The Controlling Board is not the right path for Medicaid Expansion

The controversy over whether to expand Medicaid in Ohio just got stepped up another notch.

Today, Governor Kasich requested that the Controlling Board approve the expansion of the Medicaid program. From the Plain Dealer,

COLUMBUS, Ohio — The Kasich administration will ask the controlling board at its next meeting for authority to spend about $2.5 billion in federal aid over the next two years to expand the state’s Medicaid program to cover Ohio’s working poor.

Gov. John Kasich, a Republican, has lobbied for Ohio to expand Medicaid coverage to the working poor since unveiling his budget plans in early February and has repeatedly called on the General Assembly to authorize the expansion.

But Republicans in the Legislature have refused to grant the expansion. Some have cited opposition to such a major expansion of a public support program. Others have cited concern about size of the national debt. General opposition to health care reform, commonly called Obamacare, also is a reason.

We’ve been cool to Medicaid expansion here at 3BP, neither strongly for or against it. Why? Because the Obamacare law in its entirety is the real 800 lb gorilla in the room, the horrible law that it is. Whether a particular state chooses to expand Medicaid under the law or not is really a minor detail. And much of the rhetoric from the anti-expansion folks is beyond ridiculous.

For example, as we explained months ago, expanding Medicaid will NOT save billions in federal spending as opponents have suggested. If you live in a state that does not expand Medicaid, but would be eligible if it did, you can just buy insurance on the healthcare exchange and the federal government is going to spend the same amount of money to cover you there. The federal spending will simply come through exchange subsidies instead of Medicaid spending.

Equally silly is the accusation that if you expand Medicaid under the law, that you support Obamacare as a whole. That’s nonsense. America’s governors and state legislatures, including Ohio’s, do not have a choice of whether their states have Obamacare or not. It was forced upon all of us. Declining Medicaid expansion does not do anything to stop Obamacare. Not one bit.

Governor Kasich evaluated the two options available to him, and decided that under the law that we have no choice but to live under, expanding Medicaid was the better option for Ohio. Other Republican governors have done the same. When a law forces you to choose A or B, choosing A does not necessarily constitute support for the law that forced you to make the choice. Despite what the tea party says, it is possible to oppose Obamacare but choose to expand Medicaid if you feel it is the best way for your state to deal with the law.

All that being said, we don’t agree with the decision to go around the full legislature and take the decision to the Controlling Board. Appropriations of this magnitude should have the full approval of the entire Ohio General Assembly.

According to the Controlling Board website, “the General Assembly delegates to the Board the power to make relatively minor adjustments to the enacted operating budget.”

There is precedent here. Kind of. Previously the Controlling Board has approved the spending of federal money to the state, such as Race to the Top funds. However, the amount of money involved in Medicaid expansion dwarfs the dollar figures of those previous decisions, and can hardly be called a “minor adjustment” with a straight face.

Put simply, if Governor Kasich believes Expansion is the best choice for Ohio, we wish he’d continue to pursue it through working with the entire legislature. (Although, to be fair, the leadership so far has refused to let the full legislature vote on the issue.)

A couple of final thoughts.

First, even though we disagree with the decision to go to the controlling board, it does show that Kasich is doing what he thinks is right, despite it being very unpopular with much of his own party. Doing what one thinks is right, over what is popular, is something that deserves respect.

Lastly, Democrats and liberals who support expansion have been mocking the governor and claiming that he “never really wanted” to expand Medicaid and accused him of using the issue to falsely appeal to moderates. He just exposed their political potshots and showed them that they were dead wrong, as they so often are. They’ve been very quiet on the issue all day. Even when they strongly agree on a policy with the governor, they withhold their approval lest they dare be perceived to support anything that he does. Sadly, it’s politics as usual for Ohio Democrats.

Author: Nick

I was born and raised in Ohio. After growing up in the Columbus area, I moved to Cleveland to study at Case Western Reserve University, and have lived in Northeast Ohio ever since. I live in Wellington with my wife and son. I work in the private sector and have never worked in the political field.

4 thoughts on “The Controlling Board is not the right path for Medicaid Expansion”

  1. Kasich’s commitment to what he believes is right is probably the best thing about him, even if it puts him at odds with people inclined to support him otherwise. I sat in a meeting with pro-life, pro-family leaders at which candidate Kasich, asked about a casino ballot issue (before the one that passed), said he wouldn’t support the specific issue unless it made sense, but that he didn’t have a moral objection to gambling. Just about every other Republican politician would have told that group that he/she would fight gambling as a social ill, because that’s what everybody in the room believed.

  2. “For example, as we explained months ago, expanding Medicaid will NOT save billions in federal spending as opponents have suggested.”

    99% of government workers and academics that opine on healthcare and insurance;
    1; Have never worked in or near the industry
    2: Have theories that were never real world tested
    3: Generally have their head up their backside and not the slightest clue what they are talking about.

    “Here’s what the tea party never tells you in their attacks on John Kasich:”

    Here is what you apparently have never heard from people that actually work in the business and know what they are talking about;

    TOTAL BS! Your arguments are ignorant of so many real world variables your conclusions would not be anywhere close to the actual result.

    First and foremost. Your talking about people above FPL, which means they have income, which usually means they have a job. 20% of the uninsured are offered coverage and decline it. For every one of those that now take that coverage offered to them the government and tax payors spend ZERO.

    Another major flaw in your attack is the employer penalty. If a employee gets Medicaid the employer is not penalized. If they employee gets a subsidy they are penalized $2000 or $3000. 80% of the uninsured work for employers working for employers with more than 50 employees meaning they are subject to penalties. Employers have options costing far less than 2-3K meaning most of that 80% will end up with coverage from work, again costing tax payors ZERO.

    Fraud in private insurance is 1/10th that of public plans.
    Private plans pay providers far better than Medicaid.
    Medicaid eligibility opens the doors to all sorts of other welfare programs
    100 more reasons your argument is fundamentally flawed.

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