Friday, June 29, 2012

Will Ohio reject half of health care reform? Or will voters reject all of it?

Well, that was a wild ride.  For politics junkies, yesterday was a huge fix -- the most anticipated, most important, most surprising Supreme Court decision since Bush vs. Gore, complete with a no-wait-yes reveal.

I was sitting in my doctor's office at 10:09 when misfired and posted, "The Supreme Court has struck down the individual mandate for health care." I pulled it up on my phone. My doctor was mostly rooting for the health care law (he's from Canada), but even he got the breaking-news junkie gleam on his face when I told him.

I left and walked into the least boring waiting room experience ever, 20 Cleveland Clinic patients looking expectantly at a TV, reading the CNN captions.  Wait, CNN was saying by 10:16... some reporter was finally reading past page 2... not under the commerce clause, but under the power to tax... 

Thanks to Walter Dellinger, who should've earned thousands on InTrade for his prediction, I knew what that meant.

"Dewey Defeats Truman -- LIVE!" the Atlantic's Megan Garber called CNN's flub. 

The network flipped at 10:19. "Supreme Court upholds entirety of health care law," it announced.

That was pretty close.  But still not right.

The Court snipped one line out of the Affordable Care Act, but it's a big one.  It ruled the states can choose not to go along with the law's expansion of Medicaid. That could lead to a weird split in the country -- liberal states going along with all of health care reform, conservative states going along with half of it.

When I say half, I mean half.  You've heard that the new law will give 30 million people health insurance, right?  Well, today the New York Times ran a chart, based on Congressional Budget Office estimates, that says 22 million people will get health care coverage through new insurance exchanges, while 17 million will get it from the Medicaid expansion.  Now, that means 17 million would get it if their state goes along.

The Medicaid expansion will be 100 percent funded by the federal government -- for a few years.  Then 95 percent. Then 90 percent.  Even though it's a generous subsidy, conservative states that feel extra-cautious about their financial future (or, not as concerned about the uninsured as others) might decide to turn it down.  See this Washington Post story for more.

Gov. John Kasich and Lt. Gov Mary Taylor have strongly resisted the health care law. Yesterday they issued a statement saying they're "very concerned" about "a sudden, dramatic increase in Medicaid spending."

They're hinting that they might decide to turn down the federal money and not expand Medicaid to cover everyone in or near poverty in Ohio.  That could become a huge issue in state politics by next year.

But I'm a step ahead.  For now, the real question isn't, will Ohio's government say no to half of health care reform?  It's, will Ohio voters say no to all of it?

What I mean is, everyone says this election is about the economy and jobs.  But what if it's really about health care? 

The economy may decide the election, but the election will decide whether the health-care law stays or goes. Romney promises to repeal it.

Republicans in Congress think they only need 51 senators, not 60, to repeal parts of it. They need to pick up four Senate seats, and they have a shot.

Ohio's looking a lot like the ultimate swing state again.  It could clinch the presidency for Obama, or put Romney very close to winning.  So the future of the health care law may have passed from the Supreme Court's hands to Ohio voters'.

1 comment:

eD said...

Hard to predict but I do believe Obamacare (and Ohio) will be rejected.

As someone who has been in the health care business for 30 years, I admit...we need reform. But increased usage of Health Savings Accounts and additional funding to the state risk pool will cost hundreds of millions of dollars less and provide better coverage.