In Ohio, House Lacks Votes to Override Kasich on Medicaid Expansion

When he ran for president in 2016, Ohio Governor John Kasich stood out among Republicans not only for expanding Medicaid, but for doing so with pride.

On Thursday, Kasich’s defense of Medicaid expansion withstood another test when the Ohio House of Representatives could not find the votes to override a Kasich veto that kept expansion intact. But that doesn’t mean lawmakers won’t try again.

Last week, lawmakers in Ohio voted for a 2-year budget that included an order for Kasich to start the process of suspending Medicaid expansion by July 1, 2018. But Kasich vetoed that language Friday, along with 47 other line items. He had support from the state’s hospitals, advocates for the poor, and a former governor, Democrat Ted Strickland. Ohio's Office of Health Transformation had said the freeze would have resulted in a loss of Medicaid coverage for up to 500,000 people over 18 months.

Medicaid expansion in Ohio began with Kasich’s end-run around the legislature in 2013; at the time, he sought the program to deal with rising problems of drug and alcohol addiction. While initial estimates put enrollment at 366,000, eventually 725,000 were added to the rolls.

Republicans in Ohio’s House are motivated to rein in Medicaid expansion because of what they see happening in Washington, DC. Congress is weighing plans to do away with expansion, which would cause the state to pick up a much larger share of the cost. Under the Affordable Care Act, federal reimbursement for the expansion group is 95%, compared with 60% for those in traditional Medicaid. As it stands now, Ohio is projected to spend $280 million on Medicaid expansion in 2018 and $338 million in 2019.

If a freeze took effect, those who receive healthcare under Medicaid expansion not be allowed to re-enroll if their incomes rose above the eligibility threshold but then later fell. Medicaid expansion goes to households earning up to 138% of the federal poverty line; in Ohio it goes to single people earning up to $16,600 a year or a family of 4 making $33,950.

According to published reports, lawmakers in the Ohio House can override the veto at a later date.