The whole country is watching the nuances of Washington pol negotiations ahead of a vote on the Better Care Reconciliation Act, otherwise known as the U.S. Senate's version of the Obamacare repeal-and-replace bill. The bejowled Mitch McConnell is working feverishly to nail down a majority of his colleagues; failing thus far, he's delayed the vote until after the July 4 recess.
Part of why McConnell's been backed into a corner on this one is the force of a small contingent of moderate Republican, including our very own Sen. Rob Portman. Just yesterday, Portman said that he cannot support
the bill as-is. He joins other Republicans in opposing this bill, mostly on the grounds that the law would phase out the Obama administration's Medicaid expansion far too quickly. In Ohio, whose population has benefited greatly from the expansion (and whose governor champions the policy), that's a political problem. More than 700,000 Ohioans have jumped on the Medicaid expansion since 2014.
But state legislators, not known for tasteful decision-making over the years, are moving ahead with a Medicaid expansion freeze in their state budget. Jim Siegel at the Columbus Dispatch reports
that this sets up a "showdown" with Gov. John Kasich as a most contentious time. The proposed freeze would begin in July 2018. Here's the Dispatch
Those covered by the Medicaid expansion as of that date would continue to be covered, but only if they don’t get better employment and drop off the Medicaid rolls, something that happens regularly. The catch is that those who leave Medicaid could not return later even if they lose their job, unless they are getting mental-health or drug treatment.
However, no one could be added to the Medicaid expansion group starting in July of next year even if they need medical help for mental-health problems or drug use.
The federal bill could cost some 1 million Ohioans access to health care coverage if it's passed. This state budget provision would cost more than 500,000 Ohioans access to Medicaid coverage, as the Governor's Office of Health Transformation points out
The state budget bill needs to be signed by Friday, and Kasich will almost surely use his line-item veto authority to scratch out the Medicaid expansion freeze. From his time in Columbus to his work on the campaign trail, the role o Medicaid in Ohio has been a touchstone of his government.
It would take a three-fifths majority of the Statehouse to override a veto like that, teeing up a fight for a razor-thin vote margin not unlike what we're seeing in Washington right now.