Health & Human Services

Ohio Supreme Court Upholds Medicaid Expansion

The state's high court decided a move by a little-known state panel to accept federal expansion money was legal.
by | December 23, 2013
The Thomas J. Moyer Ohio Judicial Center, which houses the Ohio Supreme Court. Wikimedia Commons

Despite a legal challenge by opponents, Ohio can expand its Medicaid program. On Friday the state Supreme Court upheld a decision by an obscure state board to accept federal money to insure another 275,000 low-income people through the program.

A group of Republican lawmakers and anti-abortion groups filed suit against the Ohio Controlling Board soon after it voted 5-2 in October to accept $2.5 billion from the federal government to fund expansion over the next two years.

The Controlling Board, made up of state lawmakers from both parties and a gubernatorial appointee, is allowed to adjust spending and approve grants, but only within a two-year budget period. That means keeping Medicaid expansion going in Ohio will take future cooperation from the Republican legislature. Close observers of Ohio politics say the votes are there, but many of the Republicans who were swept into office on the Tea Party wave of 2010 fear a primary challenge from their right.

Last year’s U.S. Supreme Court decision left Medicaid expansion—a critical piece of President Barack Obama’s signature health care overhaul—up to the states. Medicaid expansion provides federal money to help states to expand Medicaid to cover more (and less poor) people than qualified for the program before the Affordable Care Act. This is important to Obamacare's success because it greatly extends health insurance to people who don't have to buy their own insurance on the exchange.

The federal government is paying 100 percent of the costs for new enrollees before phasing down support to 90 percent by 2020. Most states currently limit Medicaid coverage to pregnant women, parents, children and the disabled. The expansion would cover childless adults earning up to 138 percent of the federal poverty level. Ohio is the 25th state to allow expansion (and the 4th Republican controlled state to do so).

Ohio Gov. John Kasich, a Republican, called extending Medicaid the moral thing to do. But the Republican-controlled legislature refused to include expansion in the two-year budget it passed this summer and in fact inserted a provision that would have prevented the state from covering the new group. Kasich used a line-item veto to invalidate that provision, though, and the legislature never attempted to override him. That series of events was at the heart of the legal debate over whether the Controlling Board, created in 1917 to adjust spending and handle state fiscal duties without calling the legislature back into session, acted outside of its authority.  

Opponents of the expansion noted in their suit that Ohio statute prevents the Controlling Board from acting contrary to the “legislative intent” of the General Assembly. They argued the events of last summer made that intent clear. But that same statute says the legislature’s intent is expressed in “prevailing appropriation acts,” and the General Assembly’s effort to prevent expansion never became law because Kasich struck it from the budget act, the court decided.  

“The (opponents of expansion) fail in their quest because they have not adequately shown that the Controlling Board had a clear legal duty to follow the directives of the legislature when those directives are not expressed in the final, enrolled bill,” the justices wrote.

The decision from the court was split 4-3. The dissenting justices didn’t back the arguments of expansion opponents in their written opinion; they argued the court should have dismissed the case entirely.

Justice Terrence O’Donnell noted that the legislature is free to reign in the powers of the Controlling Board or reverse its decisions. It’s not the court’s role to intervene, he argued.

“The General Assembly has both the incentive to protect its prerogatives and the institutional mechanisms to do so,” O’Donnell wrote. “This case involves an impermissible judicial foray into the province of the legislature and raises a political question that is not justiciable and which we ought not to answer. The complaint should be dismissed.”

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