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With Medicaid Expansion, Gov. Kasich’s Credibility Collapses

Former deficit hawk dives into mountain of free Medicaid money

Governor John Kasich’s proposal to expand Medicaid eligibility in Ohio after years of criticizing the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare, means a total collapse in Kasich’s credibility on Washington spending. Kasich, a Republican, was elected in 2010 due in part to his record as a fiscal hawk in the U.S. House of Representatives.


This Heritage Foundation chart depicts entitlement spending in relation to tax revenues

“His decision, a huge victory for the White House that will provide cover for more Republican governors to do the same, serves as a great case study on how difficult it is to impede the growth of government,” wrote Philip Klein at The Examiner in DC.

“Whatever justifications Kasich may give, the actual explanation for his embrace of the Medicaid expansion is political cowardice,” Klein added. “Chastened by his failed attempt at public sector union reform and Obama’s victory in the state, Kasich is up for reelection next year. And he’s afraid to stand up to the inevitable onslaught of attacks from Democrats who would charge that he was refusing to accept free money to bring health care to poor Ohioans.”

Indeed, Kasich’s rationale for expanding Medicaid eligibility is spelled out in a 29-page summary of his biennial budget proposal for fiscal years 2014-2015.

“This budget also takes the significant step of helping more low-income and working Ohioans have access to health care through Medicaid, for which the federal government will pay 100 percent for three years and level off at 90 percent beginning in 2020,” the governor’s office wrote. “While a complex decision, this reform not only helps improve the health of vulnerable Ohioans and frees up local funds for better mental health and addiction services, but it also helps prevent increases to health care premiums and potentially devastating impacts to local hospitals.”

Although Washington has spent at least $1 trillion more than its revenue every year since President Obama took office, the Kasich administration stressed the need for Ohio to get its share of federal funds, explaining, “it avoids leaving Ohioans’ federal tax dollars on the table and keeps the federal government from simply giving them away to other states.”

“Importantly, Ohio will roll back this extension if the federal government changes the rules,” the governor’s budget summary claims – as if expanded eligibility would ever realistically be revoked, should Congress some day come to terms with its spending problem.

Further cementing the fact that Kasich is embracing the growth of one of America’s largest entitlement programs, his budget proposes creating a new cabinet-level Department of Medicaid.

Federal dollars come with strings, and Washington is already $16.4 trillion in debt not including unfunded entitlement liabilities. Though he claims otherwise, Governor Kasich’s support for the PPACA Medicaid expansion represents an endorsement of a law which has already broken many of President Obama’s own promises.

By pushing more Ohioans into Medicaid as Kasich has called for, the Ohio General Assembly would be complicit in masking the inevitable failure of PPACA – and would further reduce the likelihood of market-based reforms.

Principled aversion and practical alternatives to Obama’s government-centered approach to health care have hardly been restricted to the halls of the Heritage Foundation, American Enterprise Institute, National Review, and the Cato Institute.

“The new taxes will hurt long-term economic growth and, if history is a guide, won’t be enough to pay for all the new spending,” wrote John Kasich in a March 22, 2010 campaign blog post the day before Obama signed PPACA. “In the end, the federal government will just rack up higher deficits and go deeper in debt, leaving future generations to pick up the tab.”

“Ohio government spending will go up also, adding to an already bleak budget picture,” Kasich continued. “Instead of letting states develop innovative solutions to their respective challenges, new federal mandates will require more Medicaid spending and stick states with large and unsustainable costs.”

Now, nearly three years and $3.8 trillion in national debt later, the U.S. Supreme Court has empowered states to reject expanded Medicaid eligibility – but Governor Kasich is seeking the “large and unsustainable costs” willingly.

This story originally appeared at Media Trackers Ohio.

COMMENTS

  • drfredc

    Having coverage doesn’t mean you can find a doctor to provide you care.

    Your plan or program has to pay clinics adequately for them to agree to care for you. Currently, there are lots and lots of clinics that don’t take Medicaid because its so full of rules and poor paying, that it costs more to provide care than the clinic is paid. Adding more and more people to Medicaid of one sort or another is only going to make the problem worse, not better.

    Medicaid folks better get used to long waits to get care — rationing of care. Oh yes, expect to see politicians, burrOcrats, and public unions with golden plans that you pay for walk to the front of the line.

  • littlehouse18

    I have to seriously consider moving to another country. If our healthcare is going to be at least as bad as every other country’s, might as well go somewhere where there is actually an economy. I’ve got kids to consider.

    • thirdeblue3639

      Being from Ohio, I know how you feel, but why don’t you just move to a more conservative friendly state and leave the fair-weather patriotism and histrionics to the liberals?

