Kasich Gets Medicaid Expansion Approved In Ohio

Ohio Gov. John Kasich has been able to fund his state's Medicaid expansion in 2014 by channeling the request through an obscure board, a move likely to spur legal action from conservative foes of the Affordable Care Act.

The Ohio Controlling Board voted 5-2 on Monday to accept $2 billion in federal funding to expand Medicaid coverage to about 300,000 low-income residents. The vote took place not long after allies of Kasich in the Ohio Legislature moved to replace two of the board's more conservative board members, and Kasich submitted to the Centers for Medicare & Medicaid Services his plan for expanding coverage.

“This is great news for the 300,000 Ohioans who will now be eligible for Medicaid,” said Gene King, who directs the Ohio Poverty Law Center. “Tomorrow, we can start work on outreach and enrollment.”

Highly conservative Republicans in the Ohio statehouse have moved for the better part of a year to block voting on accepting federal funds to expand Medicaid under the ACA, frustrating more moderate members. And Kasich, although a Republican himself, has supported Medicaid expansion, stressing the need to help the poor and noting the program has long predated the ACA. He has spent the past several months traveling throughout the state to gain the support of key lawmakers required to pass an expansion bill.

Kasich is also running for reelection in 2014. With the economic environment considerably improved over 2010, taking a hard-right stance on the ACA is not likely to ingratiate Kasich with the more moderate voters who gave Barack Obama a victory in Ohio in last year's presidential election.

“Together with the General Assembly, we’ve improved both the quality of care from Medicaid and its value for taxpayers. Today’s action takes another positive step in this mutual effort,” Kasich said. “I look forward to continuing our partnership with the General Assembly to build upon the progress we’ve already made to make Medicaid work better for Ohioans.”

Kasich joins two other GOP governors – Arizona's Jan Brewer and New Jersey's Chris Christie – in deciding to expand the Medicaid program. Both have cited economic arguments for doing so, saying that funding formula was too attractive to pass up. The federal government will pay 100% of the costs between 2014 and 2016, and 90% in the years after.

Christie hasn't encountered much political resistance in his state, which is filled with Democrats and moderate Republicans. But Brewer's state is much more conservative, and a campaign is underway to put the question to voters.

Meanwhile, political and legal opposition has quickly mounted in Ohio against what many see as an end-run by Kasich around the state Legislature.

“I have repeatedly stated my opposition to the expansion of Medicaid in Ohio, but the governor made this decision without legislative approval,” Senate President Keith Faber said just after Monday's board vote.

Thirty-nine Republicans in the state's House of Representatives signed a letter last week protesting the move, which they contend is in conflict regarding its legislative intent. And lawmakers are also considering measuring that would limit the Controlling Board's power in the future.

Organizations that oppose the ACA are also considering taking legal action to block Medicaid expansion, and it is expected lawsuits will be filed in state and federal court in the near future.

“It is a tenuous outcome,” said Rep. Tracy M. Heard, the leader of Ohio's House Democrats.