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It’s easy to be critical of Obamacare for the mess it has made of the U.S. health-insurance system and for expanding a Medicaid program that is simply not sustainable. But from the time the Affordable Care Act (ACA) was passed to the day a new president and Congress can change it in 2017, America’s governors haven’t had the luxury of just complaining about it. They have faced real people with real needs and real problems that need to be solved now, on the ground, not in some debating society or policy journal.


What John Kasich and his team have accomplished by collaborating with key stakeholders in the Ohio health-care system, and within the federal law and all of its regulations they had no ability to change, is impressive. Governor Kasich has called for repealing and replacing Obamacare, like all of the other Republican candidates. But before Republicans have any chance of doing that in 2017 at the federal level, Governor Kasich has made big health-care policy change a reality in Ohio.

On Medicaid, the Kasich administration helped 650,000 people whose uncovered health-care costs were being shifted onto and burdening employers and individuals struggling to pay their already-high health insurance costs. The administration enrolled them into a new Ohio Medicaid system that made 38 different reforms over five years. In 2015 alone, it saved Ohio taxpayers $1.9 billion compared with the original state-budget target. It held the program’s per capita cost growth below 3 percent while cutting the state’s uninsured rate in half.


The accomplishments of the Kasich administration do not end there. It has begun to make fundamental delivery-system reforms in collaboration with the state’s health-care providers and insurance companies to put Ohio’s health-care system on a track to financial sustainability.

Policymakers generally agree that to make our health-care system affordable over the long term, we need to move away from the fee-for-service system, which pays for more encounters, and move to a system that pays for value — for getting people healthy sooner. Since 2012, the Kasich administration has worked with consumer representatives, private-sector health plans, health-care providers, and state-agency partners to collaboratively remake the health-care payment system in Ohio one that pays for value — a system that wastes less and gets people well sooner.


Rather than imposing health-system change from the top down, starting in 2013 the Kasich administration created the Advisory Council on Payment Innovation, which ultimately involved more than 1,000 health-care leaders in Ohio — including consumer representatives, physicians, hospital administrators, insurers, and state agencies — to design and implement new systems of care based on value. The CEOs of Ohio’s leading health insurers voluntarily committed to the governor that they would help design and implement these new concepts in the marketplace:


‐In March 2015, as a result of the Kasich administration’s leadership, Ohio’s largest private health-insurance plans began measuring and reporting the performance of health-care providers for six high-cost episodes of care. A second set of episodes will be added in 2016, and still more will be measured statewide starting in 2017. Ohio is on track to reduce, by the end of 2018, the incentives for unnecessary care and to better reward the best care for more than 50 different health conditions touching 90 percent of Ohio patients.

‐In 2015, the Kasich administration formed the Patient-Centered Medical Home design team to hold down the cost of care by preventing disease and better managing chronic conditions in primary-care settings. The team worked with more than 800 Ohio stakeholders representing patients, primary-care providers, and health plans. The team created a new payment model that will financially reward primary-care practices that do a better job of preventing disease and managing chronic conditions. The new model will be implemented in both Ohio Medicaid and private health insurance starting in 2016 — two years ahead of schedule.



‐Under Ohio law, 50 percent of Ohio’s managed Medicaid payments must take advantage of these new systems by being value-based by 2020.

America’s health-care costs are simply unsustainable. Employers are increasing the share of their workers’ health-insurance premiums at alarming rates while also increasing their deductibles and co-pays. Obamacare’s unaffordable individual-market premiums and deductibles for the middle class are legendary. Medicare and Medicaid are grabbing a bigger and bigger share of the federal budget and cannot continue in their present form. Health-care entitlements must be reformed, with cost containment being the top priority.

The other Republican presidential candidates have been telling us they want to clear out the Obamacare mess, but John Kasich is the only candidate who has started the job. While the other candidates have been busy pointing out the lemons, John Kasich has been busy making lemonade, putting Ohio ahead of the curve for the day in 2017 when change at the federal level can begin.