      • jimmyg

        Eventually someone is going to tell you to move to Texas, the state many consider one of the most fiscally conservative in the nation. Consider this, Texas obtained 39.98% of its budget from the federal government in 2011 (the last data available), no. 11 in the US. Ohio obtained 38.93% of its 2011 budget from the federal government, no. 15 in the US.

        http://sunshinereview.org/index.php/Texas_state_budget

        http://sunshinereview.org/index.php/Ohio_state_budget

      • littlehouse18

        Conservative-friendly states are gradually disappearing and you have no clue about how I’ve been exercising my patriotism.

    • lineholder

      Sad, isn’t it, to think of leaving? I found myself thinking the same thing yesterday when I saw that Big Sis Janet Napolitano might run for President in 2016.

      Where would you go?

      Sweden is on the free-market rise. Doing well at it, too. Still a broader social emphasis than what we see in the US, but not socialistic to the extent that most people would think.

      http://predicthistunpredictpast.blogspot.com/search?q=sweden

      I’ve wondered about Australia myself.

      Truth is I don’t that I could do it if it came right down to. I truly do love this nation of ours.

      • littlehouse18

        Yes, I know what you mean, don’t know if I could either. My ancestors came here long, long ago to escape religious persecution, fought and died in the Revolution, ran an Underground Railroad station, and you know what? That’s not an uncommon story. But if we continue down this road undeflected from our current path … someday we’ll be like the USSR (without the defense) or God forbid, worse.

  • lineholder

    What’s the current rate of Medicaid enrollment in OH and how rapidly has it increased in the past year?

    I know how it can seem on the matter of Medicaid expansion, but that isn’t necessarily how it is. Obamacare included provisions that allow health care providers to act as enrollment agents for Medicaid. If the health care providers in OH have been proactively pursuing enrollment, once it reaches a certain point, there’s little to be gained by refusing to accept the federal plan.

    It won’t prevent the long-term damage.

    • edintexas

      Whether health care providers can act as enrollment agents is sort of immaterial. If the State does not provide eligibility for a certain group of people, then neither an agent, nor County or State welfare department employees can enroll them as welfare clients. Period. Medicaid is a “State-Federal Partnership” program, with the Feds setting forth certain minimum requirements for there to be any Federal funding and each State setting rules for the program’s operation in the state.

      This expansion will come back to bite the taxpayers in OH because the Federal funding for the expansion is limited in time. After date certain in the law, the Federal funding goes away. But, of course, the changes to the OH statutes governing entitlement to the welfare benefit does not go away. So OH taxpayers will have to pony up the difference between what they are now paying and what they will have to pay when the Federal funds disappear.

      • lineholder

        Don’t disagree with you about the long-term damage, ed. Sorry to say, but Obamacare does override state law. It’s through back door route.

        The DSH factor is being removed from the payment formula for Medicare and Medicaid services. Hospitals with high numbers of indigent patients stand to get hit really hard by it. That payment factor helped to offset the losses of the so-called “freeloaders”, you see. Once they lose that, hospitals lose a mechanism that allowed them to not only absorb costs of indigent care but also provide services on a charitable basis.

        Looking over at meaningful use requirements for electronic health records, beginning in 2014, eligible hospitals (EH) and eligible professionals (EP) will both be facing quotas in providing treatments and services to Medicaid patients. 10% for EHs and 30% for EPs. EPs will find this harder to meet, depending on the population in the area and the number of potential Medicaid beneficiaries. If EHs and EPs don’t comply, they get socked with fines.

        It’s all designed to drive EPs and EHs to accept Medicaid beneficiaries…or else, if you get my meaning. Which provides motivation for providers to proactively pursue enrollment of Medicaid beneficiaries. Some of it has to do with R&D funding associated with Medicaid patients, too.

        Taken in context with reductions to Medicare rates (about 25% reduction), and there are providers in need of revenues who will be at high risk if Medicaid expansion fails. Some EHs can’t afford to lose physicians in the area because it will drive patients to the ER. Plus, with medical necessity and readmission penalties kicking in, EHs need to have physicians in the loop to reduce the potential for those penalties.

        Obamacare is a very badly constructed piece of legislation when it comes to achieving specific goals, such as reducing costs, ensuring access to case, and maintaining high quality of care for patients. But when it comes to manipulating the health care industry to conform to the law….on that one point, it is well-constructed.

        States would have to come up with other options and quickly.

  • Ausonius

    The heart of this reversal is well-stated: “Political cowardice….up for re-election….afraid to stand up against the inevitable attacks….”

    That is precisely the problem: as an Ohioan I have seen this state ravaged by quisling RINO’s for too many years. Kasich’s disastrous FAILURE to match the campaign by unions against the bill designed to reign in public-sector unions is illustrative: after doing nothing – and I mean really nothing – for months to explain and promote the bill and prevent it from being overturned, Kasich decided to offer “compromise talks” with the unions to stop the referendum.

