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An estimated 366,000 more people in Ohio will soon be able to enroll in Medicaid, the federal-state health program for the poor and disabled, after a legislative panel on Monday cleared Republican Gov. John Kasich's request for the state to spend federal dollars to provide them with health coverage.
It was a victory for the governor, who has pushed for expansion for months — despite opposing President Barack Obama's signature health care law, the Affordable Care Act (ACA) under which Medicaid expansion falls — as well as a triumph for the Obama administration.
The GOP-controlled state legislature had balked at the expansion, for which Ohio had recently received approval from the federal government, so Kasich's administration asked the little-known Controlling Board — made up of six lawmakers and an official from the administration — for the authority to spend $561.7 million in federal money this budget year and almost $2 billion next year on the expansion.
The board signed off on Kasich's spending request in a 5-2 vote.
Among the supporters was Republican state Sen. Chris Widener of Springfield, who drew upon stories he said he heard from his constituents.
"I mean, these people are not wanting to be in Medicaid their whole entire lives," he told reporters, according to The Associated Press. "They're working Ohioans. They're Ohioans that need help for a little bit of time related to a health care issue."
Medicaid expansion allows those making up to 138 percent of the federal poverty level, or about $15,860 for an individual, to be eligible for the program.
Ohio joins 25 other states and the District of Columbia in either moving forward with expanding Medicaid or requesting modifications to the plan. Medicaid expansion is a major element of Obama's health reform law, which aims to ensure that all Americans have access to affordable health insurance.
"I think Ohio and its decision to move forward will be a big incentive for others to look at both the human costs and the fiscal and economic impact," Diane Rowland, executive vice president of the Kaiser Family Foundation, which studies health care policy, told Reuters.
Still, the Ohio board's approval of expansion is likely to spark a lawsuit.
"What just happened in there is that 90 percent of the people in Ohio just got disenfranchised because they didn't get to vote," said state Rep. Louis Terhar, a Republican, according to Reuters.
The Controlling Board — which handles certain adjustments to the state budget — consists of two Democrats, four Republicans and a Kasich appointee from the Office of Budget and Management. House Speaker William Batchelder replaced two Republican members of the legislative panel before Monday's meeting. One replacement, state Rep. Ross McGregor, R-Springfield, backed the request.
State Rep. Ron Young, one of more than 30 House Republicans who formally protested the Controlling Board request last week, said he expects to be among the plaintiffs in a lawsuit being prepared by expansion opponents.
Maurice Thompson, executive director of the 1851 Center for Constitutional Law, said the group would argue in the suit that the board is violating the legislature's intent not to expand Medicaid. He said he plans for it to be filed within 24 hours of the vote.
"The act of the General Assembly in the budget bill was very clear," Thompson told reporters, according to AP. "It was a prohibition on Medicaid expansion and an appropriation of federal funds."
Controlling Board president Randy Cole, from the Office of Budget and Management, described the administration's request as "customary."
The length of questioning showed otherwise.
Board members peppered Kasich administration officials from mental health, Medicaid and veterans services with questions about the issue for roughly two hours.
The request allows the state to spend the federal money on the newly eligible Medicaid enrollees only through June 30, 2015, the end of the current state budget. Then additional legislative action would be needed to ensure that federal funds continue to cover the expanded population.
Democratic Rep. Chris Redfern asked Kasich officials what assurances expansion supporters had that people would continue to get coverage.
Greg Moody, director of the Governor's Office of Health Transformation, said Kasich has made extending Medicaid coverage a priority.
"We do not make this decision to take federal money today and avoid responsibility in the future," he said, according to AP. "We make the decision to proceed under the terms of the federal law into the future."
Medicaid already provides coverage to 1 of every 5 residents in Ohio.
The board's vote didn't go unnoticed by the White House. Obama's senior adviser, Valerie Jarrett, tweeted congratulations to Kasich.
The U.S. government promises to pay for the expansion for three years, gradually phasing down to 90 percent.
Many Republicans in Ohio are averse to the health overhaul and resistant to expanding government programs. They have cited concerns about increasing the national debt and fears that the money from Washington could be cut off.
Several Republicans on the panel asked what would happen if the federal government didn't hold up its end of the bargain.
"If that deal changes, then we need to go back and revisit that deal," Medicaid director John McCarthy said.
Al Jazeera and wire services
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