Kasich Leading GOP Efforts to Retain Medicaid Expansion, Value-Based Reforms

As he campaigned for president, Ohio Governor John Kasich said he expanded Medicaid based on a belief that he, and society, would be judged by the treatment of the poor.

These days, he’s making a different pitch—a pragmatic one to save pieces of the Affordable Care Act (ACA) that he says have worked for his state, and brought coverage to 12 million people nationwide.

The people Kasich worries about gained coverage under Medicaid expansion, which calls for the federal government to pay 90% of the cost of extending coverage to those up to 138% of the federal poverty line (FPL). This group could be left scrambling if those matching funds end abruptly. There are fears that the individual market will not be able to absorb them, and some doubt they could pay for coverage.

Kasich, a Republican who once chaired the House Budget Committee, is urging his party to keep at least some parts of the Medicaid expansion provisions, which have made it easier for the poor to pay their bills and helped many discover they had an untreated chronic condition. He’s working with Wisconsin Governor Scott Walker, Tennessee Governor Bill Haslam, and others to keep the ACA-level funding for Medicaid expansion at least at 100% of FPL, in part to make sure the state can treat all who need help amid the nation’s opioid crisis.

While this part of his crusade has received more attention in the past week, a letter sent in January to House Majority Leader Kevin McCarthy spells out Kasich's other priority—maintaining the momentum toward value-based care. As the Congress debates a replacement for the ACA, he wrote, “we need to move on to address the underlying costs that led to the current crisis, and confront the reality that too much of what we buy is of questionable value.”

Kasich’s letter highlights the bipartisan nature of support for payment reform and the shift toward value-based care, which calls for squeezing unnecessary high-cost services out of the system and expanding access to well-coordinated primary care.

The best evidence of the commitment to value-based care is the bipartisan support for the Medicare Access and CHIP Reauthorization Act, known as MACRA, which scrapped the old Sustainable Growth Rate formula and put doctors and hospitals on a course toward being paid based on quality. Kasich’s letter said the same principles must apply in Medicaid; he touted a shift to managed care that he said has reduced the growth rate and requires fewer state workers, even while adding 700,000 people to the rolls.

His letter also calls for the following:

• Retaining reforms that allow coordination between Medicare and Medicaid
• Ensuring that a replacement for the ACA is done with a repeal for minimal disruption
• Giving states maximum flexibility over Medicaid, with a per-capita block grant program that spells out details in advance

Any transition, he wrote, must take current Medicaid enrollees’ needs into account, and “make transitions as orderly as possible.” A replacement must be shown to be “better than what individuals have now.”