Ohio governor John Kasich’s public-relations campaign for Obamacare’s Medicaid expansion could wipe out whatever chance remains for Congress to pass a substantial Obamacare-repeal bill.
Medicaid expansion puts working-age adults with no kids and no disabilities on a welfare program previously reserved for the elderly, the disabled, children, pregnant women, and impoverished families. It’s responsible for a majority of Obamacare enrollment nationwide, and three-fourths of Obamacare enrollment in Ohio.
The American Health Care Act approved by the House retains many of Obamacare’s insurance regulations and replaces Obamacare subsidies with refundable tax credits. Because the reconciliation process requires deficit reduction, any Senate bill that extends Medicaid expansion will also have to keep more of Obamacare’s taxes in place.
The AHCA does not remove from the welfare rolls anyone who has signed up for Medicaid under Obamacare; even future enrollees who sign up by the end of 2019 will be grandfathered in. But that’s not enough for Kasich, whose state budget and national reputation as a “compassionate conservative” are built around Medicaid expansion.
“When people say in my state we should drop 700,000 people, a third of whom are mentally ill or drug-addicted and a quarter of whom are chronically ill, and we should turn our back on them, that’s not America,” Kasich told CNN’s Dana Bash in March. “That’s not a country that loves all of its citizens. That is really extreme. Frankly, it borders on mean.”
“You can’t starve these programs, and that’s what’s happening,” Kasich fumed during a May interview with CNN host Jake Tapper.
Obamacare expansion added more than 11 million able-bodied, working-age adults to the Medicaid rolls from 2014 to 2016, at a cost of tens of billions of dollars per year in new federal spending. The expansion’s federal match rate is currently 95 percent — a much larger share than the federal government pays for traditional Medicaid enrollees.
Before he expanded Medicaid, Kasich said that 366,000 Ohioans would sign up by July 2015 and 447,000 would enroll by 2020. Actual enrollment exceeded 500,000 by the end of 2014, topped 600,000 a few months after that, and has been greater than 700,000 since February 2016.
There were 2.2 million Ohioans on Medicaid when Kasich took office in 2011, and the program cost state and federal taxpayers a total of $17.7 billion. By 2016, there were 3 million Ohioans on Medicaid at a cost of $25.5 billion — a 44 percent spending increase in five years.
Nonetheless, Kasich insists he slowed the rate of Ohio’s Medicaid spending growth from 10 percent to 2.5 percent. “It’s like the best growth rate in the country,” he boasted when formally announcing his 2016 presidential campaign.
Kasich has consistently portrayed Obamacare expansion as a program for drug addicts, the mentally ill, and the working poor, but expansion has no work requirements and is not in any way targeted at treating addiction or mental illness.
According to an Ohio Department of Medicaid survey, only 10 percent of the state’s Obamacare-expansion enrollees have received substance-abuse treatment; 57 percent are unemployed, 66 percent haven’t reduced their emergency-room utilization, and 52 percent say their health hasn’t improved.
With AHCA being retooled in secret by Senate Republicans, Kasich said, according to an AP story last week, “The House bill is just unacceptable to me.” He complained that the bill would “take away insurance coverage from people, and that takes us backward.” He and six other pro-Obamacare governors sent a letter to Senate leadership begging Republicans to work with Democrats to preserve Medicaid expansion.
President Trump, who has often called for federally funded universal health care, is sympathetic to Kasich’s complaints. Trump and Kasich discussed Obamacare repeal at a private meeting in February; the president recently told senators (according to an anonymous source speaking to CNN) that their version of ACHA should include more spending because the House bill is “mean.”
Like Trump, Kasich was elected as a Republican who didn’t care about special interests and would fight Obamacare. Immediately following his election in 2010, Kasich threatened lobbyists: “If you’re not on the bus, we’ll run over you with the bus.”
Three years later, Kasich expanded Medicaid unilaterally after using his veto pen to strike an Ohio General Assembly ban on doing so. He didn’t just throw Obamacare opponents under the bus, he condemned them to hell, warning that salvation hinges on supporting government welfare programs.
At more than $400 million every month for the past year, Kasich’s Obamacare expansion has cost taxpayers twice as much as he said it would.
This month, Kasich accepted Hall of Fame honors from the Ohio Hospital Association (OHA), an affiliate of the national hospital lobbying group whose early support was crucial to Obamacare’s passage.
Kasich and OHA leaders — including Cleveland Clinic CEO Toby Cosgrove, who joined Kasich at the lobbyists’ Hall of Fame ceremony — say that hospitals need Obamacare expansion money to care for the poor. Cosgrove’s $3.7 million annual salary is one of many items in hospital financial disclosures that suggest otherwise.
The Cleveland Clinic is a tax-exempt nonprofit that reported $740 million in revenue less expenses the year before Obamacare expansion took effect. The charity care costs that Obamacare expansion is meant to offset are a tiny portion of the Cleveland Clinic’s expenses, and the same is true at nearly all of Ohio’s nonprofit hospitals.
Starting with his failed push to convince the General Assembly to expand Medicaid and continuing through the presidential primary, Kasich argued that Medicaid expansion was paid for entirely with “Ohio’s tax dollars” and was affordable because of the state’s booming economy.
“We have an unprecedented opportunity to bring $13 billion of Ohio’s tax dollars back to Ohio to solve our problem! Our money coming home to fix our problems! It’s a unique opportunity,” Kasich said in his 2013 State of the State address. Ohioans, Kasich explained, “should not shoot ourselves in the foot and send our tax dollars to another state to be spent.”
Obamacare expansion is paid for with optional, open-ended new federal spending; there was never any stockpile of “Ohio’s tax dollars” set aside that would have gone to other states if Ohio had refused to expand Medicaid.
“When a state becomes more prosperous, it’s almost like a mom and dad. When Mom and Dad do well, the kids do better,” Kasich told fans on the New Hampshire campaign trail in 2015. “In my state, as we’ve done better, we have not ignored those who find themselves in harm’s way.”
Ohio’s year-over-year job-growth rate has trailed the national average every month since November 2012. Ohio can afford Obamacare expansion in the short term only because the federal government is paying nearly all of the costs — and Kasich aims to keep the federal money flowing until after he leaves office in 2019.
At more than $400 million every month for the past year, Kasich’s Obamacare expansion has cost taxpayers twice as much as he said it would. Total costs hit $13 billion in April, reaching Kasich’s seven-year projection more than three and a half years early.
“Health care is not a Republican or Democrat problem. And there isn’t a strictly one-sided, partisan solution,” Kasich wrote in a recent opinion piece for CNN. “We’ve shown in Ohio that tough problems can be resolved if people work together.”
Providing health care to the poor remains a challenge in every state. To please lobbyists and ease his budget woes, Kasich chose to offload more of the costs to a distant, deeply indebted federal government instead of using state resources for reforms that would empower Ohio’s doctors, hospitals, and private charities to find lasting solutions.
The problem with Obamacare is not that it was passed by a Democratic Congress and named after a Democratic president. The problem is that the law puts more federal rules and mandates between Americans and their health care, using deficit spending to hook local policymakers and the poor on an unsustainable new welfare program that threatens services for the truly needy.
Because Kasich embraced Obamacare, Senator Portman is in a tight spot, and he’s trying to get out of it by shifting to the left. Portman’s support for Medicaid expansion has, in turn, provided cover to more-liberal Republicans in the Senate, setting the stage for either passage of a far weaker bill than the AHCA or failure to pass any health-care bill at all.
— Jason Hart is a Web developer who lives in central Ohio, close (but not too close) to the state capital.