by Robert Higgs for

February 22, 2013



COLUMBUS, Ohio -- Gov. John Kasich touted expansion of Ohio’s Medicaid program in his State of the State address as the right and compassionate thing to do, invoking his personal faith and lessons from “the Good Book” as a guide in his decision.

The governor urged lawmakers to examine their consciences and not let concerns about government spending, something conservative Republicans in the General Assembly have expressed, trump what he laid out as a moral imperative: helping the less fortunate.

The reference to the Bible appears to be an attempt by Kasich to peel off a group that usually lands on the conservative side of issues -- the religious right -- and obtain its support for the Medicaid expansion, a cause heavily supported by the left. So far, the Republican governor seems to be having limited success.

Some Christian conservatives say that while compassion is needed, they see an equally compelling moral issue in their concerns about the federal debt and whether Ohio ultimately gets stuck with the Medicaid bill.

“We’re all concerned with the financial situation, with the great debt that we have,” said the Rev. Dr. John Hood. He is moderator of the Ohio Association of Conservative Congregational Churches. “We need to be compassionate, but we also need to be realistic about the government doing it.”

Kasich’s two-year budget proposal recommends that Ohio accept the federal government’s offer under the federal Patient Protection and Affordable Care Act to expand Medicaid to those who earn up to 138 percent of the federal poverty level.

The expansion would extend medical coverage to about 275,000 new Medicaid enrollees, state officials say. At the same time, the state will see a net gain of $235 million over the two-year budget if it accepts federal dollars to pay for the program growth.

The federal government would cover 100 percent of the cost of newly eligible enrollees for three years before reducing that support to 90 percent in future years. Kasich has warned that if the federal government failed to keep up that level of contribution, Ohio could pull out of the expansion.

It’s that pledge of federal support that has fueled some of the fiscal concerns.

“You have to set the emotional string aside,” said Chris Long, a pastor and president of the conservative Ohio Christian Alliance. Among its stated goals are to “speak for truth and morality in the public arena” and to “train Christian leaders for effective social and political action.”

“Is the federal government, in the position where it has $16 trillion in debt, (able) to promise anything?” Long asked.

“Our kids are also looking at the $16 trillion in federal debt. That’s real money,” he said. As a father who is soon to become a grandfather, he said, “I’m listening to them because they’re going to be dealing with choices that are being made now at the Statehouse.”

Lawmakers at the Statehouse have just begun hearings on the proposed budget and minority Democrats have roundly endorsed the Medicaid expansion. But that balancing act between helping what Kasich called “the most vulnerable in our state” and the expansion of government and its costs is what is on Republicans’ minds.

“There’s no question that the majority in the House want to see that the most vulnerable in society ... are taken care of,” said Mike Dittoe, communications director for the GOP House caucus.

But Republicans also question whether adding more than 200,000 people to Medicaid is the best way to do that, and whether the federal government will come through on the funding. That’s where the spending issues meet the social conscience considerations.

“It really is striking that balance between being cost effective and making sure that people are cared for in the state of Ohio,” Dittoe said.

The Senate won’t take up the budget until after it has moved through the House, and its members haven’t taken a position yet on Medicaid expansion.

“The governor did an effective job of reminding people of the importance of health care in the overall picture in Ohio,” said John McClelland, communications director for the Senate Republican Caucus.

The conservative Ohio Right to Life intends to lobby those lawmakers to approve the expansion, and plans to specifically cite the compassion issue, said Mike Gonidakis, Ohio Right to Life president.

“Our mission is to help people, be it the unborn or the born,” Gonidakis said.

“Why is it that only one party can have a monopoly on helping people?” he asked, adding that he suspects that “there’s a lot more people who identify themselves as conservatives who support this than those who do not.”

Ohio Right to Life’s role is to advocate for health of individuals from conception to death, he said.

“From a faith-based social conservative perspective, I struggle to find anybody who can tell me this isn’t a good idea,” he said. “As conservatives, we’re required to help one another.”

Some religious coalitions that already are strong advocates of the expansion agree with the view that the moral imperative and the potential costs are linked -- but with a slight variation

“I think they do go hand in hand,” said Tracey Lind, dean of Trinity Episcopal Cathedral in Cleveland and co-chair of Greater Cleveland Congregations, a coalition of 40 religious groups that has urged the state to expand Medicaid.

“I think fiscal responsibility is another word for stewardship. And I believe there is a moral imperative,” Lind said.

She noted what Kasich also has argued; that accepting the government’s offer will bring billions of tax dollars to be spent in the state and aid Ohio’s economy. Rejecting the expansion will just mean Ohio loses out.

“I think it’s fiscal irresponsibility not to participate,” Lind said. And with the Supreme Court’s ruling upholding health care reform, “whether you support the Affordable Care Act or not is irrelevant because it is the law of the land now.”

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