As he announces his presidential ambitions on Tuesday, Ohio Gov. John Kasich will be greeted with well-deserved criticism from conservatives over his expansion of Obamacare.
To recap, in 2010 Kasich was elected as an opponent of Obamacare, but in 2013, under pressure from hospital lobbyists, he embraced the program's expansion of Medicaid, framing his cynical move in the language of Christianity, and attacking conservative opponents for being "heart-hearted." When the Republican legislature rightfully rejected the expansion, Kasich bypassed lawmakers and rammed it through a separate panel.
Now that he's running for president, he'll try to portray himself as an opponent of Obamacare, and he's likely to offer a number of defenses of his policy choice (several defenses were collected in a video put together by Ohio native Jason Hart of Watchdog.org, who has doggedly chronicled Kasich's compulsive dishonesty on this topic). Below I've listed five of Kasich's most common defenses to conservatives, and explained why none of them excuse his actions.
Kasich Defense 1: The Medicaid expansion and Obamacare are totally different
"When people try to tie Medicaid to Obamacare, I don't see the connection," Kasich has said. "Medicaid is Medicaid, Obamacare is Obamacare. They're two different things, and I don't see that they're really connected."
There are 393 appearances of the word "Medicaid" in the legislative text of Obamacare. The expansion of Medicaid itself is authorized in Title II, Subtitle A of Obamacare -- a section called, "Improved Access to Medicaid." The Medicaid expansion is one of the main two ways through which Obamacare expands insurance coverage. By 2025, the Congressional Budget Office projects that Obamacare will add 14 million people to Medicaid. The Medicaid expansion will account for $824 billion (or slightly more than half) of Obamacare spending over the next decade, according to the CBO.
It's also worth noting that Medicaid is the one aspect of Obamacare that both left and right agree is explicitly a single-payer system. The logical implication of Kasich's position of boasting about rejecting setting up a state-based exchange while expanding Medicaid is that Obamacare would have been better if it simply expanded single-payer healthcare in the U.S. instead of monkeying around with regulated exchanges that featured private insurers.
Kasich Defense 2: I just wanted to bring back Ohio money
"I don't support Obamacare," Kasich has insisted to CNN's Jake Tapper. "I want to repeal it, but I did expand Medicaid, because I was able to bring Ohio money back home to treat the mentally ill, the drug addicted, and to help the working poor get healthcare, but I am opposed to Obamacare."
To start, it's worth reiterating that repealing Obamacare would repeal the Medicaid expansion, as demonstrated by the CBO report issued last month, which noted, "A repeal of the ACA would include a repeal of…an expansion of eligibility for Medicaid." Thus, it is directly contradictory for Kasich to hold these two views simultaneously – that he supports expanding Medicaid and repealing Obamacare.
As for bringing back money to Ohio, that argument could theoretically pass muster if it were a situation in which money not spent by Ohio were automatically funneled to other states and spent anyway, as with the economic stimulus bill. But that isn't the situation with Medicaid, the funding for which is only authorized to be spent in states that agree to participate in the expansion.
It's also worth noting that although the federal government picks up the full tab for the expansion in its first three years, starting in 2017, states will have to start pitching in and by 2020 will have to cover 10 percent of the costs. As it is, Medicaid is crippling state budgets and is among the largest state expenditures.
Kasich Defense 3: Expanding Medicaid was about asserting states' rights
In a statement released last fall, Kasich argued that, "[T]he Supreme Court split expansion from the rest of the ACA and left it to the states to decide."
The Supreme Court didn't "split" Medicaid expansion from Obamacare. In fact, it did the opposite -- it split existing Medicaid from the Obamacare Medicaid expansion. To refresh everybody, what was at issue in the Supreme Court case was that as written, Obamacare was threatening to withhold existing Medicaid funding to states that refused to participate in the expansion. But in the majority decision, the Court ruled that the changes to Medicaid in Obamacare represented, "a shift in kind, not merely degree."
The majority determined that, "the original program was designed to cover medical services for four particular categories of the needy...Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage."
In other words, the Supreme Court decided that traditional Medicaid was different from Obamacare's Medicaid expansion, and thus funds from the existing program couldn't be withheld to coerce states into participating in the new program.
The ruling gave states the ability to reject an expansion of one of the central components of Obamacare — to limit the imposition of the law on their states. But instead of exercising this right to stand for conservative principles and fiscal sanity, Kasich instead chose to bypass the legislature to facilitate the growth of Obamacare and dependence on government.
The phony invocation of "states rights" is a tactic often employed by state-level Republicans with national ambitions to frame a big government policy as a manifestation of conservative principles. The idea is to blur the distinction between having the freedom to pursue certain policies at the state level, and the actual policies themselves.
One close parallel is how Mitt Romney attempted to invoke the states' rights argument to defend his Massachusetts healthcare law, which mandated the purchase of insurance, expanded Medicaid and provided subsidies to individuals to purchase government-designed insurance on a government-run exchange.
Kasich Defense 4: Medicaid expansion saved lives
"What we've seen as a result of this? Saved lives, there's no question about it," Kasich has said in defending the Medicaid expansion.
There is no serious research to support the conclusion that the Medicaid expansion in Ohio has saved lives, and in fact, what academic evidence we do have on the program more broadly has suggested there is no link between expanding Medicaid and decreased mortality. A landmark study done on a pre-Obamacare expansion of Medicaid in Oregon found, "no significant improvements in measured health outcomes" among those who gained coverage through the program as compared with those who did not.
Kasich Defense 5: Reagan expanded Medicaid, too
"Ronald Reagan expanded Medicaid," Kasich has said on multiple occasions when pressed on his support.
This is the one defense that has some grounding in the truth, but it still is a shaky argument that shouldn't get Kasich off of the hook.
Republican politicians often try to invoke the iconic conservative president to excuse all of their deviations from conservatism.
It cannot be stated enough that despite Reagan's rhetoric and many genuine accomplishments, he was far from perfect when it came to limiting government, and one of the areas where he particularly disappointed conservatives was when it came to the growth of entitlements. Two wrongs do not make a right.
Having said that, it's also worth noting that there are several key differences between Reagan's Medicaid action and Kasich's, as articulated by former Reagan Attorney General Edwin Meese and Buckeye Institute President Robert Alt in the National Review.
Reagan's expansion was limited to giving the states an option to extend Medicaid benefits to children and pregnant women in poverty, which the authors noted, "assured that pregnant women would not be financially worse off carrying their children to term than they would be if they chose to have an abortion."
This isn't a free market argument, to be sure, but at the same time, it's important to remember that Reagan was working with a Democratic-controlled House of Representatives. In contrast, Kasich has a Republican legislature he bypassed that legislature to ram through the Medicaid expansion over lawmakers' strong objections.
Note: portions of this post have appeared in previous articles I have written about Kasich's dishonesty when it comes to defending his expansion of Obamacare.