DeWine says he wants to make Medicaid better, vague about protecting expansion population

Ohio Gov. Mike DeWine last week talked up an effort to retool the state’s $27 billion-a-year Medicaid program to make it “one that focuses on people and not just on the business of managed care.”

But he’s also supporting the nomination of a U.S. Supreme Court justice who could vote to invalidate the Affordable Care Act and possibly strip healthcare from more than a half-million Ohioans. DeWine’s office was vague last week when asked if the governor wanted to keep coverage for those Ohioans, many of whom are among the state’s working poor.

DeWine’s position on the Affordable Care Act, also known as Obamacare, has evolved over the years. Passed in 2010, two of its better-known provisions are requirements that insurers cover people without regard to preexisting health conditions and that Medicaid would cover people earning up to 138% of federal poverty guidelines.

The law came under a barrage of legal challenges — including one DeWine joined on his first day in office as attorney general in 2011. Even so, in 2012 the U.S. Supreme Court in a 5-4 decision upheld the constitutionality of the law, but said states could decide for themselves whether they wanted to expand eligibility.

Then-Gov. John Kasich, Republican, did so in 2013 and by 2018, Medicaid officials said the portion of Ohioans who were uninsured had been cut in half. 

State Medicaid data show that as of February, before the coronavirus pandemic struck, 525,000 Ohioans were receiving health care coverage as part of the Medicaid expansion. That’s about 4.5% of the state’s population.

In 2017, as he began his run for governor and with Ohio in the grip of an opioid crisis, DeWine changed his position on the Medicaid expansion, saying he wanted to reform Medicaid, but as governor he wouldn’t pull out of the expansion offered under Obamacare. Many Ohioans were receiving addiction treatment under the program.

Now the health system for the poor is even more in demand. The coronavirus pandemic has hit that group hard and it reportedly has made the opioid crisis worse.

Against that backdrop, DeWine last week announced that Medicaid managed-care providers were being asked to submit proposals for a re-imagined Medicaid system. He said they would pursue “A vision of what we hope will be a better, healthier, more productive state of Ohio.”

But at the same time, DeWine is supporting Amy Coney Barrett, President Donald Trump’s latest nominee to the U.S. Supreme Court.

“Judge Coney Barrett’s prior writings and judicial opinions show that she will interpret the law fairly and impartially, and I urge the U.S. Senate to act quickly to confirm her nomination,” DeWine said in a statement.

However, among those prior writings are some critical of Supreme Court rulings upholding Obamacare. In 2017, Barrett wrote that Chief Justice John Roberts’ 2012 vote to uphold the law “pushed the Affordable Care Act beyond its plausible meaning to save the statute.”

If Barrett is confirmed according to the calendar proposed by Senate Majority Leader Mitch McConnell, she’ll be on the court — and very possibly the swing vote — on Nov. 10. That’s when the high court will hear Texas v California, the latest challenge to the constitutionality of the Affordable Care Act.

So when he was running for governor, DeWine said he supported keeping Ohio’s Medicaid expansion and last week he said that he wants to reform Medicaid in a way that makes Ohio healthier and more productive. But at the same time he’s supporting a Supreme Court nominee who has expressed hostility to the law and might cast a vote that could strip 525,000 low-income Ohioans of their health benefits.

Does DeWine support keeping the Medicaid expansion even if Barrett and the court invalidate the Affordable Care Act? The answer isn’t terribly clear.

“While this scenario is hypothetical, eligibility for this category of beneficiaries is set by federal law,” DeWine press secretary Dan Tierney said last week in an email responding to that question. “Governor DeWine has kept Medicaid expansion during his tenure.”