In his weekly conference call with reporters Wednesday, Ohio’s senior U.S. Senator wants Ohioans to weigh-in on “Healthy Ohio,” Gov. John Kasich’s proposal to force people poor enough to qualify for Medicaid to pay monthly premiums for health care coverage that would have strings attached to it if the federal government allows Ohio officials to follow through on his proposal.

For a fiscal and social conservative like Gov. Kasich, it’s par for the course to dispense some bitter pills mixed in with his so-called curative prescriptions. Of great concern to Sen. Sherrod Brown, twice elected statewide in 2006 and 2012, is the governor’s proposal to require nearly all non-disabled adults, including some pregnant women, on Medicaid who currently qualify for the program to pay premiums to maintain coverage and would impose caps on yearly and lifetime expenses. Additionally, the proposal includes additional co-payments and cost-sharing requirements.

Bitter Pills

The back story starts with Gov. Kasich’s expansion of Medicaid in Ohio, via the Affordable Care Act judged constitutional by the U.S. Supreme Court in 2012, that so far has provided health coverage for more than 600,000 Ohioans. In Ohio’s 2016-2017 budget bill signed into law by Gov. Kasich is a proposal by the Ohio Department of Medicaid to apply to the federal government for permission to change, or “waive,” the way the program is currently run. Sen. Brown told reporters he’s encouraging Ohioans to share their stories about Medicaid expansion and what it means for the health and well-being of Ohio’s communities on his website.

Sen. Brown said the twist in the program represents “politics at its worst.” It’s hypocritical and worse than ironic, he said, that Healthy Ohio plans to kick people off their health care plan. Mr. Brown said Gov. Kasich could have line-item vetoed the proposal from the legislature but didn’t. His worry is that federal Medicaid officials might approval all or parts of it, but his job was to advocate for Ohioans to keep these bitter pills out of reach of already struggling Ohioans and their families. Kasich administration officials say Medicaid is just a transition to private insurance, but Sen. Brown countered that Medicaid is a form of insurance. “That argument,” he said, “is not being straight.”

From a political perspective, in a decidedly political election year, Sen. Brown understands that John Kasich, to win favor with Republicans as he runs for president, has to be as critical as possible of President Obama’s Affordable Care Act. He has advocated that the whole waiver request be denied.

A guest on the call with Sen. Brown was James Misak, MD, of MetroHealth. Dr. Misak was involved in securing MetroHealth’s early Medicaid waiver and discussed how the model improved the health status and outcomes of low-income populations.

“The MetroHealth Care Plus program in 2013 enrolled over 28,000 previously uninsured Cuyahoga County residents in an early demonstration to study the impacts of expanded Medicaid coverage combined with access to high-quality, coordinated health care,” Dr. Misak told reporters. “Enrollees demonstrated improvements in care and outcomes for diabetes and high blood pressure while decreasing emergency department utilization and overall costs of care.” The doctor’s view is that continuous health coverage matters. “Changing a currently successful Medicaid program to one that leads to gaps in coverage and care will most likely result in higher costs for the health system and poorer health outcomes for Ohioans.”

Sen. Brown, who’s second term is up in two years and whose name has been mentioned as a possible running mate for Hillary Clinton should she be the Democratic presidential nominee, wants Ohioans to make their voices heard during the public comment period before the plan is submitted to the Centers for Medicare and Medicaid Services for review. Those two opportunities present themselves Thursday, April 21st at the Ohio Department of Medicaid in Columbus and next Tuesday at Mercy Health Home Office in Cincinnati.

Sen. Brown declined to comment on whether basic beliefs held by Gov. Kasich—including his belief in personal responsibility and weaning people off of dependency on government—were drivers on this policy. Motives might not be central to Mr. Brown’s thinking, but outcomes clearly are, and his hope is that Ohioans are left worse off after visiting their doctor.