Regarding the question of Medicaid expansion, whether to offer more low-income uninsured Ohioans access to health care through the state and federal funded health program for the poor, John Kasich arrived at a decision that is both pragmatic and justified on moral grounds. The budget the governor proposed on Monday acknowledges the benefits of extending the program to citizens whose income is no more than 138 percent of the federal poverty level of $15,415 a year.
In doing so Kasich, commendably, has put the health of many Ohioans and the state’s economic interests above the usual partisan politics. Correctly, he has pointed out that “when you look at the facts, when you strip out ideology or political considerations” it makes “the most sense” for Ohio to accept the federal offer to pay between 100 percent and 90 percent of the cost of coverage for those who become eligible for Medicaid under the Affordable Care Act.
And the essential fact for Ohio, as recent studies make quite clear, is that the state has more to gain than lose from expansion, one estimate pegging the net gain at $1.4 billion by 2022. The pragmatist in Kasich recognizes the financial calculus at play: If he opts out of expansion, Ohioans still will pay federal taxes, some $13 billion over seven years, which will help finance health care in other states. The state will miss out, too, on the revenues from businesses and jobs generated by federal and state spending on health care.
The proposed expansion is expected to grant eligibility to about 366,000 Ohioans, beginning next January. Without insurance, sick patients face a choice of no care at all or the most expensive care, in the emergency room. Not surprisingly, they choose the latter, sticking hospitals with costs for which they are not compensated. Those costs ultimately surface as higher rates for other services, the spiraling costs reflected in increased premiums to employers and those who are insured.
If Kasich is facing up to the “great sense” in taking the federal deal, the challenge for him now is to make the reality as obvious to his conservative colleagues in the Statehouse. Given the facts on the table, the rigid Republican opposition to Medicaid expansion in Ohio appears more like a partisan pact to spite what they call “Obamacare.” Statewide, a broad base of advocates, including hospital associations, chambers of commerce, religious and civic groups, has emerged in support of the expansion. Kasich disavows the Affordable Care Act at every turn — which is fine if that’s what it takes to provide the coverage low-income Ohioans need.