“Great states can do great things.” Former Ohio Gov. John Kasich preaches Medicaid expansion to NC legislators

In an afternoon full of recitations of numbers and policy details on states’ experiences with Medicaid expansion, former Ohio governor John Kasich told North Carolina legislators that getting health insurance to more people was just the right thing to do.

“What I would say to the fine members of the legislature in North Carolina, to the people in North Carolina, there’s a lot of people that need a lot of help,” said Kasich, a Republican who championed Medicaid expansion in Ohio. That state expanded Medicaid in 2014, opening the government insurance program to low-income adults without dependent children.

“We have to open our hearts to those people,” Kasich said. “That doesn’t mean that when we do that that we put ourselves on the road to bankruptcy. It means that we have good management. And at the same time to able to expand this program.”

A legislative committee in North Carolina considering Medicaid expansion called on representatives from other states on Tuesday to talk about how they did it.

Expanding Medicaid would make about 600,000 people in North Carolina eligible for health insurance. Most low-income adults younger than 65 do not qualify for Medicaid. Those that make too little to qualify for subsidized health insurance available through Affordable Care Act marketplaces are said to fall into the health insurance gap.

Gov. Roy Cooper, a Democrat, has been trying for years to get Medicaid expansion in the state, with efforts that started even before he took office. Republicans in the legislature have rejected the idea since a U.S. Supreme Court ruling from 2012 declared Medicaid expansion under the ACA is optional.

North Carolina is one of 12 states that has not expanded Medicaid.

Rep. Donny Lambeth, a Republican who has authored bills that would set up an insurance plan for low-income adults, is co-chairman of the House and Senate committee considering Medicaid expansion. He has said hopes to present a package of proposals later this year.

The committee on Tuesday heard mostly positive experiences from the leaders and policy makers from four states that expanded Medicaid: Indiana, Montana, Michigan, and Ohio. All four had GOP-controlled legislatures when they expanded, and three had Republican governors. All incorporated work requirements into their Medicaid expansion plans that were never enacted or have been suspended.

In Ohio in 2014, the highest proportion of people using Medicaid who were diagnosed with cancer were the nearly 30,000 covered under expanded Medicaid in its first year.

Kasich asked North Carolina legislators to imagine not having health insurance and dealing with a cancer diagnosis.

“Can you imagine that? And if we have the chance to reach out and literally hand them a lifeline,” he said.

“Boy, if we can figure out how to do this, you’ll have people thanking you forever. That will be part of your personal legacy,” he said.

“Great states can do great things.”

Indiana adopted Medicaid expansion under Mike Pense when he was governor. About 500,000 people are covered under Indiana’s expanded Medicaid program. Indiana adopted a system that looks like private health insurance, where people get accounts similar to heath savings accounts, with incentives for preventive care and improved health, said Dr. Jennifer Sullivan, a former head of the Indiana social services agency that oversees Indiana Medicaid.

“This can expand without general fund costs,” she said. “The expansion helps hospitals and doctors. Expansion helps access in rural areas. And expansion decreases costs through better preventive care and disease management.”

Michigan also structured its Medicaid expansion program to look like commercial insurance, with health savings accounts and copays, said Dominick Pallone, executive director of the Michigan Association of Health Plans.

Only Montana officials offered a somewhat downbeat assessment of their experience with expansion. The Biden administration did not allow the state to require recipients to work, and the voluntary workforce program for Medicaid beneficiaries was never adequately funded and gets little use, said Montana’s Medicaid program leaders.

Nonetheless, Montanans enrolled in Medicaid through expansion work at least half of the year, said Adam Meier, the state’s Medicaid director. And the state saw 1600% increase in telehealth use, he said.

At a separate legislative committee meeting Tuesday also dealing with healthcare, lawmakers discussed why people in mental health crises get stuck in emergency departments for weeks and months waiting for space to open in hospitals where they can get psychiatric care.

Though people who are younger than 65 and are without insurance are 13% of the state population, they account for 35% of the visits to hospital emergency rooms for mental health care, according to state Department of Health and Human Services data.

Expanding Medicaid would free up state money now spent on mental health care for uninsured  people, said Dave Richard, North Carolina’s Medicaid director. That state money could then be redirected to meet other critical needs, he said.