EDITORIAL: The governor and the Medicaid expansion

Akron Beacon Journal (OH)

Feb. 26--John Kasich has been emphatic about preserving the Medicaid expansion. Of late, the governor has been making the case in Washington, where his fellow Republicans in Congress are looking to repeal and revamp the Affordable Care Act. On Friday, he met with President Trump. He has been huddling with Republican governors who share his thinking.

What the governor has going for his argument is the real difference the expansion has made in improving the quality of lives and advancing Ohio. What he faces are Republicans in charge on Capitol Hill eager to implement ideas they long have held for remaking Medicaid, the broad outlines of which the governor has shared.

Take the concept of shifting the program to block grants or per-capita limits on federal money routed to states. Medicaid currently tracks need, thus allowing for expanded coverage in hard times. Block grants or per-capita limits retreat from such flexibility. They inevitably put financial pressure on states and risk shrinking coverage for the poor and vulnerable.

The governor has a record of supporting block grants. Yet, surely, he can see the complications, just as it is problematic to reduce the federal share of funding for the Medicaid expansion, another Republican proposal under discussion. What has been key to the expansion is the federal government covering 90 percent of the cost for the duration. Reduce that amount to the typical share of 57 percent, and states would face a big tab, $32 billion in 2019, according to the Center on Budget and Policy Priorities.

Many likely would narrow the program in dramatic fashion or drop the expansion entirely. Ohio would need to come up with $1.2 billion.

In this instance, the federal government has the financial scope and muscle for the job.

Those who have watched the governor and his team work at modernizing Medicaid know that they would like to see the expansion population (from 100 percent to 138 percent of the poverty level) move into the private insurance exchange for coverage. After his meeting at the White House, he made plain the condition for such a move: In effect, do no harm.

Or as the governor wrote in a coinciding Forbes column: "I cannot emphasize enough the importance of providing a stable transition for those who have gained coverage. Eliminating coverage without a viable alternative would be counterproductive and unnecessarily put at risk our ability to treat the drug addicted and mentally ill who now have access to a regular source of care and treatment services."

In Ohio, as the Center on Budget and Policy Priorities points out, more than one-half of those enrolled in the expansion have used their coverage to gain mental health and drug treatment services. As a result, many now lead more productive lives. Count the expansion, too, as helping to put communities in a stronger position to battle the heroin epidemic.

As the debate has evolved in recent weeks, notably, the advocates at town hall meetings, congressional Republicans have made improvements to their proposals. Now John Kasich is well placed to press for more than something better than last proposed. A spokeswoman for the state Office of Health Transformation got it right in the Columbus Dispatch: "We want to preserve the progress we've made in our state." That means the governor remaining true, resisting any slippage in the Medicaid expansion.

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