A Conservative’s Defense of Governor Kasich’s Proposed Medicaid Expansion

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It is well known that Governor John Kasich proposed to expand Ohio’s Medicaid program to an additional 275,000 low-income Ohioans, as part of the state’s biennium budget.  The Governor’s proposal came as a surprise to many observers and drew praise from many across the political spectrum.

The proposal also drew considerable ire from some conservatives who saw the proposal as a surreptitious acceptance of Obamacare in the Buckeye State.  Ultimately, the Governor’s proposal was removed from the state budget, and GOP legislators in both the House and Senate are continuing to work on legislation that would reform the Medicaid system, and potentially expand the program.

Frankly, I strongly disagree with the critics of the Governor. Unlike many of the critics, I base my support on not only my long-standing reputation as a “rock-ribbed” conservative Republican, but also on my 30+ year career as an expert on health care reform.  Although the expansion of the existing Medicaid system is not an ideal solution to the problems our health care system currently faces, it is a pragmatic choice given the actual range of potential alternatives that are available today.

Significantly, Governor Kasich is by no means alone among the nation’s GOP governors in proposing to expand his state’s Medicaid program. Republican governors from Arizona to New Jersey are adopting the same course of action, in recognition that the negative impact of refusing to expand their existing Medicaid program outweighs the good.

As conservative Republicans, we are fortunate that 30 of the 50 Governors’ offices across the U.S. are in GOP control. Republican Governors like Ohio’s Kasich have consistently fought for lower taxes on individuals and businesses in their respective states, and we’re seeing positive results in those “Red” states. For example, here in Ohio private sector businesses have created over 160,000 jobs since Kasich took office in January 2011, a welcome reversal of the trend during Democratic Governor Ted Strickland’s failed four years, during which Ohio lost 400,000 jobs.

Moreover, the $8 billion hole that Strickland left in Ohio’s budget was filled–without a tax increase.  In fact, as a result of the budget recently signed by Governor Kasich, every Ohioan will see a 10% income tax cut, and small business owners will receive a 50% tax cut on the first $250,000 earned by their businesses. In addition, the state’s rainy day fund, which Strickland left virtually empty at 89 cents, is filled to the brim at nearly $1.5 billion. In short, Ohio government is economically stable and its credit rating is secure–at a time when the same can’t be said of the United States under President Obama’s direction.

Clearly, Governor Kasich is a conservative who practices what he preaches. In fact, any suggestion that John Kasich is for “big government”–the same John Kasich who once balanced the federal budget while he was a member of Congress and who saved the nation billions by fighting against wasteful spending on the outdated B-2 bomber program—is misplaced.

Governor Kasich’s rationale for Medicaid expansion is rooted in his overriding desire to improve Ohio’s economy and create an environment in which private industry and small businesses can create jobs. The Governor also understands that an important aspect of any state’s economic well-being is maintaining a robust health care system and a healthy workforce.

Simply stated, even though the overall Obamacare program will be disastrous for our nation’s economy, Ohio’s failure to expand its Medicaid program at this time would make the situation even worse for our state.  Ohio businesses that already face higher costs because of mandates would be subject to additional costs and penalties that could cost them as much as $88 million annually, according to a study by Jackson-Hewitt.  It’s for that reason that many opponents of the overall Obamacare scheme, such as chambers of commerce across the state and the Ohio Manufacturer’s Association, support the Governor on this issue.

It is also important to understand that our hospitals (which are typically one of the largest employers in each of Ohio’s counties) are going to be adversely impacted by one of the perverse provisions of Obamacare. We all have heard the Obama Administration touting the benefits of ObamaCare as a “fix” for the problems with our health care system. In reality, under its actual provisions, the nation’s hospitals actually will receive less funding to cover the cost of treating the poor who have no private insurance and currently do not qualify for Medicaid.

As these Obamacare decreases in reimbursement are phased in over the next few years, Ohio’s hospitals will likely be forced to cut essential health services (especially in rural areas of our state), unless we have a solution that will allocate more funds to these hospitals and other health care providers. Right now, the only potential solution to this funding dilemma is to expand the Medicaid program to cover these patients and pay for these needed services. That’s why the Ohio Hospital Association supports Governor Kasich on this issue.

In addition, we cannot ignore that prenatal and OB/GYN services are some of the most costly health care services. That’s why Ohio Right to Life supports the Governor on this issue.  Ohio Right to Life recognizes that access to reliable health care for Ohio’s women means more healthy babies will be born in our state.

Finally, as the federal government continues to struggle to provide much needed and well deserved health care benefits for our nation’s veterans, Ohio’s plan to expand Medicaid will provide health care coverage to an estimated 26,000 veterans.  Frankly, the thought that anyone who has fought for our country would not have access to needed health care services is disgraceful. The fact that over nearly 10 percent of the proposed Medicaid expansion population consists of veterans is why groups like the Ohio National Guard Association and the Advisory Committee on Veteran’s Affairs support the Governor on this issue.

The Governor recognizes that expansion of an inefficient government program, like Medicaid, is not the ideal solution to improving the problems with our current health care system. He also understands that “fixing” the problems in our health care system cannot be accomplished by imposing a badly drafted, one-size-fits-all, federal program.  However, until Obamacare can be repealed so that more appropriate, targeted reforms can be enacted, Ohio cannot ignore the pressing problems that ObamaCare has created for impoverished Ohioans in need of health care services.

The answers aren’t easy, and they never will be for a conservative, Republican governor of a state that is making an economic comeback when the headwinds from Washington only make things harder. However, on this issue I believe that Governor Kasich has made a strong case for why Medicaid expansion is the right path for Ohio. It is the pragmatic choice, and the wise choice in facing this difficult dilemma caused by Obamacare.

 Finished reading: take our poll on expanding Medicaid.


Bill Todd is a prominent Republican lawyer engaged in private practice in Columbus. For over 30 years, he has been deeply involved in conservative causes including tax reform, tort reform, school choice, election reform, and pro-life related matters.  His principal substantive  expertise is in the field of health law and health system reform.


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