to the premium and co-pay provisions, Burke’s bill has work requirements. Ohio Medicaid currently has a work requirement application before the federal government. A Medicaid spokesman said Thursday morning it hasn’t heard back from the feds on whether the state can proceed with the requirements, which are controversial.

Also in the Senate is Rep. Matt Huffman’s Senate Bill 25, which would impose even tougher work requirements for Medicaid expansion recipients. For instance, in the state’s proposal before the feds, enrollees up to age 50 would have to work. In SB 25, enrollees up to 65 years old would have to work.

Burke said that his and Huffman’s bills are needed make sure the Senate has a voice in any Medicaid changes made under the DeWine administration.

Burke said his bill hasn’t yet been assigned a committee. Unlike hundreds of other bills sponsored in the legislature, this one may have a shot at becoming law, since he is the chairman of the Senate Health, Human Services and Medicaid Committee.

He said he wants to talk to the DeWine administration about its feelings about whether and how much Medicaid recipients should pay. A message left with DeWine’s spokesman about the bill was not yet returned.

“As someone who works in Medicaid, I just want to get a discussion going,” Burke said.

Ohio Consumers for Health Coverage, a coalition that said it fights for consumers to have higher quality and affordable coverage, opposes both Senate bills.

“While SB 60 is less burdensome than SB 25 in that SB 60 applies an exemption at age 50, it still begs the question why the Senate wants to restart the waiver process and what impact it will have at the end,” said Graham Bowman, Ohio Poverty Law Center Attorney, a member of Ohio Consumers for Health Coverage, in a statement.