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.