Governor John Kasich was dismissive of Ohio Treasurer Josh Mandel’s concerns about Medicaid expansion when questioned on the topic at a February 14 press event, telling reporters, “it’s a complicated issue.” The governor, a Republican, referred to his school funding plan and his time in Congress while suggesting opponents of Medicaid expansion are ill-informed.
“Oh, I don’t make too much of it – I mean, it’s a complicated issue,” Kasich said. “You know, it’s sort of like the school funding, right? I mean, everybody was hyperventilating when they saw the printouts, and then it settles down.”
The governor’s response to questions about Mandel’s February 11 letter – thus far the clearest opposition to Medicaid expansion publicly expressed by a state-level Republican official – begins at the 1:18 mark of the following video, courtesy of Marc Kovac at Ohio Capital Blog.
“The Medicaid issue is something people need to look at carefully. There’s gonna be – look, it’s a complicated issue,” Governor Kasich said. “It took us months to really unravel all of it, and I made a decision, and I don’t worry about people chirping about it. It’s just part of the process.”
Prior to Kasich’s February 4 announcement of his decision to implement a central piece of President Obama’s Patient Protection and Affordable Care Act (PPACA) by expanding Medicaid, free market think tanks Opportunity Ohio and The Buckeye Institute for Public Policy Solutions both issued releases opposing Medicaid expansion.
Meanwhile, news reports and press materials on the governor’s website have revealed the Kasich administration worked with the Universal Health Care Action Network of Ohio, a socialized medicine lobbying group, to message the governor’s PPACA Medicaid expansion decision.
Seeking to determine what right-of-center health policy experts Governor Kasich consulted before deciding to dramatically expand one of the nation’s largest entitlement programs, Media Trackers reached out to the American Enterprise Institute (AEI), The Galen Institute, the Cato Institute, and The Heritage Foundation.
“My only discussions with members of the administration on this question concerned whether accepting the Medicaid expansion would be legal,” wrote Jonathan Adler, a Case Western Reserve University law professor and AEI adjunct scholar. Adler noted that the issue of Medicaid expansion itself does not fall within his area of expertise.
For guidance on that question, Joseph Antos, AEI’s Wilson H. Taylor Scholar in Health Care and Retirement Policy, wrote, “The governors office didn’t speak with me, and doubtful about anyone else at AEI.”
Antos described several alternatives to Kasich’s decision, writing, “Scott Walkers approach, which reduces eligibility for Medicaid to 100% [of the federal poverty line] and sends those above that line to the exchange, makes more sense from a state perspective.”
“Another approach is to hold off and try to negotiate a better Medicaid deal with the White House, one that gives the state more control over Medicaid without having to go back to CMS for every little change in the program,” Antos added. “Perhaps the best approach is for the states to hold off on Medicaid and have Republicans pass a bill that give states more complete control in exchange for a predictable budgeted amount for each Medicaid beneficiary.”
Asked whether the Kasich administration contacted her for input, Galen Institute president Grace-Marie Turner wrote, “No, regretfully, they did not.”
“Governors are missing an incredibly important opportunity if they agree to expand Medicaid without first demanding reform of this expensive, cumbersome, outdated program,” Turner explained. “One of the tragedies of passage of [PPACA] is that millions more people were added to Medicaid without reforming what is the worst health care program in the country!”
Turner directed Media Trackers to a recent column about Medicaid expansion titled “Twelve Reasons to Say No,” which she authored with Manhattan Institute for Policy Research senior fellow Avik Roy.
Cato Institute senior fellow Michael Tanner told Media Trackers, “No, Governor Kasich did not speak with anyone at Cato.”
Tanner continued, “If he had we would have strongly advised against expanding Medicaid,” referencing his February 10 column “Obamacare’s ‘Giveaway’ Is Anything But Free.”
The Heritage Foundation did not reply in time for publication, but Heritage Center for Health Policy Studies director Nina Owcharenko published a story February 5 titled, “Why Medicaid Expansion Is Still Wrong for the States.” Owcharenko and other Heritage health policy analysts were also quoted in Opportunity Ohio’s January 18 report highlighting major concerns about Medicaid expansion.
Asked at the February 14 event whether he felt Treasurer Mandel understood Medicaid expansion, Governor Kasich demurred, saying, “I’m not going to get into a battle with Josh here.”
“I haven’t read the letter, but I think it’s about, you know, the overall health – long term – of Medicaid,” the governor added. “I was the chairman of the budget committee that balanced the budget, I understand Medicaid. Is that program gonna need to be reformed in the next decade or so? Yes, but we have an issue today, and so it’s why we have in our proposal that if the federal government starts changing all the rules, we won’t continue to be in the program. I think it’s very reasonable.”
Kasich then reiterated, “I will tell you though, it’s complicated, and you have to look at it from a lot of different aspects.”
The Republican governors of Pennsylvania, Wisconsin, Iowa, North Carolina, South Carolina, Oklahoma, Texas, Idaho, South Dakota, Louisiana, Mississippi, Alabama, and Georgia have all refused to enact the PPACA Medicaid expansion in their states.