Summer recess is around the corner for the Ohio legislature, but the prospect of an expanded Medicaid remains as murky as it was when John Kasich proposed it in February. In short, the governor has let the initiative get away from him, his Republican colleagues now seeming to drive Medicaid “reform” in all directions.
There never was an illusion it would be easy to get the proposal through a Republican Statehouse hostile to the idea. But the odds against Kasich’s success seemed no higher than, say, in Arizona, where the Republican Gov. Jan Brewer (no friend, either, of President Barack Obama’s health-reform law) nonetheless opted to expand Medicaid, confronting identical opposition from her Republican base and legislature. Brewer played hardball, even calling lawmakers into special session on the issue. On Thursday, the Arizona legislature delivered. Brewer had on her desk a bill expanding Medicaid coverage to 240,000 more residents.
The effort to expand Medicaid in Ohio falls short of Brewer’s focus and dogged tactics, unfortunately, but it is not short of compelling arguments or support that finds chambers of commerce, labor unions, welfare advocates, health-care providers, charities and public agencies all on the same page.
The federal offer to foot the entire bill for three years for those who will become eligible, scaling down gradually thereafter to 90 percent, remains a rare, generous deal. Studies underscore the gains, including: the benefits of appropriate care to some 275,000 Ohioans who currently don’t have it; the estimated $13 billion in federal funding that would generate a range of economic activities to improve the bottom lines of state and local governments; and the reduction in hospital costs for uncompensated care, which inflates health-care spending.
Yet with everything that is riding on Medicaid expansion, state lawmakers have not found a way to craft a single coherent bill that would lock in the potential gains for the people and economy of Ohio. Neither has Gov. Kasich proved much of a Pied Piper of late in drawing a Republican following to support Medicaid expansion.
The result is a Medicaid debate that veers in all directions. Last month, Barbara Sears, a Republican from Monclova, introduced a variant on Kasich’s expansion proposal in the House, to tepid reception. Meanwhile, Ron Amstutz, who chairs the House Finance and Appropriations Committee, sought to rework Medicaid and other welfare programs to lower costs and increase efficiency. In the Senate, David Burke and Democrat Capri Cafaro have offered a bill they describe as a first step to a Medicaid overhaul, with the focus on workforce development changes and cost containment.
The irony in all this Kabuki dancing is that Kasich already is far ahead in implementing the “first steps” in Medicaid reform his colleagues are demanding. It remains his advantage to press.