Gov. Kasich says make no mistake: By expanding Medicaid in the proposed two-year state budget, he’s not endorsing to President Obama’s Affordable Care Act.

“We are going to continue our insurance regulation in Ohio. We are not going to let the federal government take that over.  … We are also not endorsing an individual mandate.  And these (federal) insurance reforms have the potential to be devastating on the state.”

But Kasich says he has been working with the federal government to allow Ohio to have more flexibility over its Medicaid program.  And he thinks that’s what will happen in the end. So, he’s willing to expand Medicaid now.

Nearly 300,000 people
Kasich says by doing that, nearly 300,000 low income Ohioans will be eligible for Medicaid coverage.

His plan includes a new Medicaid co-payment when people make non-emergency trips to emergency rooms. That’s to discourage them from resorting to getting medical care in the most expensive setting.

“We don’t want 275,000 Ohioans getting their primary care in an emergency room. It is not sustainable, it doesn’t work, it is not humane and it costs everybody a lot of money.  And it’s more than just the cost of the visit.

'It's our money, bring it home'
He’s also looking forward to the heavy subsidy the feds will give the state to cut the costs of the expanded Medicaid coverage; “$13 billion of our own money back here to treat and solve Ohio’s problem.  It’s our money, let’s bring it home.”

Kasich says his plan would save the state $235 million in this two-year budget alone. And he says it would strengthen and expand local mental health and addiction services, freeing up $100 million in local community funds.

Praise from usual foes
Kasich’s proposal would expand Medicaid to people making up to 138 percent of the federal poverty level. And that pleases Jane Taylor, the state director for Ohio AARP.

“This will be significant to help those who are 50 to 64. There … are those who’ve lost their jobs, (and tell us) how much they are struggling in trying to find health care, and those who have lower paying jobs (and) just don’t have health care,” she says. “But they’re still making too much money to qualify for Medicaid under the current rules.

Taylor maintains the expansion will lower costs across the entire health-care system

A 'but' from conservatives
But Robert Alt of the conservative think tank, the Buckeye Institute, disagrees. He says expanding Medicaid will lead to problems.

“There is too great of a risk in the long term,” he says. “Our other concern is that Medicaid provides a very poor standard of outcomes and we don’t think you should be driving more Ohioans into a failing program.

For his part, Gov. Kasich says he shares the concern about what will happen in the future to the Medicaid program.

But he says Ohio had a narrow window to sign on before the Medicaid rules change and fewer dollars are available to Ohio’s hospitals and health care providers  And Kasich is hopeful the federal government will provide Ohio with the flexibility the state needs to make the expansion possible.

“If the federal government pulls the rug from under us and does not work with us, it’s going to create chaos. … They are making a promise.  Live up to it.”