If Barack Obama’s signature domestic policy survives the winter, it will be thanks in part to a Republican governor. Ohio Gov. John Kasich is fighting to continue Obamacare’s expansion of Medicaid to working-age adults with no kids and no disabilities, even though its costs have skyrocketed out of control.
While congressional Republicans debate how quickly to wind down Obamacare’s Medicaid expansion – a welfare program that has cost federal taxpayers $11 billion in Ohio alone – Kasich is planning a trip to D.C. to demand Congress keep the new deficit spending coming.
“I just want to know what’s going to happen to all those people who find themselves left out in the cold,” Kasich said during a press conference last week. In its first three years, Kasich’s Obamacare expansion added 720,000 working-age Ohioans to the welfare rolls.
“Our hospitals needed Medicaid expansion,” Kasich insisted, repeating an Ohio Hospital Association talking point that has never been supported by the revenue and expenses Ohio’s nonprofit hospitals report to the IRS.
According to hospital lobbyists, every state’s hospitals need billions in new federal deficit spending. But a 2015 analysis by credit rating agency Moody’s found that hospitals in states that expanded Medicaid “did not outperform hospitals in non-expansion states,” despite shifting more of their indigent care costs to taxpayers.
This isn’t the first time Kasich has helped Democrats prop up a key pillar of Obama’s health law. During his presidential campaign and for years leading to it, Kasich traveled the country wagging his finger at Republicans who never learned to stop worrying and love Obamacare.
Other GOP governors have followed Kasich’s lead in expanding Medicaid, but Kasich gets the biggest headlines because he has accused expansion critics of letting poor people die and has warned opponents they’ll suffer eternal consequences.
Sen. Rob Portman and Rep. Pat Tiberi, two Ohio Republicans close to Kasich, are already undermining repeal efforts by hinting that Obamacare expansion should continue indefinitely with slight state-level customizations.
Obamacare’s myriad taxes, mandates, and marketplace regulations are interconnected in a way that will make piecemeal repeal difficult. Repealing the law’s Medicaid expansion, however, should be an easy win for Congress.
Medicaid expansion makes anyone with income below a certain threshold eligible for a program meant for the elderly, the disabled, pregnant women, and children. Kasich touts expansion as a way to help drug addicts, the mentally ill, and the working poor – even though income is the sole eligibility criteria, with no work requirements of any kind.
At last week’s press conference, Kasich cited findings from an Ohio Department of Medicaid phone survey of expansion enrollees as proof he was right to embrace Obamacare. But the survey showed that fewer than a third of enrollees suffer from mental illness, and fewer than a third have substance abuse problems.
ODM found that 57 percent of Ohio’s Obamacare expansion enrollees are unemployed, 52 percent have not seen an improvement in their health, only 34 percent have reduced their emergency room visits since signing up, and 70 percent of enrollees with substance abuse problems receive no substance abuse treatment.
Expanding Medicaid, Kasich has said, allowed him to “bring Ohio money back home,” preventing other states from getting $13 billion of “Ohioans’ federal tax dollars” in the first seven years. He circumvented a legislative ban on Obamacare expansion, waving off concerns about the cost with appeals to his experience in Congress in the ’90s.
In just three years, Kasich’s Obamacare expansion cost $11.3 billion, and not a penny of that new federal spending was “Ohio money” that would have otherwise gone to another state.
Kasich estimated that 447,000 Ohioans would sign up for Obamacare expansion by 2020. By the end of 2014, more than 500,000 able-bodied, working-age adults had enrolled in the welfare program.
Although Obamacare expansion is not targeted at drug addicts, it’s fitting that Kasich talks about addiction whenever he discusses the policy: Medicaid consumed nearly half of Ohio’s budget when Kasich took office, and he increased Medicaid spending by 44 percent from 2011-2016. The vast majority of that new spending is federal money.
States have to pay for 5 percent of their Obamacare expansion costs starting this month. Before that, 100 percent of the tab was covered by the federal government – or, more accurately, with IOUs politicians keep writing on behalf of current and future taxpayers.
At 5 percent, Ohio’s share of its Medicaid expansion costs will be roughly a quarter of a billion dollars this year. That’s $250 million that cannot be spent on education, public safety, infrastructure, or state-based healthcare programs, while the other 95 percent of the new welfare costs are added to the $20 trillion national debt.
Worse, Obamacare gives states far more federal money for their Medicaid expansion enrollees than for those covered by traditional Medicaid, creating a perverse incentive for state lawmakers to prioritize childless, able-bodied adults over pregnant women, the elderly, children, and disabled individuals on Medicaid waiting lists.
Ohio isn’t the only state where Medicaid expansion costs and enrollment have surged past projected maximums. A recent Foundation for Government Accountability study showed that all 24 of the Obamacare expansion states that have released a year of enrollment data have already signed up more able-bodied, working-age adults than they ever expected to.
In those 24 states, FGA found, sign-ups expected to peak at 5.5 million now exceed 11.5 million. With enrollment far higher than anticipated and per-enrollee costs 49 percent higher than projected last year, Obamacare expansion’s burden on federal taxpayers and the truly needy will keep getting worse unless Congress ignores Gov. Kasich and follows through on promises to repeal Obamacare.