Obama KasichAs the members of the General Assembly return from summer recess we will hear talk, threats and promises of “needed Medicaid reform” from Governor Kasich, Democrats, news outlets and Republican legislators, parroting the demands of the hospital/welfare activist lobby.  There will be no mention, though, of implementing the Affordable Care Act.  The Governor’s camp-followers will insist their rewriting of Medicaid eligibility has nothing to do with the Obamacare train wreck facing Ohioans in 2014 and everything to do with reforming Ohio’s Medicaid system.  They will not admit the indisputable truth, that Medicaid expansion is a key component of Obamacare implementation in Ohio and that it is the one component Ohio’s General Assembly can refuse. In fact, just 19 months ago, under Kasich’s leadership, the State of Ohio joined with 25 other states to tell the US Supreme Court Obamacare’s Medicaid expansion was unconstitutional.  Ohio’s brief to the Court stated,

“Title II of the ACA expands the Medicaid program in multiple respects and transforms it from a cooperative program addressed to specific categories of the most needy into a mandatory program designed to fulfill the individual mandate for the entire non-elderly population with income below 138% of the federal poverty line.

Despite describing Medicaid expansion as the key means by which Obamacare would fulfill the individual mandate for tens of millions of Americans just 19 months ago, the Governor and his backers now insist that their proposed expansion of Medicaid is not Obamacare implementation, but just a modest reform effort to make the existing program more effective in targeting a small, marginalized population, “the poorest of the poor” and “Ohio’s most vulnerable.”  The Obama Justice Department made the same claim to the Supreme Court in 2012, but the Court sided with the “then” Governor Kasich, the State of Ohio and the 25 other states who saw through the charade.  The Court’s majority opinion bluntly replied,

“Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire non elderly population with income below 133 percent of the poverty level. It is no longer a program to care for neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage.”

The court substantiated its argument by pointing out in dollars and cents what this extraordinary remaking of Medicaid would mean to the country and to the states.

“In light of the expansion in coverage mandated by the Act, the Federal Government estimates that its Medicaid spending will increase by approximately $100 billion per year, nearly 40 percent above current levels….”

So it seems during the past year and a half, the US Supreme Court and the “now” Governor Kasich have parted ways when it comes to identifying society’s most vulnerable.  The Court made it clear in its majority opinion for whom the Medicaid program was established and they recognized that Obamacare meant a significant departure from past practice with “dramatic” consequences to the states.

“There is no doubt that the Act dramatically increases state obligations under Medicaid.  The current Medicaid program requires States to cover only certain discrete categories of needy individuals—pregnant women, children, needy families, the blind, the elderly, and the disabled….The Medicaid provisions of the Affordable Care Act, in contrast, require States to expand their Medicaid programs by 2014 to cover all individuals under the age of 65 with incomes below 133 percent of the federal poverty line.

Governor Kasich may be singing a new tune when he attempts to add able bodied adults to the definition of society’s most vulnerable, but the people of Ohio who elected him are not humming along.  65% of Ohio’s Republican primary voters oppose Medicaid expansion and the more we hear of employer mandate delays and unlawful subsidies for Congress, the Obamacare opposition becomes ever more emboldened.  This important point is not lost on the Republican state legislature.  It is why they removed Medicaid expansion from Kasich’s biennial budget and it is why they now talk of Medicaid reform.  But, the grassroots are too savvy to fall for this legislative masquerade.  Reform is just an alias for expansion and silly headlines in the press demonstrate the lie.  A recent Columbus Dispatch article concerning the reform effort carried a headline which read, Ohio could save and expand Medicaid, study says and a Cincinnati.com headline read, Study:  Taxpayers could benefit from Ohio Medicaid expansion.

Acting as though Republican voters would consent to Medicaid expansion by blindly accepting unproven and unidentified reforms is ludicrous and reveals how desperate statehouse Republicans have become to fulfill Kasich’s call for Obamacare.  And the folly of their reform strategy demonstrates how great the divide between the ruling class and the working class has grown.  The producers, the taxpayers, cannot risk their lot on academic projections.  We live in the here and now and the money we spend is our own.  It is honestly earned, not taken from the sweat of another’s brow.