WASHINGTON—Ohio’s Republican governor John Kasich and Democratic Sen. Sherrod Brown huddled in Columbus last month, and their conversation immediately turned to one of the hottest topics in Washington: the GOP push to “repeal and replace” Obamacare.
Brown would not disclose the details of their odd-bedfellows chat, but he said that Kasich is “very concerned” about the GOP plans to unravel the law’s Medicaid expansion. Kasich himself voiced that sentiment in a brief exchange with Ohio reporters on Wednesday.
“Let’s just say they got rid of it, didn’t replace it with anything,” Kasich said of GOP plans to kill the Affordable Care Act, also known as Obamacare. “What happens to drug treatment? What happens to mental health counseling? What happens to these people who have very high cholesterol and are victims of heart attacks, what happens to them?”
Kasich is most concerned about the 700,000 Ohioans who gained coverage through expansion of Medicaid,the state-federal health program for the poor, was an unaffordable bloating of the government’s health rolls, not to mention an embrace of Obama’s despised health law. But Kasich, especially during his presidential bid, staunchly defended the expansion, saying it was rooted in his Christian faith and brought Ohio’s most vulnerable population out of the shadows.
Now, the fate of Medicaid expansion will be a major flashpoint as Congress opens debate on dismantling the health care law and putting in place a GOP alternative. Ohio was one of 32 states that took advantage of the expansion, which now covers 11 million Americans.
And Kasich, as a high-profile Republican governor and possible 2020 presidential contender, could play a major role in the debate—either as a flame-throwing critic of his own party’s attitudes toward the poor, or as an instrumental voice in shaping the Republicans’ final health reform proposal. In a savvy PR move, Kasich’s administration released a report last week showing how Medicaid expansion has helped improve the health and financial well-being of thousands of Ohio residents.
“Governors, especially Republican governors, are likely to play a very important role in not only what the replacement plan looks like but the Medicaid debate more broadly,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, a liberal think tank in Washington.
In the coming weeks, the GOP-controlled House and Senate are expected to approve a budget agreement that will allow lawmakers to repeal key pieces of the Affordable Care Act, including the Medicaid expansion, on a fast-track basis. To prevent a lapse in coverage, Republicans plan to delay the effective date of that repeal until they come up with a replacement plan.
“During that time period, the expansion under Medicaid will be fully funded,” said Sen. Rob Portman, R-Ohio. He said Republicans will make sure they’re not “pulling the rug out from under people.”
But it’s far from clear what the GOP alternative will look like. Republicans haven’t even agreed on how long they need to keep Obamacare in place yet.
“We are not there, we’re working on it,” said Rep. Pat Tiberi, R-Genoa Township, who sits on one of the House committees that will craft the GOP plan. “But there’s going to be a transition period … We’re not cutting people off today, tomorrow, next month.”
But Democrats, along with some outside experts, are skeptical that the Republicans will come up with legislation that provides the same level of insurance coverage as Obamacare. Or that they will come up with an alternative health reform bill at all.
“They’ve had seven years and they’ve never said what they want to replace it with, other than this sugar pill of selling (insurance) across state lines and tort reform,” said Brown, referring to two popular GOP health policy proposals. “It wouldn’t take care of any of these millions of people.”
Kasich seems to share at least some of that anxiety, but he’s more cautious about expressing it.
“There’s room for improvement (of Obamacare), but to repeal and not to replace?” he said Wednesday. “I just want to know what’s going to happen to all those people who find themselves out in the cold.”
Tiberi and other Republicans say they want to give states more flexibility to run Medicaid, allowing them to innovate and tailor programs that suit their particular populations. As an example, he pointed to a federal waiver Ohio requested, and the Obama administration rejected, that would have allowed the state to require some Medicaid beneficiaries to pay premiums for their coverage.
“That’s a big bugaboo for (Kasich), that they didn’t get the waiver,” Tiberi said, adding that Kasich recently asked him if the GOP alternative would allow for that. Tiberi’s answer? “I don’t know, not yet… That would be the goal.”
But Solomon, with the think tank, and other critics say states already have significant wiggle room to tweak their Medicaid programs. And she said the GOP’s talk about “flexibility” is code for gutting the program, by slashing funding and forcing states to shoulder more of the cost. She said that would likely result in states restricting eligibility and throwing people back into the ranks of the uninsured.
A spokeswoman for Kasich’s Office of Health Transformation declined to say what Kasich wants to see Congress do on the Medicaid front. She noted that GOP leaders have asked Kasich and other governors for input on their replacement plan.
“We are in the process of developing our formal response to them,” said Connie Luck, the spokeswoman. “Until we respond, however, commenting publicly would be premature.”
Kasich is also planning to participate in a Senate GOP roundtable on health care reform on Jan. 19, the day before Kasich’s one-time political nemesis and soon to be president, Donald Trump, takes the oath of office.
The Enquirer’s Jessie Balmert contributed to this story.
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