John Kasich, Ohio’s Republican governor, often argues that expanding Medicaid is the Christian thing to do. Most recently he has said that the policy is rooted in a Biblical concern for the downtrodden.
Expanding Medicaid provides some financial peace-of-mind for people who did not previously have insurance, while also replacing private insurance for some recipients. It may not do much to improve recipients’ health, though, or give them access to doctors. The cost-benefit ratio is not impressive. There is a moral case for doing it — but a better case, I think, for letting the beneficiaries take most of the Medicaid money and use it to buy insurance on the market.
Whatever you think of Kasich’s argument, though, it’s hard to square with the political decisions it is meant to justify.
Medicaid is a joint federal-state program in which the federal government pays more than half the costs. The federal government pays almost all the costs of the Medicaid expansion in Obamacare. This set-up creates a powerful incentive for state-level politicians to say yes to the expansion. If they say yes, they are granting their voters benefits that are almost entirely paid by voters in the other 49 states. If they say no, their voters are still on the hook for the benefits taken up by other states. Kasich nods toward this point when he says that his acceptance of Medicaid expansion brings Ohio’s money back home.
Kasich was a powerful federal officeholder in the 1990s: the chairman of the House Budget Committee. During that time he did not advocate an expansion of Medicaid. Nor, to my knowledge, did he advocate it at any time prior to becoming governor. He became an enthusiastic supporter of it only when, as a governor, it offered him a chance to spend money on his voters on the tab of other states’ voters.
That makes him a pretty typical officeholder. What distinguishes him on this issue is the Christian gloss he has put on it. Kasich may sincerely believe that Medicaid expansion is the Christian thing to do. He seems, though, to have come to this view at a highly convenient time.
(Update: Should add this disclosure since Kasich is likely to run for president.)