John Kasich proved patient. In February, as part of his two-year state budget plan, the governor proposed that Ohio join the expansion of Medicaid established in the Affordable Care Act. His fellow Republicans in charge of the legislature resisted the concept, even as the governor pressed the case, citing, among other things, the support for hospitals and health coverage extended to the working poor and those with mental illness.
The governor waited through the summer, and into the fall. Yet the Republican majorities have made plain via their delays that they are not interested in expansion. On Friday, the governor ran out of patience, and appropriately so. The Kasich team announced that it would seek approval from the State Controlling Board for the expansion. The decision followed federal approval last week of the state plan for extending Medicaid coverage up to 138 percent of the poverty level.
Put another way, the federal money is available, $560 million in the first year of the biennium, nearly $2 billion in the second, the feds covering 100 percent of the cost for the first three years. By gaining Controlling Board approval at the meeting next week, the state will be ready when the expansion takes effect in January.
Already the Kasich administration has moved to update, restructure and improve Medicaid to make the expansion work. Unfortunately, that hasn’t impressed enough Republican lawmakers. Ideally, the legislature would have approved. But the second-best option isn’t letting the opening slip past, not with the wide range of support, from medical organizations to chambers of commerce.
Chances are, if the Controlling Board gives its assent, a lawsuit challenging its authority will follow. With that in mind, the administration points persuasively to Ohio law allowing a state agency to spend federal money via a legislative appropriation or authorization from the Controlling Board. More, the administration notes that state law provides the option of covering “any of the optional eligibility groups” under Medicaid.
The seven-member Controlling Board includes two Democrats and a representative of the governor. So, one of the four Republican members must complete the majority. The administration appeared to have the dynamic in mind as it framed the three leading reasons for its decision: saving jobs, elevating health outcomes and mitigating “the harmful consequences of Obamacare.”Actually, the expansion involves expanding opportunity, as much as anything, the poor and vulnerable in a better position to make something more of their lives. In that effort, the governor wouldn’t be deterred — to the benefit of all Ohioans.