On Medicaid, GOP lawmakers out for themselves

Ohio Governor John Kasich explains to a crowd in the Ohio Statehouse atrium why he believes the legislature should extend health coverage through Medicaid.
Ohio Governor John Kasich explains to a crowd in the Ohio Statehouse atrium why he believes the legislature should extend health coverage through Medicaid.

The State of Ohio can provide health insurance, starting next January, to 275,000 working-poor citizens across this state who now lack coverage. That total includes 18,000 Lucas County residents and 26,000 military veterans. It remains the right thing to do.

Or state lawmakers can “reform” Ohio’s Medicaid program in a way that could kick low-income and disabled people off its rolls, rather than expand enrollment, by subjecting them to harsh work demands and time limits on eligibility. That would leave these folks, and the state in general, poorer and sicker. That would be wrong.

Expanding Ohio Medicaid, nonpartisan experts say, would save the state hundreds of millions of dollars, generate $1 billion in state and local tax revenue through 2022, create 32,000 jobs, stimulate economic development, cut crime, reduce hospitals’ high costs of uncompensated emergency care, and prevent the shifting of those costs to consumers with private health insurance and to the employers who provide it.

The federal Affordable Care Act, also known as Obamacare, would allocate $13 billion to the state over seven years for Medicaid expansion — nearly all of its cost. Ohio business lobbies, medical providers, police agencies, veterans organizations, and religious and social-service groups all support expansion. So do most Ohioans, polls suggest.

Arrayed against all that, curtailing Medicaid would enable Republican lawmakers to cozy up to the extremist fringe of Obamacare haters, in Ohio and in powerful national special-interest groups, who could affect their re-election prospects next year.

What will Columbus do? Anyone who’s paid any attention to Statehouse machinations over the past three years knows which way to bet. And the bet isn’t on the have-nots.

Gov. John Kasich, who’s as Republican as they come, tried to include Medicaid expansion in the new state budget that took effect this month. Not that he’s an advocate of Obamacare — he has refused to create a state online insurance marketplace that the health-care law calls for, leaving that task to Washington bureaucrats.

The governor is disingenuous when he says, as he did last week, that “I don’t see the connection” between Medicaid expansion and Obamacare. But he understands that you don’t leave $13 billion in federal aid, much of it from taxes paid by Ohioans, on the table. And he continues to speak eloquently and with evident sincerity about the moral imperative of helping Ohio’s poor and struggling families cope with their medical needs.

Neither the economic nor social argument impresses the Republican lawmakers who control the General Assembly. They included in the budget a provision that specifically prohibited Medicaid expansion, which the governor vetoed. Legislative leaders talk about voting on bills this fall that would change, but not necessarily expand, the program.

Is some deep intellectual or ethical principle at work here? Please — we’re talking about the legislature. GOP lawmakers’ priorities are (1) getting re-elected in 2014, and (2) beyond that, perpetuating the political system that keeps them in power.

The legislative redistricting plan that Governor Kasich and other GOP leaders bulled through for last year’s election is designed to create so many safe seats as to place incumbents beyond voter accountability in general elections. (Not to say I told you so, but Ohioans could have voted last November to throw out the rotten Republican gerrymander and replace it with a nonpartisan reapportionment system — and opted for the status quo.)

The greater threat to many Republican lawmakers would be a primary challenge next year from a well-financed, even farther-right challenger. That’s why you’re seeing so many GOP legislators buddying up to groups such as Americans for Prosperity Ohio, an outfit bankrolled by the oil-billionaire Koch brothers that opposes Obamacare and the state Medicaid expansion with equal vehemence.

Americans for Prosperity last week denounced Ohio Medicaid as an “unaffordable, broken program.” Many Republican lawmakers engage in similarly sharp, albeit vague, rhetoric.

You wonder how Mr. Kasich feels when he hears such barbs, since the Governor’s Office of Health Transformation is the greatest success of his administration. It has limited the cost of Ohio Medicaid without sacrificing quality of care or curbing access to it.

The office has won national accolades for fighting fraud and identifying abuse, among providers and recipients. What do lawmakers think they can do to improve Medicaid that the professionals haven’t done?

Some Republican lawmakers offer the excuse that they oppose Medicaid expansion because Washington could renege on its financial commitment and stick Ohio with the bill. But Mr. Kasich insists the expansion won’t proceed if it isn’t funded — a position affirmed by state and federal regulators.

Democrats complain that the governor needs to spend less time making speeches and more time twisting arms of defiant Republican legislators. There probably are enough votes among lawmakers of both parties to pass Medicaid expansion now; state Rep. Barbara Sears of Monclova Township, for example, is a responsible exception to the general GOP obstructionism.

But state House Speaker William Bachelder — taking a cue from his counterpart in Congress, House Speaker John Boehner of Ohio — is loath to let a bill come to the floor unless most Republicans support it. In other words: Only Republican votes count. Senate President Keith Faber has been equally intransigent.

To get Medicaid expansion in place by Jan. 1, Kasich administration officials say they need legislative approval this summer. That likely would require our full-time lawmakers to cut short their summer recess and return to the Statehouse.

Ohio’s GOP lawmakers can work in the best interest of this state and its taxpayers. Or they can pursue political self-interest, as they define it, by taking orders from the Koch brothers and the Tea Party. They can’t do both.

Instead, lawmakers need to choose. Governor Kasich has started that process, gently. Now it’s your turn.

Let your legislators know that they haven’t earned a vacation. Tell them they need to come back to Columbus — the sooner the better — to pass the Medicaid expansion, without subverting it with phony “reforms.”

And however much the electoral game is rigged against Ohio voters, keep this cynical nonsense in mind in 2014 when you help to choose the next General Assembly.

David Kushma is editor of The Blade.

Contact him at: or on Twitter @dkushma1