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Friday, December 9, 2016

While the left is focused on the Republican Party’s miserable post-shutdown poll numbers and the right is celebrating the flaws in Healthcare.gov, the biggest and brightest news for the future of the Affordable Care Act (ACA) has come out of the nation’s most crucial swing state.

Ohio has become the 25th state to accept the ACA’s Medicaid expansion, which was made optional to the states in a 2012 Supreme Court ruling.

What is extraordinary about the Buckeye State’s acceptance of the program — which will allow residents earning up to 138 percent of the poverty level to receive subsidized health care — is how hard Governor John Kasich (R-OH) pushed for expansion, and how he did it.

Ohio’s Republican-dominated state legislature rejected Medicaid expansion three times earlier this year, after Kasich became one of about a half-dozen Republican governors who signaled he wanted his state to embrace the ACA provision. Instead of accepting defeat, the governor took the matter to the Controlling Board, an obscure entity that normally handles small budgetary matters. More than three dozen Republican legislators protested this move to circumvent the legislature.

The board voted 5-2 on Monday to accept $2.5 billion in federal funds for expansion to cover up to 275,000 Ohioans.

Kasich — who during the 1990s was the chairman of the House Budget Committee that produced the first balanced budget in decades — prepared his state for Monday’s vote by waging a public relations campaign for expansion that took two of the right’s most cherished symbols and used them to advance President Obama’s signature legislative achievement.

The governor continually invoked Ronald Reagan and “Christian compassion” as he argued for providing health insurance for the working poor. This further enraged right-wingers, who favor using the Gipper’s image to push lower taxes and Christian fundamentalism to push conservative stands on social issues such as abortion and same-sex marriage.

Republican governors in states like Ohio that President Obama won have a hard time turning down expansion for a simple reason: They’d like to keep their jobs.

It’s also a great deal for the states, with the federal government paying 100 percent of the coverage at the outset with that percentage tapering down to 90 percent by the end of the decade.  The federal government currently pays about 57 percent of the cost of Medicaid. States that reject the program will have to provide the tax revenue to pay for it anyway, without the coverage that should keep the working poor out of emergency rooms and drive down insurance rates for all residents.

Kasich’s use of the Controlling Board to accept Medicaid expansion may end up being found illegal. Regardless, the governor — a potential 2016 candidate — has put Republicans in his state in a position where they will now have to take a concrete benefit away from residents, instead of arguing against a vague promise.

This is a decision that will also likely impact the 2016 election. Now if a candidate argues for a full repeal of the Affordable Care Act, he or she will be calling for health insurance to be snatched back from more than 200,000 working Ohioans.

No Republican has ever been elected to the White House without winning Ohio.

Photo: KY Governor Beshear via Flickr

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