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Ohio is expanding Medicaid. Will other red states follow?

October 21, 2013

    Juliette Mullin, Editor

    After months of debate and roadblocks, Gov. John Kasich (R) has done what briefly appeared impossible: He's expanded Medicaid in Ohio. At least, for now.

    How Kasich made it happen

    Over the years, we've tracked Kasich's evolution from early opponent of the Affordable Care Act (ACA) to vocal advocate for the law's Medicaid expansion.

    He hasn't been the only Republican governor to change his mind on the ACA provision; Arizona Gov. Jan Brewer (R) similarly went from critic to supporter, eventually pushing the Medicaid expansion through her Legislature.

    But unlike Brewer, Kasich was unable to overcome fierce opposition to expansion in his own state's Republican-controlled Legislature. So he found a way to get around it: He went to the state's seven-member Controlling Board for permission to spend $2.56 billion in federal money to expand Medicaid starting Jan. 1, 2014. 

    In a 5-2 vote today, the legislative oversight panel approved the expansion, which will make an additional 275,000 low-income residents eligible for the state's Medicaid program, the Columbus Dispatch reports.

    The move is expected to face fierce legal challenges and could eventually be blocked by a judge. But, for now, it's moving ahead as Kasich planned.

    The announcement will be met with cheers at many of the state's hospitals, where officials maintained an "aggressive" push for expansion. In April, David Bronson—president of Cleveland Clinic's regional hospital network—said, "It's clear we're not going to give up on this. This may take some time to turn the tide but we're not giving up."

    If Ohio had not moved to expand Medicaid (or if legal efforts to stop it are successful), the Kaiser Family Foundation estimates that the state would have the fourth-largest coverage gap in the United States, with 330,240 residents living in the administrative "twilight zone" where they do not receive ACA insurance subsidies and are not eligible for Medicaid.

    Will more states follow?

    Just last week, state health policy experts met in Washington, D.C., and explained why they think many of the states currently refusing to expand their Medicaid programs through ACA are going to change their tune.

    They argued that many of the hesitant states will opt for alternate expansion models, like the one being pioneered by Arkansas. We're already seeing signs of that trend in a handful of states, including Indiana, Iowa, Pennsylvania, and Oklahoma. And a couple days ago, a spokesperson for Maine Gov. Paul LePage (R)—who has said he would not support a Medicaid expansion—signaled that he also might be considering an alternate model.

    "Part of it is the politics," said Catherine Hess, managing director for coverage and access at the National Academy for State Health Policy, adding, "I think they really want to do all that they can to provide viable options that are going to work politically for states that want to do aspects of what's in the ACA."

    But in many states, the anticipated shift may not come in time for expansion next year, the first year the provision takes effect.

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