The decision Monday to expand Medicaid in Ohio by accepting $2.5 billion, made by a small bi-partisan panel of legislators, is good news for Gov. John R. Kasich, who had he lost the vote Monday could have damaged his chance to win a second term next year and beyond that, possibly scuttled his hopes of jumping into the Republican presidential primary season in 2016.
But in a 5-2 vote of the Controlling Board, a little known and little covered budget oversight group that since its creation in 1917 has normally handled agency budget adjustments, Ohio became the next Republican-run state to expand Medicaid.
Gov. Kasich commented on today's vote, saying his administration and the General Assembly have improved both the quality of care from Medicaid and its value for taxpayers.
"Today’s action takes another positive step in this mutual effort," he said, adding that he looks 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."
According to the Kaiser Family Foundation, today's vote in Columbus makes Ohio the 25th state plus the District of Columbia to expand Medicaid.
State Sen. Tom Sawyer, State Rep. Chris Redfern, State Sen. Chris Widener, State Rep. Ross McGregor and Chairman Randy Cole voted to do what the legislature failed to do months ago, in the final hours of casting Ohio's next two-year $62 billion budget.
For about 366,000 Ohioans who would become income eligible to participate in the federal/state health care program for the poor, disabled and elderly under 65 years of age, the decision to expand Medicaid—as provided in last summer's decision by the U.S. Supreme Court that ruled the Affordable Care Act constitutional and offered states the option to opt in or out of Medicaid—the long awaited decision will help them with health care delivery.
State officials who testified today said approximately $400 million could be saved in the process by avoiding the cost of emergency room care for eligible individuals and families who previously had no other alternative to treat sickness or injury.
State hospitals, the County Commissioners Association of Ohio and the Ohio Chamber of Commerce have joined Gov. Kasich and Democrats in advocating for expansion of Medicaid up to 138 percent of the Federal Poverty Level, which for an individual is about $15,860. Ohioans 0-18 years of age, parents, disabled workers and disabled under 65 years of age are Medicaid eligible.
But while three Republicans joined two Democrats to achieve a policy objective that had been thwarted through regular order in the legislature, today's win by Gov. Kasich could be eclipsed as soon as Tuesday, when a lawsuit will be filed to challenge today's decision by the Controlling Board.
According to Maurice Thompson, a lawyer with the 1851 Center for Constitutional Law, a non-partisan legal center dedicated, according to its website, "to protecting the constitutional rights of Ohioans from government abuse," he and his clients will be huddling before the lawsuit is filed.
Watch Thomson on 60 Seconds Ohio
Thompson, who answered questions from reporters following the vote, has previously said the Controlling Board may appropriate federal funds not previously approved by the legislature but it cannot do it in a manner inconsistent with the intent of the General Assembly.
Thompson called today's meeting a vote "of a small oligarchy" of legislators, "some of whom were switched out at the last minute for politically expedient reasons," as reported by The New York Times.
Chris Littleton, a prominent Tea Party thought-leader and organizer, was displeased with today's vote. "It was disgraceful," he told CGE in an email.
In the budget debates earlier this year, Gov. Kasich's desire to have the legislature approve an expansion of Medicaid was killed when the Ohio House of Representatives, now run by Republicans with a 60-39 supermajority margin over Democrats since 2012, defied its first-term governor by not including this and adopting other Kasich policy proposals are proposed.
"“[The General Assembly] pulled the very same expansion from the budget and passed a budget that included a prohibition against this kind of expansion that was only removed when it was [line-item vetoed] by Governor Kasich,” Thompson told a reporter weeks ago, in preparation to today's showdown with Tea Party organizers who do not want an expansion based on their notion of government debt and self reliance. "The General Assembly’s intent is pretty clear," Thompson added.
The rumored change in lawmakers took shape today when Rep. Ron Amstutz (R., Wooster), a controlling board member by virtue of being the Chairman of the House Budget and Finance Committee was seen standing in the back of the North Hearing Room in the Statehouse in Columbus today.
Amstutz, who served in the House, then the Senate and now in the House again, is among those said to aspire to become the next House Speaker when current Speaker Bill Batchelder moves on due to term limits next year. He signaled weeks ago that he wouldn't be a yes vote. Batchelder said he removed Amstutz and Representative Rosenberger, another possible future speaker, "so that the leadership race could not be an issue at Controlling Board today."
Amstutz said he had "grave concerns about the place, the time, and the substance of this proposed controlling board action." His preferred path, he said, is to take it through the legislature, "a far superior and more creative solution by legislative enactment than what I fear may result from effectively crimping the legislative process."
