The race for Ohio Governor is shaping up to be a race for the future of healthcare for the state’s most vulnerable residents. And one candidate in the race refuses to say whether he would preserve coverage for over 700,000 low-income Ohioans.

Medicaid expansion, a critical component of the Affordable Care Act, was embraced by Republican John Kasich as a way to provide healthcare to low-income Ohioans, funded almost entirely with federal dollars. Kasich has fought off attempts by the GOP-dominated legislature to protect the program, but with a new Governor set to take office in January, the program’s future is clearly in doubt. And every candidate for Governor has been very clear when talking to voters about their plans to keep or end the Medicaid expansion.

That is, every candidate except Mike DeWine. 

It’s not that Mike DeWine isn’t talking about Medicaid expansion; it’s that he’s talking about his plans for the expansion in the vaguest possible terms. DeWine has said that, if elected Governor, the first thing he would do “is ask the Trump administration to give us more flexibility” on Medicaid. He’s also called for “some waivers.” Jon Husted, his running mate, has alluded to a “third way” beyond continuing Ohio’s Medicaid expansion as is or ending the expansion altogether. 

What do “more flexibility,” “some waivers,” and a “third way” mean, exactly?

DeWine isn’t saying. But if you ask any healthcare expert, they’ll tell you those terms are campaign double-speak for a plan to fundamentally change Medicaid as Ohioans know it. The Medicaid program, we should add, includes not just the 700,000 low-income adults served by expansion, but more than 3 million Ohio children, the elderly and people with disabilities.

On a call with reporters Thursday, Innovation Ohio President Janetta King explained that when DeWine says he wants to make Medicaid “sustainable,” he means he wants to reduce Medicaid spending. Specifically, that can be achieved in one of three ways: Either fewer people will be covered by Medicaid, the program will cover fewer services, or providers will be paid less. In short, DeWine’s plan pits vulnerable Ohioans against each other.

“Which of those three things, or how many of them, are you going to do? Who is no longer going to be covered? How are you going to decide who of the 700,000 is more deserving?”
– Janetta King

Here’s what we do know about Mike DeWine’s plan to upend Medicaid so far

First, one waiver proposed by DeWine’s camp would convert Medicaid into a block grant. Currently, Medicaid is jointly funded by both the state and federal government, which helps ensure that everyone who is eligible for Medicaid and applies for the program receives benefits. Block granting Medicaid, however, essentially means that Ohio would walk away from the state-federal partnership, and the cost burden would be shifted to the state.

In practice, this means that Ohio would be forced to cap Medicaid costs — even as the aging population grows, the opioid epidemic continues to accelerate, and the country prepares for the next economic recession. A Medicaid block grant would also likely result in some populations being dropped from Medicaid, particularly populations that typically incur higher health care costs — such as the blind, the disabled, and seniors. 

Another proposal Mike DeWine is promulgating is a waiver to impose Medicaid work requirements. However, such a requirement could cost county governments hundreds of millions of dollars in new administrative costs, and potentially throw tens of thousands of Ohioans off their health insurance. (Not to mention that an assessment of Ohio’s Medicaid expansion found that the expansion has helped enrollees find and keep jobs.)

As Amanda Wurst of Protect Our Care Ohio put it, DeWine’s Medicaid proposals “will fundamentally change the current Medicaid program and pit Ohioans against each other.” 

“DeWine’s so-called ‘third way’ is nothing more than a talking point to avoid telling voters what he will really do if elected to lead this state,”
– Amanda Wurst.

Mike DeWine’s attack on Ohioans’ health care should come as no surprise. As Attorney General, DeWine pursued a politically-motivated lawsuit against the Affordable Care Act, threatening millions of Americans’ health coverage. 

The result of Ohio’s race for Governor could carry grave implications for Ohioans who, thanks to Medicaid expansion, no longer have to choose between getting the medical care they need and paying their mortgage. As Dr. Kristin Foley, a Columbus-area physician, told reporters, “The Medicaid expansion in Ohio, which brought Medicaid to 700,000 Ohioans, has been incredibly successful.”

Mike DeWine and Jon Husted can call their Medicaid plan a “third way” or whatever else they want. But semantics won’t change the serious harm DeWine’s plan will inflict on Ohioans, their families, and the state’s economy.

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