"The last guy to expand Medicaid was Ronald Reagan." It was with lines like that that Ohio Republican governor and likely presidential candidate John Kasich rubbed a small audience of influential conservatives in New York City the wrong way Wednesday night.
Appearing at the swank Four Seasons Restaurant, Kasich spoke to the same group that heard Wisconsin Gov. Scott Walker make the case for his own imminent presidential candidacy last month, an event that made headlines when former New York City Mayor Rudy Giuliani questioned whether President Barack Obama loved his country.
Giuliani was absent this time, but Republican New York businessman John Catsimatidis was in attendance, along with economist and radio host Larry Kudlow, Laffer Curve supply-side champion Arthur Laffer, and magazine publisher and former presidential candidate Steve Forbes.
Sparks flew when Kudlow gave the floor to Manhattan Institute scholar and Forbes healthcare blogger Avik Roy, who asked: "Is it fair to say you support repealing Obamacare except for the Medicaid expansion?" Roy added that Kasich has been asserting that Medicaid critics on the right "are going to hell."
Kasich, who has expanded Medicaid by accepting federal money in Ohio, repeated the biblically-oriented arguments he has made before, suggesting that balancing budgets is not the question politicians would get asked in the afterlife, but what they did for the poor.
He conceded that Roy had described his position on Obamacare and Medicaid correctly, but also told Roy, "I'm gonna send you the transcript so you can get it right," saying of an event at which he was quoted, "I was out at a Koch brothers' conference. A lady was yelling at me saying, 'you're using God against your people.' "
The former House Budget Committee chairman also said: "Obamacare's a bad idea because it's top-down and does not control costs." But Roy countered with: "You're saying Obamacare is top-down government. Is Medicaid not top-down government?"
Then Kasich said to Roy of those on Medicaid: "Maybe you think we should put them in prison. I don't. I don't think that's a conservative position. Because the reality is, if you don't treat the drug addicted and the mentally ill and the working poor, you're gonna have them and they're gonna be a big cost to society. I think rehabbing them, getting them on their feet, training them and getting them jobs, is a conservative position."
Medicaid is a massive burden on state budgets, its spending skyrocketing from $118 billion in 2000 to $275 billion by 2010. Before passage of Obamacare it was forecast to jump to $487 billion by 2020, but the president's health overhaul is expected to boost Medicaid's costs by another $100 billion a year by that time.
Roy himself has written, citing a University of Virginia study of nearly 900,000 major surgeries from 2003 to 2007, that "surgical patients on Medicaid are 13 percent more likely to die than those with no insurance at all, and 97 percent more likely to die than those with private insurance."
Conservative reformers have proposed turning Medicaid into a block grant program, in which the federal government would give an annual lump-sum that would give the states the flexibility to redesign their health care programs; others prefer a system of federally-provided vouchers or refundable tax credits, with which private coverage could be bought.
"I'm not telling you Medicaid's all that great," Kasich finally told his audience. "There's fraud in Medicaid. But you know what? The precious resources we get are changing things. The trend in Ohio now is the number of visits to the emergency room is dropping; it's more consistent with the general population. So we're beginning to see results."
But in remarks made by the crowd afterward there was dissatisfaction that Kasich was touting government spending-oriented fixes rather than private solutions.
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