Sunday, Jun 24, 2018
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David Kushma

Drop the teacup, lawmakers, and expand Medicaid


Gov. John Kasich wants to use the federal Affordable Care Act to expand Ohio’s Medicaid program for low-income and disabled people.


The Republicans who control Ohio’s General Assembly are making an instructive choice. They are denying health insurance to hundreds of thousands of working-poor Ohioans — and defying the governor of their party — so they can pander to the hard-right bloc of GOP voters.

These lawmakers are betting that they will be rewarded, not punished, at the polls next year for working against the best interests of the state and its taxpayers. And given the way Ohio rigs its legislative elections, that calculation may be smart politics, even though it’s terrible public policy.

Gov. John Kasich is no fan of President Obama or Obamacare. Yet he wants to take advantage of the federal Affordable Care Act to expand Ohio’s Medicaid program of health insurance for low-income and disabled people.

The governor’s proposed state budget includes such an expansion. Washington would pay for nearly all of it — an estimated $13 billion.

Mr. Kasich’s plan would provide coverage almost immediately to 275,000 Ohioans who lack health insurance. Over a decade, that total would rise to 456,000 people, including 25,000 in Lucas County.

Medicaid now serves more than 2.2 million Ohioans — about one of every five of us. Most of the state’s Medicaid recipients are children.

With insurance, the new recipients will be more likely to seek preventive and basic health care, and less likely to wait until they are really sick to go to the emergency room and get expensive treatment they can’t pay for but legally can’t be denied. The cost of such uncompensated care now gets shifted to taxpayers, hospitals, those of us with private insurance, and our employers.

Medicaid expansion in Ohio also will save state government hundreds of millions of dollars, generate 32,000 jobs, create more than $1 billion in economic activity, and increase state and local tax revenue by $1 billion through 2022, a recent study by the nonpartisan Health Policy Institute of Ohio concludes.

There is broad agreement on the merits of expansion: not just by the Republican governor, but also among health-care providers, business lobbies, unions, human-service advocates, religious groups, and anti-abortion activists.

But that consensus does not include frightened Republican lawmakers (Rep. Barbara Sears of Monclova Township is a courageous exception who supports Medicaid expansion) or the Tea Party zealots who threaten to oust them in next year’s primary election unless they make Big Bad Obamacare go away.

The House passed a budget bill last month that not only deleted Mr. Kasich’s Medicaid plan, but also explicitly prohibits expansion. Instead, GOP lawmakers said they want to study the issue and introduce separate legislation in September. Democrats proposed a stand-alone bill last week that would expand Medicaid, but they don’t have the votes to pass it.

Republican Senate leaders promptly took the issue off the table as well. They announced the appointment of a task force to examine state Medicaid “reform” outside the budget process.

Such cop-outs will fool only those who want to be fooled. Critics complain of — but don’t identify — rampant waste, fraud, and abuse in Ohio Medicaid. To the contrary, the Governor’s Office of Health Transformation continues to work effectively to control the program’s costs and expand access to care without compromising its quality.

That’s exactly what Republican lawmakers say they want. So removing Medicaid expansion from the budget merely gives them an excuse to talk the matter to death.

Jon Honeck is more optimistic than I am. He is director of public policy and advocacy at the Center for Community Solutions, a nonpartisan research and analysis group in Columbus and Cleveland. He says the fact that lawmakers have even agreed to keep talking about Medicaid offers reason for hope.

“I’m grasping at straws to a certain extent,” Mr. Honeck told me. “It’s a road with a lot of twists and turns, and it would be better to put [expansion] in the budget, but I still think it’s going to happen, some way.”

Trying to salvage something from this fiasco, the Kasich and Obama administrations are examining a plan to recruit private insurers to handle much of Ohio’s Medicaid expansion. That would be better than doing nothing, but it wouldn’t be a great victory.

Private insurance is more expensive than Medicaid. Privatizing the expansion would increase its cost, which means it would insure fewer Ohioans and their coverage would be more meager. The governor was right the first time, and shouldn’t give up on his original plan.

Opponents of Medicaid expansion cite Ohio voters’ 2-to-1 approval in 2011 of an anti-Obama-care amendment to the state constitution. The vague, deceptively worded ballot proposal rejected the Affordable Care Act’s central requirement that nearly all adult Americans must buy health insurance — and employers must provide it — or pay a financial penalty.

The amendment remains purely symbolic; a state constitution can’t nullify a federal law. The U.S. Supreme Court has since upheld the so-called individual mandate. Yet antagonists portray the two-year-old vote as the last word on Ohioans’ disdain for the health-care law.

More recent measures of public opinion are more relevant. A Quinnipiac University poll released in March concluded that while more Ohioans still disapprove than approve of Obamacare, they support Medicaid expansion by 48 to 42 percent.

For most GOP lawmakers, though, the more self-interested finding in the poll is that nearly two-thirds of respondents who called themselves Republicans said they oppose expansion, while one-fourth support it. So Republican legislators who dare to offend their party’s unforgiving base by supporting Medicaid expansion could face even farther-right opponents in the primary next year.

And that’s a greater concern to these lawmakers than the general election. The gerrymandered map of legislative districts that the Ohio GOP rammed through before last year’s election is so one-sided that it is designed to preserve the party’s control of the General Assembly not just after 2014, but for years beyond that.

Last November’s election returns made clear that the Republican-Democratic split among Ohio voters remains even. But any pretense that the legislature represents all Ohioans equally is long gone.

The best course for Ohioans who support Medicaid expansion now appears to be getting a proposal on the November statewide ballot. That’s a long shot, but the alternative is waiting for state lawmakers to do the right thing rather than the partisan thing.

Good luck with that.

David Kushma is editor of The Blade.

Contact him at: or on Twitter @dkushma1

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