The Facts About Ohio’s Medicaid Expansion

Gov. John Kasich opted in 2013 to push for Ohio to expand Medicaid under the Patient Protection and Affordable Care Act, more commonly known as Obamacare.

At the annual We the People Convention in Columbus that fall, I joined Greg Lawson of the Buckeye Institute for a panel discussion of why Medicaid expansion was a terrible idea. Download the slide deck I used at the event for the details of what I presented.

After vetoing an Ohio General Assembly ban on the policy, Kasich expanded Medicaid unilaterally and pressed the quasi-legislative Ohio Controlling Board (FIX LINK) to appropriate Obamacare money for the expansion — threatening to bankrupt Ohio’s entire Medicaid program (FIX LINK) if he didn’t get his way.

In its first 18 months, Kasich’s Obamacare expansion cost $1.5 billion more than anticipated (FIX LINK). After two years, enrollment in the program was 650,000 and total costs exceeded $6 billion.

For the sake of Ohio and all the other Medicaid expansion states influenced by Kasich’s Obamacare advocacy, let’s review how reality clashes with all of Kasich’s favorite Medicaid expansion talking points, starting with this overview I put together in 2017 (download as a PDF):

A summary of Ohio Medicaid expansion data from January 2017

Skyrocketing Medicaid spending growth

Gov. Kasich often brags about slowing Ohio Medicaid growth from 10% to 2.5% in his second budget… what he doesn’t mention is that Obamacare expansion was separate from his second budget because he circumvented the legislature and implemented it unilaterally.

Based on Ohio Department of Medicaid data, Ohio’s Medicaid spending increased by a staggering 33% during Kasich’s first term.

New federal spending is not “Ohio money”

To maintain his reputation as a fiscal conservative, Kasich frames Obamacare expansion funding as “Ohio money” he is “bringing back” to the state. It’s not, as the Congressional Budget Office and Congressional Research Service (FIX LINK) can confirm.

Obamacare expansion is paid for with billions of dollars per year in new federal deficit spending. Kasich knows his decision to take Obamacare spending conflicts with everything he claims to stand for, so he lies about where the money comes from.

Ohio’s needy nonprofit hospital networks

(Cross-post, summarize, and link to uncompensated care research)

Welfare for working-age adults with no kids and no disabilities

Kasich accuses Obamacare critics of callously ignoring the drug-addicted, mentally ill, and working poor. But Obamacare expansion transforms Medicaid into a sweeping welfare trap with eligibility based only on income.

In 2012, the left-leaning Urban Institute projected that 90% of the Ohioans added to the Medicaid rolls under Obamacare expansion would be childless, able-bodied, working-age adults. By 2015, enrollment was already higher than the Kasich administration expected it would be in 2020.

Before Obamacare, Medicaid was meant for pregnant women, the disabled, the elderly, children, and impoverished families. These are the people most likely to be hurt by Obamacare expansion, which is funded at a much higher federal match rate than traditional Medicaid.

When the state share of traditional Medicaid benefit costs is 38% and the state share of Obamacare expansion costs is just 5% in 2017, who do you think state lawmakers are more likely to squeeze?

Obamacare expansion’s impact on recidivism rates reviewed the numbers to confirm Kasich’s claim of a 20% recidivism rate in Ohio. Not only did Kasich understate the recidivism rate, he did so while trying to attribute the low rate to his Obamacare expansion.

State records show Ohio’s recidivism rate increased from 27.1% to 27.5% after Kasich’s Obamacare expansion took effect in 2014.

Is Obamacare expansion justified by the Bible’s call to care for the poor?

Gov. Kasich has consistently argued Obamacare expansion is “what the Lord wants,” attempting to silence Republican critics by accusing them of being bad Christians.

Kasich didn’t just smear Ohio conservatives with this argument — he repeated in in state after state during his 2016 presidential campaign:

Obamacare expansion and Ohio’s economic recovery

For the sake of his presidential campaign, Kasich tried to convince voters his Obamacare expansion was a byproduct of Ohio’s economic recovery. As Team Kasich spun it, Ohio was doing so well financially that the state could afford to — no, was morally obligated to — expand Medicaid.