In the course of his ongoing crusade for Medicaid expansion, Ohio governor John Kasich has suggested that Ronald Reagan, Saint Peter, and God Himself all would support his plan to accept Obamacare’s Medicaid expansion.
While we do not have special insight into the mind of the Almighty or His divine agents, we do know something about Ronald Reagan. Expanding a failing, big-government program that reduces flexibility for the states and traps generations of Americans in dependency is not consistent with the kind of conservative solutions that Reagan sought during his terms as governor of California and president of the United States.
Governor Kasich bases his argument that he is doing what Reagan would have done on the fact that Reagan expanded Medicaid when he was president. Rather than furthering Kasich’s case, however, Reagan’s actions shed light on precisely why it is that the Obama plan embraced by Kasich is so antithetical to the policies that Reagan promoted.
Kasich first points out that in 1986, Reagan signed a bill that gave states the option of participating in a program to add poor children and pregnant women to Medicaid. Aside from offering a genuine choice to the states (as opposed to the economic coercion of Obamacare), this expansion had a factor missing from the current debate: abortion.
In an era when there were perpetual fights over using public funds for abortion, the expansion assured that pregnant women would not be financially worse off carrying their children to term than they would be if they chose to have an abortion. And the policy worked. A study from the pro-abortion Guttmacher Institute found that abortions decreased and births increased following the expanded coverage in sampled states.
By contrast, Obamacare’s Medicaid expansion does nothing to help pregnant women and children. Indeed, as Ohio argued in court, Obamacare’s Medicaid expansion “transformed” the basic nature of the Medicaid program from one that gave states flexibility and applied coverage to the categorically vulnerable like pregnant women and children into a general entitlement based solely on income.
Given this shift, and the poor performance of the Medicaid program in general, it is not surprising that multiple prominent pro-life leaders in Ohio oppose Kasich’s plan for Medicaid expansion.
Kasich then points to the fact that Reagan permitted children who were restricted to receiving Medicaid-funded care in hospitals to be eligible for that care at home as well. It is a stretch to characterize this as a program “expansion” — it was more of a correction.
Reagan cut through irrational federal regulations to allow children to live with their parents, where they could receive care that would cost the taxpayer one-sixth as much as institutional care. By contrast, Obamacare has added thousands of pages of bureaucratic regulations and will cost the federal government untold billions.
But this was not the only Medicaid regulation that Reagan sought to eliminate. His policy from the beginning was to seek repeal of federal Medicaid regulations and statutory mandates other than those related to cost controls. He sought to give the states flexibility in running the program and proposed converting Medicaid into a block-grant program.
Obamacare’s Medicaid expansion, by contrast, sets a one-size-fits-all policy. States are forced to ask permission, which has been preemptively denied, to provide for personal responsibility, work requirements, or co-pays or to modify the coverage criteria. Successful state programs have been rejected or have been given very short renewals.
The political reality in which Reagan worked was with a House dominated by Speaker Tip O’Neill and Representative Henry Waxman, which limited Reagan’s ability to succeed in broader reforms. By contrast, Governor Kasich does not have a liberal legislature that must be persuaded of the notion that it’s folly to expand a failing federal program. Rather, Kasich has spent tremendous capital attempting to convince the Republican majorities in both the Ohio House and Senate that massively expanding the Medicaid program is the right thing to do.
When Ohio’s legislature rejected the expansion, Governor Kasich took the extraordinary step of entering into an agreement with the federal government to expand anyway, threatening to bankrupt the state’s Medicaid program if a special appropriations board did not ratify his decision.
Yes, Reagan worked with both parties to change the way Medicaid was run. But he did so with certain principles held true. Obamacare’s Medicaid expansion is inconsistent with those principles.
While imitation may be the sincerest form of flattery, it does a disservice to the memory of Ronald Reagan to cloak in his mantle failing programs that weaken the states and increase government dependency.
— Edwin Meese III served as chief of staff to Governor Reagan and as counselor to President Reagan prior to being confirmed as the 75th attorney general of the United States. He currently serves as the Ronald Reagan Distinguished Fellow Emeritus at the Heritage Foundation. Robert D. Alt is the president of the Buckeye Institute for Public Policy Solutions and is a visiting senior legal fellow at the Meese Center for Legal and Judicial Studies at the Heritage Foundation. He is a contributor to National Review Online.