Will John Kasich veto GOP lawmakers' attempt to hamstring Medicaid expansion?

COLUMBUS - Ohio's GOP lawmakers have thrown down a challenge for Gov. John Kasich, who now must decide whether to veto their freeze of his Medicaid expansion – a move that could essentially kill the program for many lower-income adults.

This week, Kasich visited Washington to tout the benefits of Medicaid expansion in improving access to health care. Meanwhile, his fellow Republicans were working to undo the program at home. 

Ohio's Republican lawmakers want to prevent new, lower-income adults from enrolling in Medicaid starting July 1, 2018. At that point, anyone who dropped off the rolls, perhaps because they received higher wages during a given month, would be unable to re-enroll. Many Medicaid members drop off and re-enroll each year, so the freeze would end the health care program for those people.    

Medicaid expansion has been Kasich's main answer to drug treatment as the state grapples with a heroin and opioid overdose epidemic. Ohio leads the nation in the number of opiate overdose deaths. 

GOP lawmakers' original proposal, originating in the Ohio Senate, had threatened the drug treatment many Medicaid members receive. About $650 million of the $940 million spent annually combatting addiction in Ohio comes from Medicaid, with $280 million of that from the expansion under Obamacare. 

On Tuesday, lawmakers added an exception for those with a drug addiction or mental illness. They could enroll in Medicaid even after July 1, 2018. That exception and other changes to Medicaid would have to be approved by President Donald Trump's administration.  

Kasich's fellow Ohio Republicans want to find some way to restrict Medicaid expansion. They worry about the growing costs of the program and its hazy future in Washington. On Tuesday, GOP members of Congress delayed a vote on their Obamacare replacement, uncertain if they had the votes.

And some Ohio lawmakers are still upset that Kasich went around them to expand Medicaid in 2013. 

Ohio House Republicans initially proposed regulating Medicaid expansion more carefully rather than killing it outright. But the chamber's more conservative members supported halting new Medicaid expansion enrollees, siding with their Senate colleagues. That approach prevailed in the final budget released Tuesday.

Other last-minute changes in the state's two-year budget included: 

• Spending about $180 million on fighting Ohio's heroin and opioid problem. The money would reimburse coroners for drug testing those who die from overdoses, provide care for babies born with drug dependence and increase access to recovery housing. About $35 million of that comes from money previously earmarked to share with cities that have income taxes. 
• Adding a work requirement for many people on Medicaid. Those in training, in drug treatment or with mental health diagnoses would be exempt. This change would require approval from the federal government. 
• Easing graduation requirements for the class of 2018.
• Extending the sales tax holiday – one weekend in August – into 2018.
• Allowing concealed handgun license holders to sue business owners to force them into allowing guns in their parking lots. A previous proposal would have allowed them to sue for money from the business owners as well.

The governor has until Friday night to line-item veto any proposals he doesn't like before signing the bill into law. Democrats have asked Kasich to veto the restrictions on Medicaid. 

Kasich wouldn't talk Wednesday about the budget or what he wants to remove. "We'll have plenty to say when the time is right," he told reporters in Columbus.

If Kasich vetoes the language, the Republican-controlled Legislature has another option. Lawmakers could override the veto with a three-fifths majority in both chambers. It's not clear if lawmakers have enough votes to upend Kasich's decision.