Ohio Gov. John Kasich’s poll numbers may not be skyrocketing, but the cost of expanding Medicaid in his state certainly is.
For Watchdog readers, neither of these things will come as a surprise. When Kasich announced his bid for the presidency last year, Watchdog’s coverage of his major policy decisions as governor of Ohio had already been nearly a year in the making. Since then, Kasich’s presidential campaign has brought his controversial decision to take advantage of President Obama’s unpopular 2010 healthcare law into the spotlight as Republican primary voters decide whether the Ohio governor’s policies align with their values.
Kasich’s Obamacare expansion
Watchdog reporter Jason Hart first took up the story in September 2014. Ohio’s Medicaid enrollment under the expansion had just topped 367,000, passing Kasich’s initial projection for enrollment levels at July 2015. In the year and a half since, the governor’s projections for his state have continued to fall far short of the actual tally. Last March was the most expensive month yet for the expanded program, costing taxpayers $411 million as more working-age adults with no kids and no disabilities flocked to the Medicaid rolls. This puts Kasich’s Obamacare expansion on track to cost $28.5 billion by the year 2020 – more than twice as much as his administration projected.
This has raised questions from critics who worry that expanding health care for able-bodied adults could be a disincentive to work. How many of the Ohioans who have recently enrolled in Medicaid have jobs?
No one knows, not even the Ohio Department of Medicaid. Last Spring, the department told state Senate members that 43 percent of enrollees were employed, but it has no current data on how many of Ohio’s 673,000 Obamacare expansion enrollees are gainfully employed. ODM also doesn’t track how many of these new enrollees had private or employer-sponsored health insurance prior to enrolling in Medicaid – or how many of them are incarcerated.
Never mind that Kasich initially estimated 447,000 people would sign up under the expansion by 2020. That means that “if ODM capped Obamacare expansion enrollment at its current level,” wrote Hart, “the two-year-old program would already be 48 percent larger than the Kasich administration said it would be after seven years.”
Lest anyone be confused about how Medicaid expansion became part of Ohio law in the first place, Hart has a helpful breakdown of how the policy fight played out in 2013:
- The Ohio House stripped the Obamacare Medicaid expansion from its version of the 2014-15 budget.
- The Ohio General Assembly explicitly banned expansion in the final 2014-15 budget sent to Kasich’s desk.
- Kasich used a line-item veto to strike the legislature’s ban on expansion.
- The Kasich administration, with approval from the Obama administration, expanded Medicaid to the guidelines set in Obamacare.
- The Kasich administration asked the Ohio Controlling Board to appropriate funding to pay for the Medicaid expansion.
- The Ohio Controlling Board approved Kasich’s Obamacare expansion funding request.
- Six Republican legislators and two Right to Life groups sued over Kasich’s Controlling Board maneuver, but the Ohio Supreme Court ruled in the Kasich administration’s favor.
The end-run around the state legislature is not quite the story Kasich has been telling primary voters over the past year. He claims the legislature didn’t want to vote, so he convinced General Assembly leadership to pass Medicaid expansion through the Controlling Board, but ranking members of Ohio House leadership at the time tell a different story.
The “Obamacare Roadshow”
Another favorite talking point of Kasich’s is the claim that he slowed the growth of Medicaid from 10 percent to 2 1/2 percent – a drastic reduction. A Watchdog analysis of the numbers from ODM (see chart below), though, found that Ohio’s Medicaid enrollment and spending have actually grown at a much faster rate since Kasich was elected governor in 2011. Actual enrollment growth during his time in office is above 9 percent.
Kasich also likes to claim that Medicaid expansion is paid for with “Ohio money,” but as Hart points out, this claim is misleading at best. There is no special lockbox of “Ohio money” that Kasich chose to bring “back to Ohio.” The program is paid for with billions in new deficit spending from the federal government (which has a massive debt of its own).
During the primary elections Kasich has brought his “Obamacare roadshow” all over the country, but it has not always been well-received by Republican primary voters. In Maryland, he said he would repeal Obamacare while keeping the largest part of the unpopular law – the expansion of Medicaid – in place. In Wisconsin, when a town hall voter challenged his decision to “choose the Washington-based solution,” Kasich bristled. He pulled out his 2 1/2 percent talking point and framed his decision to expand Medicaid as an opportunity to treat the mentally ill, drug-addicted, and working poor, even though the program isn’t targeted at any of those groups.
Kasich has tried making a similar argument in Virginia, Florida, and South Carolina on the campaign trail – all states that rejected Medicaid expansion, and all states that chose a different candidate for president.