During his talk at the Cleveland City Club on Wednesday afternoon, John Kasich played with the idea of washing a state lawmaker’s car as part of persuading her to support the expansion of Medicaid. The governor also quipped about the need to “kick them in the shins if they’re not going to vote for this.” Mostly, he made the moral case for aiding the poor and vulnerable, arguing the expansion reflected a religious obligation to show compassion for the disadvantaged.
A governor should speak powerfully in this way, and it has been heartening to see Kasich doing so. He clearly has his eye on reluctant fellow Republicans in the legislature, many resistant because of their disdain for the Affordable Care Act and their concern for the country spending too much. What is not likely is that many in the majority caucus will be moved by the notion that their opposition reveals spiritual shortcomings. They seem pretty certain about the quality of their moral compass.
The strongest argument for the Medicaid expansion, extending health coverage to those up to 138 percent of the poverty level, is that the move would benefit Ohio (and the country) as a whole.
How? Consider those with severe mental illness, or addictions, or both. Many of them do not have health insurance today. Expand Medicaid, and many would receive coverage, bringing steady treatment, the medication leading to productive lives, to taking jobs and otherwise making contributions. Put another way, and worth repeated emphasis, the expansion results in new opportunities, people in position to fulfill hopes and dreams.
Surely, that is something upon which Republicans and Democrats can agree. More, those improved lives translate into less crime, a small yet significant number with mental illness no longer cycling through county jails.
Too often the falsehood is spread about “expanding a broken system.” Medicaid needs improvement, the Kasich team has been at the vanguard of the effort. Medicaid is not broken, operating at a lower cost than private insurers, delivering better health outcomes for those in the program.
Less expense, improved health, together they benefit all Ohioans, from enhancing the work force to freeing dollars for investment elsewhere.
Local hospitals, rural and urban, support the expansion, eager to trade the inefficiency and cost of uncompensated care. Put these institutions in a better position, and lawmakers would aid leading employers in their regions. Or would they rather put hospitals and jobs at risk?
What should not be missed about the Medicaid expansion is its practical dimension, the state spending just 2.8 percent more during the next decade than it would without health reform. In other words, the benefits far exceed the costs.