    By that time their constant unanswered attacks had changed the polls far in their favor, and Kasich showed up on a Saturday in August to an empty table. The unions laughed at him, and won a 60% victory.

    Why the Republicans let the unions spread their propaganda for months with no and then little response remains a mystery.

    Haley Barbour once said that a charge unanswered is a charge admitted. That was certainly true in this case.

  • earlgrey

    I hope Conservatives respond to this appropriately. I fear we are just getting too tired.

    • metrication

      I hope as well. But, I’m sure the debt ceiling/sequestration fight in Washington, where Obama is on poor footing, will be a huge boost to Conservatives.

      • commonsenseobserver

        I don’t know about the debt ceiling, but I don’t see that Obama has any leverage on the sequester.

      • plh

        We could really use an actual victory for once. A total in-your-face smackdown of any one item of the President’s agenda would go a long way of showing that he is NOT invincible. I’d even settle for letting the sequester cuts take effect, especially now that he doesn’t.

  • rockxie

    I simply cannot imagine how Kasich, a man whom I respected, has sold himself out simply for re-election. What is to become of us when none of our party has character?

    • celador2

      Gv Walker of Wisconsin is a loud critic of Obamacare and would not comply with exchanges. He says the federal HHS runs them no matter what option a state takes. ‘Partnership’ or not the feds call the shots.
      He moved a few thousand adults to the new exchange recently, reported POLITICO a day or two ago. But Gv Walker has not expanded Medicaid like Kasich has to cover the newly eligible consumers for subsidies.
      POLITICO quoted critics who said the limited income consumers were better off cost wise on Medicaid as Medicaid covered more out of pocket expenses than did other plans.
      Scott Walker may have had taxpayers in mind when he opted to move thousands to the ACA exchange to be run by HHS than to expand Medicaid in Wisconsin.
      He too faces reelection in 2014.

    • celador2

      Respect for John Kasich is something I always will have. I was almost born in Ohio and have family there. I have admred him and followed his dynamic ground breaking leadelrship on budgets and taxes career since the Contract group of 1994.
      I wanted him to run for president and have not ruled him out. Maybe he can expalin all this. Still he is disappointing as Kasish is a ground breaker for the new way to do things.

  • usadying

    AZ governor Jan Brewer caved too. Too much money to ignore. It’s nice to know that Republicans can be bought just like everyone else. It’s so very sad.

  • siobhankelly

    Medicaid will expand, and parents with private insurance who have been paying for their kids to stay on their plan will drop the kids off the plan, and put them on Medicaid. The parents stay on private insurance. The American Academy of Pediatrics, run by radical leftists (still calling female genital mutilation “cutting” after they thought they were offending Muslim’s feelings) , has been pushing for years to expand Medicaid, with the goal of government healthcare for all. They were the main cheerleaders for Obamacare, before anyone knew what was in it. They do not represent pediatricians, who are having difficulty keeping private offices open, with the mandatory EMR systems, increasing regulations and demands from the government, and poor reimbursement, which is very poor with Medicaid. But the goal is to have physicians employed by the government- large health clinics, no private practices. Often the children have both private insurance and Medicaid, but the parent only uses Medicaid, which should be secondary.You would be surprised who admits to having private insurance when the office declares it will no longer take Medicaid. There is widespread fraud in the system which grows when Medicaid expands.

    • lineholder

      Your last sentence is probably one of the most problematic aspects to this situation. That and the admin costs states will end up carrying due to expansion…no matching federal funding on that.

    • oldmom2

      I think their goal is Single Payer or Medicare for all, not government run health clinics. Their goal is dismantling the for profit insurance industry.

  • http://impudent.edublogs.org/ kyle8

    I think it was here when I predicted that all of the Governors will eventually cave in. And I stand by that. The politics are inexorable. They will all cave in, so don’t be too hard on Kasich.

  • lineholder

    Jason, thought you might appreciate these…

    The article of Sebelius appealing for Governors to go ahead with expansion.
    http://www.washingtontimes.com/news/2013/feb/4/sebelius-obamacare-here-stay-needs-states-help/

    Letter from a legal firm describing impact opting out of Medicaid will have on Medicare and Medicaid DSH payments (read it carefully…very interesting outcomes)
    http://www.ppsv.com/assets/attachments/Impact%20of%20States%20Opting%20Out%20of%20Medicaid%20Expansion%20on%20Medicare%20and%20Medicaid%20DSH%20Payments%20D0442503.PDF

    Items included in fiscal deal signed in Jan 2013 that pertain to health care (note additional increase of $4.2 billion reduction in DSH above and beyond what was already scheduled)
    http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/congress-passes-fiscal-cliff-sgr-deal-at-hospitals-expense.html

    Which brings us back to WHY Sebelius made that plea…

    Deadline is Oct 2013.

