Medicaid Expansion Is Set for Ohioans

Tony Dejak/Associated Press

Gov. John R. Kasich at the Cleveland Clinic on Friday, making a case for expansion.

COLUMBUS, Ohio — As a Republican chairman of the House Budget Committee in the 1990s, John R. Kasich wielded a ferocious budget ax. On Monday, as Ohio's governor, Mr. Kasich defied his party's majorities in the state legislature to push through a multibillion dollar expansion of Medicaid under President Obama's health care law.

By a 5-2 vote, an obscure committee, the Controlling Board, which normally oversees relatively small adjustments to the state budget, accepted $2.5 billion in extra Medicaid funds from the federal government. The money, recently approved by Medicaid administrators in Washington, will provide coverage for 275,000 Ohioans who have not been eligible for the program, the Kasich administration said.

The vote was an extraordinary — and possibly illegal, critics in Mr. Kasich's own party said — end run by the governor around the General Assembly. Mr. Kasich, who initially declared himself an opponent of the Affordable Care Act and who has declined to set up a state online health insurance marketplace, has argued all year that his sense of Christian compassion, not to mention cool economic practicality, favored extending Medicaid to poor adults and those with disabilities who do not currently qualify.

But Republican majorities in both houses of the General Assembly blocked expansion. Opponents expressed disbelief that Washington would keep its promises under the health care law to pay almost all of the costs of expanding Medicaid, the joint federal-state health insurance program for the poor, and worried that Ohio taxpayers would have to pay.

A budget sent to the governor by the General Assembly forbade Medicaid expansion without lawmakers' approval. Mr. Kasich vetoed that item. At least three bills to expand Medicaid have failed.

Mr. Kasich, who has championed job creation as he prepares for a re-election campaign next year in his swing state, has argued that expanding Medicaid eligibility will be an economic booster shot, because companies will be lured to Ohio by a healthier work force. Expansion is supported by state hospitals, the County Commissioners Association of Ohio and the Ohio Chamber of Commerce.

Under the Affordable Care Act, low-income workers are to receive federal subsidies to buy insurance starting in 2014. But there is a "coverage gap" for some who earn less than the poverty level but do not currently qualify for Medicaid. The federal law allows states to expand Medicaid eligibility to people with incomes of up to 138 percent of the federal poverty level, about $15,860 for an individual. The 2012 Supreme Court decision that upheld the law also allowed states to opt out of Medicaid expansion.

With Monday's vote, Ohio became the 25th state plus the District of Columbia to expand Medicaid, according to the Kaiser Family Foundation. Nearly a dozen Republican governors have moved to do so, despite the efforts of Congressional Republicans to "defund" the health care law. Gov. Rick Snyder of Michigan, a Republican, waged a long and finally successful fight to expand Medicaid. In Pennsylvania, Gov. Tom Corbett reversed himself and recently endorsed a Medicaid expansion plan in defiance of the State House.

Mr. Kasich, who sought the Republican presidential nomination in 2000 and is thought by some analysts to still harbor ambitions in that direction, proposed expanding Medicaid in his budget address in February. He was represented at Monday's hearing by Greg Moody, of the Governor's Office of Health Transformation.

The office's Web site, makes the administration's case for Medicaid expansion. "No matter what Ohio decides on Medicaid, health insurance premiums are going up as a result of Obamacare," it said. "It would make a bad situation far worse if Ohio does not extend Medicaid coverage and reclaim its share of federal taxes to support jobs here in Ohio — jobs that will be created in other states with our money if Ohio does not extend coverage."

The seven-member controlling board includes the state budget director and six senior members of the Legislature appointed by both parties. As of this weekend, the outcome of the vote seemed uncertain. But on Monday morning, House Speaker William G. Batchelder replaced two members of his party who opposed Medicaid expansion. One of the new members voted for the expansion, the other against.

Mr. Batchelder was one of 39 House Republicans who protested last week that the governor's decision to take the matter to the Controlling Board violated state law. Speculation around the Ohio Statehouse was that Republican leaders wanted to support the governor but did not want to submit to a roll-call vote exposing their troops to reprisals by Tea Party groups staunchly opposed to the federal health care law.

Immediately after the vote, the conservative Buckeye Institute announced it would sue over the decision to go through the Controlling Board. Maurice Thompson, director of the 1851 Center for Constitutional Law, called it a vote "of a small oligarchy" of legislators, "some of whom were switched out at the last minute for politically expedient reasons."

Mr. Batchelder said in a statement that he replaced two members because both men were candidates to succeed him, and he did not want their competition to influence the decision.

Mr. Kasich said the vote built on efforts by his administration to improve Medicaid. His administration says it has lowered the program's rate of increase in costs to 3.3 percent annually from almost 9 percent a year before he took office.

"Together with the General Assembly we've improved both the quality of care from Medicaid and its value for taxpayers," Mr. Kasich said in a statement. "Today's action takes another positive step in this mutual effort."

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