Republicans and Democrats deciding on their nominees for president must weigh a variety of factors: Candidates’ personalities, their electability, and perhaps most importantly, their records on the issues. Ohio Gov. John Kasich is an attractive candidate for many reasons, but conservative voters have good reason to doubt his dedication to limited government, based on his record on healthcare.
Importantly, Kasich chose to expand Medicaid, the government health insurance program for low-income people, through executive fiat during a critical national debate about the role of government in healthcare.
Originally, the Affordable Care Act (or Obamacare) was designed to force all states to expand eligibility for Medicaid for any American with an income up to 138 percent of the federal poverty level. After the Supreme Court ruled in summer 2012 that this was coercive, states had a choice: They could expand Medicaid using generous (but time-limited) federal funding to help defray the cost of expansion, or they could opt out and continue to run their Medicaid programs as they had before the new federal law.
Kasich chose to expand the program, and at great cost. The Ohio Medicaid expansion cost $6.4 billion in its first two years, and Medicaid spending in the state increased 33 percent during Kasich’s first term. There is nothing conservative about this.
When Kasich supporters say the expansion “helped” 650,000 Ohioans enroll in Medicaid, conservatives should translate this claim: Ohio already covered the indigent poor, including the disabled, pregnant women and children, but the expansion moved 650,000 able-bodied, childless adults into a broken government program, where health access and outcomes are far inferior to private insurance.
Kasich wants to present a false choice between going on Medicaid and going uninsured, but that’s not the whole story: The Medicaid expansion crowds out private insurance. According to an estimate from the Foundation for Government Accountability, Ohio’s crowd-out rate is 54.9 percent, meaning approximately half of enrollees in the expansion left private insurance (employer coverage or individual plans) for the flypaper of Medicaid dependency.
It’s not just what Kasich did that should concern conservatives; it’s how he did it. When the Ohio General Assembly voted against the Medicaid expansion — and even banned it — Kasich vetoed this ban and unilaterally and abusively used his executive power to expand the program.
Worst of all, Kasich relies on liberal-Democrat talking points to try to shame his opponents on this issue as bad Christians.
Many limited-government Christians feel insulted and even hurt by Kasich’s defense of the Medicaid expansion. Conservative Christians oppose expanding the role of government into healthcare and other arenas, because we recognize that often government action unintentionally hurts the very populations it intends to help.
To suggest that only government can help the poor — or that one’s concern for the poor must translate into support for big government — is to accept a faulty premise most frequently pushed by liberal Democrats. This ignores the important role of private, charitable safety nets and does not inspire confidence in the decisions that Kasich might make as president.
By expanding Medicaid, Kasich aided the Obama administration politically by increasing the number of people enrolled and making support for ObamaCare’s Medicaid expansion “bipartisan.” Kasich’s actions will make it harder, not easier, to rollback Obamacare should free-market reformers ever get the chance to change federal law. Politically, it is always easier to expand benefits than to limit them.
That said, just because Kasich made the mistake of expanding Medicaid does not mean he is not fit to be president or even the GOP nominee, if that is what voters choose. In fact, Mitt Romney was a flawed candidate on the issue of healthcare, too. But Republicans — for the most part — recognized that Romneycare was a stain on his record; they didn’t try to spin the program into something it was not.
Kasich and his supporters should be honest about the Medicaid expansion. It was not conservative. It did not save money. It did not limit government. Team Kasich should make the case for their candidate in other ways. But they should not pretend that the Ohio Medicaid expansion was a success for conservatives or anyone else.
Hadley Heath Manning is director of health policy at the Independent Women’s Forum. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
