Gov. John Kasich is spending the weekend in Washington – meeting with President Trump today, and then participating in meetings with governors about changes to the Affordable Care Act. And whatever happens with the ACA has major implications to the state and hundreds of thousands of Ohioans.
Three years ago at this time, Gov. Kasich was selling the expansion of Medicaid he put into his budget to state lawmakers suspicious of the Affordable Care Act. The ACA allowed states to expand Medicaid with the federal government paying 100% of the costs for the first three years, and eventually going down to a 90/10 federal/state split in 2020. Kasich said he didn’t support the ACA, and didn’t consider Medicaid expansion to be an endorsement of it. He said simply, it was about capturing federal dollars that Ohio is sending to Washington and bringing them back to help lower the state’s health care bills: “$13 billion of our own dollars back here to treat and solve Ohio’s problem,” Kasich said then. “It’s our money. Let’s bring it home.”
State lawmakers pulled Medicaid expansion out of Kasich’s budget, so he took it to the smaller panel of lawmakers on the state controlling board, which approved it in late 2013. Since then, more than 700,000 Ohioans have signed up for Medicaid under the extension. And Republicans in Congress voted more than 60 times to scrap the ACA. Now Republicans dominate Congress and President Trump is in the White House, so there’s now a real possibility of a repeal.
Greg Moody is the director of the governor’s Office of Health Transformation, which oversees Medicaid in Ohio. Moody said this week that Kasich is pushing for repealing the ACA and replacing it with something that will correct what critics see as serious flaws – for instance, making some changes to insurance market regulations and adding more flexibility in Medicaid. “So for example, the Affordable Care Act required us to cover everyone up to 138% of poverty. We’re interested in covering to 100% of poverty, and then above that folks can get coverage through the private insurance market,” Moody said. The state’s Medicaid department says 150,000 people are in that group between 100% and 138% of poverty who are now covered by expansion but potentially wouldn’t be if the rules are changed. (By the way, 138% of poverty is an annual household income of a little over $28,000 for the average family of three in Ohio.)
And there’s a bigger question here. After his budget rollout in February 2013, Kasich talked about a “circuit breaker” in the plan – a provision that would allow Ohio to opt out of Medicaid expansion if the feds’ participation dropped to the point where it was a loss for Ohio. But he stressed that if the federal government didn’t live up to what he called a promise, there would be chaos. “But believe me, we’ve looked at the circuit breaker, and we think we can implement a circuit breaker, but it will bring a very difficult situation to health care providers across the state,” Kasich said then.
Moody says now that Ohio could step back from Medicaid expansion if the federal government stops paying its part of it. “There were eight states that made the decision to expand that have some version of a trigger, where if the federal financing changes, in some cases they’re automatically out of the program. I would have to check, but I believe that ours is a ‘may’, that we may then opt out of the program,” Moody said. “But it’s clear authority to step out of the expansion if the federal financing arrangement changes.”
Kasich has said publicly it that repealing the ACA without replacing it would be – quoting here – “a very, very bad idea because we cannot turn out back on the most vulnerable.” If it’s repealed, it’s estimated Ohio would lose $3.5 billion in federal Medicaid funds.
Moody couldn’t say for certain what will happen to the 700,000 Ohioans covered by Medicaid expansion if the ACA is repealed and not immediately replaced. “We have seen a lot of benefits from the expansion. We are very in tune with that. We feel a responsibility to maintaining those benefits for Ohioans. So what I would say is that we are taking responsibility to act to make sure those benefits continue,” Moody said. That responsibility, he said, includes lobbying federal lawmakers and officials, and talking to governors and leaders in other states to come up with ideas.