In the contentious debate over the federal health care bill recently approved by Democrats in Congress and signed by President Barack Obama, you may have heard supporters cite numbers from the Congressional Budget Office to argue that the proposal is fiscally-neutral.

In reality, the new law just passes the buck to the states, many of which are already struggling to balance their budgets.

In Ohio, for instance, where state leaders are expected to face a $4 to $8 billion structural deficit during the next budget process in 2011, the federal health care package requires that we expand Medicaid eligibility to individuals under the age of 65 who have incomes up to 133 percent of the federal poverty level.

An analysis by state officials found that this change will grow Medicaid enrollment in Ohio by 25 percent, bringing an additional 554,000 Ohioans into the program.

Ohio already spends $4.5 billion per year in state funds to provide Medicaid services to low-income Ohioans, and the new federal health care rules will force Ohio taxpayers to shell out hundreds of millions of dollars more for the program over the next decade.

According to estimates released by the National Governors Association and the National Conference of State Legislatures, Ohio may have to provide an additional $350 million in Medicaid payments beginning in 2017 through 2019 under the health care overhaul.

This means that without a huge tax increase, there will be less state money to fund education, prisons, libraries, local governments and other necessary services.

The health care bill may be budget-neutral for the federal government, but it is not budget-neutral for the state of Ohio.

While there are noble goals driving the health care effort in Washington, D.C., I believe the plan carries a number of unfair consequences for state and local governments, Ohio businesses and individuals.

For example, Ohioans who earn above 133 percent of the federal poverty level will be required to buy insurance in the private market even if they can’t afford it, or they will have to pay a penalty that could reach several hundred dollars per year for some households.

At the same time, those who are unable or unwilling to work will receive care for free through the government.

In addition, the federal health care law includes a number of new taxes, fees and other costly mandates on businesses, which threaten to stifle economic development, force some companies to shut down or discourage others from hiring new workers.

For instance, employers who fail to provide health insurance for eligible employees could be fined $2,000 or more per full-time worker.

Currently, no person who walks into a hospital, whether they are insured or uninsured, is denied treatment.

Hospitals are then reimbursed for this uncompensated care by the federal government.

However, the feds will begin to cut payments for uncompensated care over the next several years based on the assumption that all Americans will have some type of health insurance, which is highly unlikely. If their assumption is not correct, hospitals will have to absorb these costs.

Further, the federal government is forcing changes under their health care overhaul to programs that Ohio has already addressed in a more efficient manner, such as coverage for high-risk patients, young adults and children.

I may be accused of just saying “no” to health care reform, and that is okay. It is my job to speak out against a plan which I believe will be bad for my constituents.

Ohio has successfully partnered with the federal government over the years to help reform Medicaid and provide greater access to health coverage for those in need.

But, with passage of the federal health care bill late last month, leaders in Washington are now forcing a policy on our state that will put a significant strain our already tight budget, raise costs for individuals and businesses and limit the rights of every Ohioan to make their own health care choices.

I believe that is wrong.

John A. Carey is a member of the Ohio Senate and represents the 17th District. He can be reached at Ohio Senate, Statehouse, Columbus, Ohio 43215 or by phone at (614) 466-8156.