With only days left before President-elect Donald Trump takes the oath of office, Ohio Republican Governor John Kasich is very concerned about Trump’s promise to repeal Obamacare and the repeal’s effect on his 2014 Ohio Medicaid expansion program. In a January 4 news conference, Kasich expressed this concern:
Let’s just say they got rid of it, didn’t replace it with anything. What happens to drug treatment? What happens to mental health counseling? What happens to these people who have very high cholesterol and are victims of heart attacks, what happens to them?
Critics might say it’s paradoxical for Kasich to oppose Trump’s repeal of Obamacare since he campaigned as a champion of its repeal during his presidential run. However, as his statement suggests, what Kasich really wants is to keep those Obamacare features he likes. This includes allowing children to stay on their parents’ insurance plans longer, keeping coverage for pre-existing conditions, and providing low-income subsidies to help the poor buy insurance; and of course, Medicaid expansion.
Kasich originally was heavily criticized for Ohio’s Medicaid expansion and received nearly zero support for his plans, even from within his own party. In fact, the state legislature not only stripped his proposed expansion out of the budget, but also passed legislation that expressly prohibited the expansion from going forward. The party’s members were also very vocal in their opposition to the expansion.
Most objections to the expansion centered on independent estimates on projected rising costs. But dire cost projections and the actions from the legislature didn’t stop the governor. He used his line-item veto to strike the legislative language and unilaterally expanded Medicaid eligibility by manipulating the Ohio Controlling Board, led by a Kasich appointee. (The Ohio Controlling Board manages adjustments to the state budget.)
Originally, the Kasich administration estimated the expansion would cost taxpayers approximately $4 billion between 2014 and 2016. But in reality, Ohio’s Medicaid expansion has cost taxpayers nearly $7 billion for those years. Furthermore, as Forbes reports, the Foundation for Government Accountability estimates that Kasich’s program is set to run nearly $8 billion over budget by the end of 2017.
Despite the increased costs, criticism, and the method Kasich used to pass the program, he never shied away from boasting about it throughout his presidential campaign. And on December 30, 2016, Kasich released a very positive report touting the successes of his Medicaid program for Medicaid-eligible enrollees. (Referred to in the report as Group VIII enrollees, defined as persons age 19 through 64 with incomes at or below 138% of the federal poverty level.) The report states:
In summary, Medicaid expansion has been beneficial to Ohio Group VIII enrollees in terms of: (1) access to physical and mental health care; (2) health care utilization and reduced emergency department use; (3) detection of unknown or unaddressed prior health conditions (particularly chronic health conditions); (4) security of and opportunities for employment; (5) the lessening of family financial stress; (6) declines in medical debt-holding; and (7) an increase in the ability to pay other nonmedical bills (e.g., household utilities, food, transportation).
Finally, despite the short time elapsed since Medicaid expansion, Group VIII enrollees reported modest physical and mental health status gains, and most reported an increase in household, employment, and health security. Overwhelmingly, new enrollees reported being grateful for their Medicaid expansion health care coverage and valued having access to Ohio’s health care system.
The report also mentions Ohio’s results are similar to studies in other states.
What the report didn’t specifically cover was program costs. But at this point, it becomes nearly impossible for the average person to know what to believe. For his part, Kasich remains steadfast that critics’ estimates are incorrect and his program is coming in below cost estimates.
One thing is certain: the Kasich administration initially predicted 365,000 able-bodied adults would sign up in the first year. But within seven months, the program had already exceeded its first-year projections with more than 650,000 added to the program. According to Kasich’s report, by May 2016, the total rose to 702,000. That type of increase doesn’t lend itself to decreased costs.
Kasich never endorsed Trump for president, and it is well known there is no love lost between the two. Therefore, although Ohio’s general assembly requested the report, in politics it is difficult not to assume most actions don’t have political overtones. Thus, the timing of its release may be just another opportunity for Kasich to give Trump a poke in the eye, using the report merely as another weapon in the Kasich-Trump proxy war.
However, victories and defeats in proxy wars come from all directions and at any time. On January 6, the Ohio GOP central committee voted to replace the chair of the state party, Matt Borges, a close Kasich ally, with Jane Timken, a local GOP county official and Republican donor who was endorsed by Trump.
Timken’s victory is all that more remarkable considering Borges and Kasich worked very hard to keep their allies on the state central committee during the last election cycle. Apparently, enough of those allies jumped ship deciding it’s time to back Trump over Kasich. Losing a battle is one thing, but losing it by troop defection is another, especially for someone who badly wants his signature overhaul of Medicaid to be a model for other states.