Attorney General Mike DeWine made headlines last week with his announcement that he now supports the Medicaid expansion authorized as part of the Obama-era health care reform known as the Affordable Care Act. This miraculous transformation, we are to believe, has occurred after DeWine spent the entire 2018 primary season–which wrapped up only weeks ago–blasting anybody who could even remotely be tagged as supporting Medicaid expansion. Now, turning on a dime, DeWine would like us to believe that he is a friend of the poor and near poor Ohioans who depend on Medicaid.
What’s really going on here?
Let’s get the obvious out of the way: supporting Medicaid expansion in Ohio is a political no-brainer. According to one recent poll, 77% of Ohioans support the expansion. From a political perspective, this is not exactly a profile in courage.
There is, of course, a more principled reason why we might applaud DeWine for settling, at least for now, even if it is a reversal of his position of only weeks ago, on supporting Medicaid expansion. It remains, as Governor Kasich called it when he pushed through the expansion in 2013, a “matter of life and death.” Almost 700,000 Ohioans now depend on the Medicaid expansion for their access to health care services. As the scholarly literature has long told us about Medicaid, we can assume that this coverage not only improves Ohioans’ health, but helps them to avoid debt caused by medical bills, which means that more Ohioans will be able to pay their rent, keep their lights on, afford food, and meet other basic necessities. Medicaid is quite literally a safety net.
In its coverage of the DeWine announcement, the media has tended to miss the mark. For example, a Dispatch article covering the event was mistakenly titled “DeWine pledges to keep full Medicaid expansion coverage.” Readers would have good reason to assume that the word “full” meant that DeWine would continue the current program. Yet, the article also quotes DeWine as noting that under a DeWine/Husted administration, Medicaid “will not exist as we know it.”
DeWine is referring to proposed work requirements as a condition of Medicaid eligibility. But virtually all health policy scholars who have studied the question agree that though such requirements will have little effect in forcing more Medicaid eligibles to work. As Wendy Patton, senior project director at Policy Matters Ohio, has noted, “Work requirements are redundant and unnecessary because most people are working. The problem is there aren’t enough well-paying jobs.” Instead, such requirements will merely serve as a bureaucratic barrier to enrollment, denying many–perhaps up to 18,000–Ohioans who rely on Medicaid for their health care needs–and who may actually be eligible for the program, even those who are currently employed–the ability to receive necessary services.
And you thought Republicans hated bureaucracy and red tape.
There are legal problems with this proposal as well. A federal district judge recently rejected similar requirements proposed by Ohio’s neighbor, Kentucky, on the basis of that state’s governor’s having not taken into consideration the effect work requirements would have on access. Among other things, the judge called the proposed requirements “arbitrary and capricious.” You can’t just implement a work requirement without at least showing an interest in how many people such a plan will injure.
Long story short: in no way is it accurate to say that DeWine pledging to “keep full Medicaid expansion coverage.”
If all of DeWine’s waffling and pandering on the issue isn’t enough for you, there’s a perhaps clearer way to envision what is likely to happen to Medicaid if DeWine is elected. As Plunderbund noted in a recent Tweet, there is a more pragmatic reason to not be too giddy about DeWine’s announcement. Recently, Governor Kasich displayed his support for full Medicaid expansion by vetoing an attempt by the Republican-led legislature to freeze enrollment. Considering that candidate DeWine’s support for Medicaid expansion is mainly rooted in political opportunism, and only if it “will not exist as we know it,” what do we predict a Governor DeWine would do in the face of an attempt by his own party to roll back health care for 2/3 of a million Ohioans? Does anybody really believe he would take on his own party when his own support for Medicaid is so tentative?