  • http://travismonitor.blogspot.com Freedoms Truth

    Ah, swing state politics…. sad, but the real cure was/is to win elections.

    “Governor John Kasich’s proposal to expand Medicaid eligibility in Ohio
    after years of criticizing the Patient Protection and Affordable Care
    Act (PPACA), commonly known as Obamacare, means a total collapse in
    Kasich’s credibility on Washington spending.”

    I dont see it that way. Gov Rick Perry criticized the 2009 Federal Stimulus, but when push came to shove, Texas got stimulus funding.

    Kasich is taking benefits from a program that he believes shouldnt have passed, but the fact is that any governor not taking the ‘free money’ (as in free heroin samples from the drug dealer), they will get questioned as to why burden their state taxpayers on something the feds can cover. Never mind that its OUR money, its a hobsons choice set up by obamacare. Evil, in its own way.

    It is great that many Governors are saying no to the exchanges. And some to the medicaid expansion. Part of the problem with leviathan government is that it uses this chicanery to force its will.

    • jasonahart

      That Gov. Perry failed to stick to his guns on stimulus spending does not exonerate Gov. Kasich.

      If you believe, as anyone who can count ought to, that Washington spending is a crushing burden on all 50 states, there’s no way to rationalize expansion of a program that obscures the true cost of health care, distorts the health care market (such as it is), and will accelerate federal default.

  • daniel22

    Kasich was not the first. Sandoval here in Nevada did the same thing and for the same reasons Kasich did. Sandoval is one of the GOP golden boys a so called up and comer. When will people ever learn that nothing is ever free?
    If they think getting a doctor here in Nevada is hard now just wait until this thing kicks in.

  • sliverlining

    What is the big deal about re-election?
    Is it so important that you throw out all your principles and promises so you can get re-elected because, watch out, the “other guy” will just throw out his principles and promises?!
    Politicians suck. Kasich is a politician.

  • silentnomore

    The Republican Party is full of politicians who have been around way before the Tea Party movement. It may be time to look at how many of those not-so-Conservative Republicans jumped in front of the Tea Party parade? I don’t know about Kasich, but I do know about Rick Perry, and he is definitely one who jumped in front of the parade.
    Kasich has been in politics a long time. People don’t stay in politics very long unless they are willing to get their hands dirty, i.e. make backroom deals. Sometimes those backroom deals come back to haunt them. Is that the case with Kasich? …just a thought.

  • conservative_dan

    I really had faith in Kasich, but this is yet another betrayal of trust. It’s a good thing this happens after his book “Stand for Something”, because this shamefully destroys that stance. Looks like Rand Paul and Ted Cruz are the only real conservatives left. I hope they do not disappoint as well.

  • adair

    I used to really like Kasich on the House floor. He was one of the good ones. He was the principal designer of the balanced budget that was achieved during Clinton’s time. What a tragedy.

  • sarah417

    Wasn’t Ohio the swing state that put Obama over the top? A Republican Governor?Correct me if I’m wrong.
    A conservative Supreme Court Chief Justice, John Roberts. Makes the call. It’s a TAX not a fee.
    I don’t speak legalese but didn’t Justice Ginsberg just dismiss the case against Obama regarding the legality of the three NLRB appointments?
    Who’s paying these people off? Who’s threatening them?

  • rationalanalyst2

    Rational thinking is slowly returning to some members of the GOP. Kasich, among others are seeing just how bad economic conditions are for many Americans – - especially the Elderly. The Governor of New Jersey quickly came to his senses when the Hurricane hit the East Coast. Others are following suit.

    There is a Civil War of sorts, going on within the Republican Party. The Neo-Conservatives are doing their best to see that a recent label: “The Party of Stupid!” sticks.

    Pick up the latest addition of, “TIME,” Magazine; and read the Article where that very phrase is used. Rigidity and the unwillingness to Compromise is undermining Republican Unity. In fact, isn’t a new Moderate, SUPER PAC being formed to, counter the thinking, actions, and influence of the RW, “Stupids;” who would rather destroy the Party than to work with other, more moderate members? Even their Ideology is falling apart. (Immigration, Women, Debt, Jobs, etc.) What is the GOP today; and, Who are they? Read the TIME Magazine piece. It will make you sick!

    • jasonahart

      Even discounting your Capitalization of seemingly random Words, this is not a terribly rational Comment. But thanks for trolling!

  • jack777

    Remember when: Republicans had principles and voters supported them because of it? They have already forgotten how big government big spender George Bush and a complicit Congress led directly to first losing the House and Senate, then to Obama?