EDITORIAL: Their ‘very, very bad idea’ for the Medicaid expansion

March 12--Paul Ryan, the House speaker, talks about ensuring a "stable" transition for those Americans benefiting from the Medicaid expansion. His words echo the standard set by Gov. John Kasich and others who have witnessed how the expansion has advanced lives, bringing health coverage to 700,000 Ohioans. Yet House Republican leaders have a curious concept of stable. They propose ending the expansion, in essence, presenting states with an offer they cannot afford to accept.

All of it still fits the description the Ohio governor applied three weeks ago when he traveled to Washington to argue against phasing out the expansion. It's a "very, very bad idea."

As part of their plan to "repeal and replace" the Affordable Care Act, Ryan and colleagues would permit the expansion to continue, at current federal funding levels, until 2020. At that point, states choosing to accept new enrollees would be required to pick up a larger share of the cost, paying from 2.8 times to 5 times more per person, according to the Center on Budget and Policy Priorities.

For those in the program who stay continuously enrolled, states would see no change in funding. The reality is, their ranks would shrink steadily. The way Medicaid works is that most cycle into and out of the program. In time, practically everyone would be a new enrollee at the reduced federal funding level.

The Center on Budget and Policy Priorities calculates that to fund fully the expansion, Ohio and 31 other states (including the District of Columbia) would face coming up with an additional $253 billion during the next decade.

The Kasich team estimates the state would need $1.5 billion a year to continue coverage for those eligible under the expansion.

It gets worse. The House Republican plan also proposes to alter dramatically how federal money is allocated for the program. No longer would Washington pay a set percentage of the medical bills. It would send each state a flat payment for each person who is covered. As designed, this per-capita limit would not keep pace with current Medicaid spending. Thus, the center sees states coping with another funding gap, a shortfall of $116 billion for the decade.

That's $369 billion in total, or putting Ohio and the other states on an almost certain path to abandon the expansion.

Again, only the federal government has the financial muscle and scope to cover such an expense. At the same time, the expansion is affordable. Consider the $600 billion in tax cuts for the decade, largely flowing to wealthy households, in the House Republican plan.

More, Medicaid is efficient, with lower and slower-growing costs than private health insurance. States already have much flexibility in operating the program. If Congress wants to add room for testing ideas, go ahead as long as eligibility and quality are protected. Of the leading entitlement programs, Medicaid addresses almost exclusively the needs of the poor and vulnerable, including many with mental illness. Thus, adequacy and stability are high priorities.

Of all the flaws in the Affordable Care Act, the Medicaid expansion is not one of them. To mess with this achievement "makes no sense," as John Kasich often and responsibly reminds.

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