The heat is on
The political heat of the day came in exchanges between Chris Redfern [D-Catawba] and Gov. Kasich's chief of Medicaid and Governor’s Office of Health Transformation, John McCarthy and Greg Moody, respectively.
Redfern, whose second job is Chairman of the Ohio Democratic Party and who returned to the legislature last year when he again won his district in Northern Ohio, engaged in asking politically loaded questions of McCarthy and Moody. On at least one occasion, a question with a tip on it prompted panel chairman Randy Cole to remind Redfern to be civil, while advising Moody he need not respond to any question related to the 2016 presidential race, which Redfern broached when he criticized Gov.Kasaich for calling the ACa "Hillarycare," a reference to former First Lady and Secretary of State Hillary Clinton, who many believe will be the Democratic candidate for president.
Redfern challenged Moody on why he used the term "Obamacare" four times in a written presentation to the House Budget and Finance Committee during budget hearings on the state's biennial budget and 24 times orally? Was Obamacare, the nickname Republicans dubbed the Affordable Care Act passed in 2010 and that President Obama has used to describe his signature healthcare insurance law, used in a pejorative fashion, he wondered.
He also asked who the "we" was that Moody kept referring to in talking about how to better and more efficiently deliver Medicaid, the federal/state program that consumes about 40 percent of Ohio's budget. Republicans and Tea Party advocates want to reduce that percentage.
McCarthy and Moody tiptoed through Redfern's heat-seeking questions, designed to show Gov. Kasich, who he said voted against it at least five times when he was a Member of Congress for 18 years, and Lt. Gov. Mary Taylor, who runs the state department of insurance, as hypocrites.
Kasich and Taylor refused to run their own healthcare insurance exchange, letting the Obama administration do it instead. They have been likewise unrepentant in declaring the ACA a bad idea that will drive healthcare costs up while being a job killer, favorite GOP talking points.
McCarthy said that even though priorities change over time, and that any decision made today only extends to the end of the state's current biennial budget, which expires before July 1, 2015, extending Medicaid will remain a priority. As such, he said, it won't be given short shrift by lawmakers in future budgets.
He also acknowledged that if Medicaid is not expanded, Ohio could run out of money by the end of this fiscal year or the beginning of the next fiscal year in July of 2014.
When Redfern repeatedly asked for guarantees from the two, McCarthy said he could not offer a guarantee. "There is no guarantee to anything in life," McCarthy told Redfern.
Kasich's Democratic challenger weighs-in on today's decision
Cuyahoga County Executive and Democratic candidate for governor Ed FitzGerald issued the following statement in reaction to the Controlling Board’s action today on Medicaid expansion:
"Medicaid expansion is the right thing for Ohio, so today’s Controlling Board decision is a positive development. It shouldn’t be overlooked, however, that Governor Kasich’s decision to bypass the legislature is a temporary end run certain to invite legal challenges, and that his constant political attacks on the Affordable Care Act have only served to confuse the issue. This is an instance where an appropriate outcome is being ill-served by Governor Kasich’s deeply flawed process, and Ohio’s working families deserve better on such an important matter."
Speaker of the Ohio House William G. Batchelder's statement on today’s vote:
“I think it is important for us to recognize what today's meeting of the Controlling Board is about. Existing law gives the director of Medicaid the ability to set Medicaid eligibility levels without legislative involvement. This has already been done by Governor Kasich's administration, and today's meeting of the Controlling Board is to ensure the solvency of the state's Medicaid program.
“This is not a vote in favor of or opposition to the federal healthcare law, otherwise known as “Obamacare.” The decision to change Medicaid eligibility has already been made by the Governor's administration.
“Additionally, there has been speculation that the leadership race for the 131st General Assembly would play some role in this decision today. In fact, it was my decision to proactively remove both Representative Amstutz and Representative Rosenberger so that the leadership race could not be an issue at Controlling Board today. I am grateful to all members involved for their understanding of that decision.”
Jane Taylor, state director for AARP Ohio, applauded today's action at the Statehouse to accept federal funding to extend Medicaid coverage to low-wage workers with no health insurance or Ohioans in their 50s and 60s who had been denied coverage only because they don’t have dependent children..
"We commend Gov. John Kasich for his resolute commitment to ensure that Ohio did not lose this opportunity to grant access to health coverage to adults who struggle to make ends meet. His heart-felt advocacy will see hundreds of thousands of Ohioans gain the coverage that will protect and improve their health," she wrote.
"In the end, all of us will benefit when fellow Ohioans can get the physical and mental health care they need," Taylor said.
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