Critics of expansion question the board’s legal authority to move ahead. Ohio OKs Medicaid expansion

An obscure Ohio board has approved Obamacare’s Medicaid expansion, but a likely legal fight by furious conservatives is looming.

The decision, 5-2, by the state Controlling Board to back expansion at the urging of Republican Gov. John Kasich would accept billions of federal dollars to extend coverage to an estimated 300,000 poor Ohioans. Kasich pursued a vote of the board after efforts to win over his Republican-led Legislature failed to gain traction.


“Together with the General Assembly, we’ve improved both the quality of care from Medicaid and its value for taxpayers. Today’s action takes another positive step in this mutual effort,” Kasich said in a statement. “I look forward to continuing our partnership with the General Assembly to build upon the progress we’ve already made to make Medicaid work better for Ohioans.”

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Critics of expansion questioned the board’s legal authority to approve a major coverage expansion. Thirty-nine Republicans in the Ohio House — including Speaker William Batchelder — filed a protest letter Oct. 16 contending Kasich’s gambit “does not carry out the clear intent” of the Legislature.

“The Ohio Constitution grants legislative authority solely to the Ohio General Assembly, an authority which cannot be delegated,” the lawmakers wrote. “This request is thinly veiled legislation creating new eligibility levels and funding levels for Medicaid. … The controlling board request … is contrary to the Ohio Constitution and current statutory law.”

Backers of expansion told POLITICO they anticipate lawsuits challenging the board vote from Republican lawmakers and advocates of limited government.

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Few Republicans, save perhaps Arizona Gov. Jan Brewer, fought harder for expansion than Kasich. He’s a fiscal conservative and the former chairman of the House Budget Committee, but he’s crisscrossed his state all year, imploring Republican lawmakers to reconsider their hard-line anti-Obamacare stances and accept the federal funding to cover the state’s poor. But neither his moral nor his economic arguments won over GOP lawmakers.

The seven-member Controlling Board is charged with adjusting the state budget to reflect fluctuations in federal funding. Because Medicaid expansion is technically just an increase in federal funding to cover more low-income residents, Kasich has argued that the board has the power to approve it unilaterally.

The board is made up of a Kasich administration budget official and six lawmakers. The vote was all but assured early Monday. Kasich’s own appointee, as well as two Democratic appointees, were certain to vote for expansion, and local reports suggested that at least a couple Republican members were leaning toward endorsing expansion, and they ultimately did.

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If the expansion is upheld, an estimated 300,000 previously uninsured Ohioans could become eligible for Medicaid on Jan. 1. The state would also be in line for billions of dollars in stepped-up Medicaid funding for states that approve expansion.

Ohio would also become the 25th state to expand Medicaid and the eighth led by a Republican governor to support expansion. The others are Arizona, New Mexico, Nevada, North Dakota, New Jersey, Iowa and Michigan.

Kasich is up for reelection next year, and although he’s argued against Obamacare as a whole, he’s sought to distinguish expansion from the rest of the law, emphasizing that Medicaid has long predated the new health care law.