Ohio's Republican legislative leaders may call a vote this week on rolling back outgoing GOP Gov. John Kasich's Medicaid expansion.
They say they may move to override Kasich's veto last year of a budget bill that would have frozen new enrollment of low-income adults in the state's Medicaid expansion program and limited participation to people who have received treatment for mental health or substance abuse disorders.
Ohio House Republican spokesman Brad Miller told the Associated Press that "everything is on the table" during the lame-duck session that starts Thursday.
The Ohio fight is the latest sign that Republicans across the country still want to roll back the Affordable Care Act's Medicaid expansion, even though voters in a number of states approved ballot initiatives mandating expansion and elected pro-expansion Democratic governors.
Kasich's June 30, 2017, veto protecting the future of his hard-fought Medicaid expansion struck down a provision of the two-year state budget that called for freezing new Medicaid expansion enrollment that July and preventing those who dropped off the program from re-enrolling.
Fellow Republicans in the Legislature supported the item as a way of containing the state's staggering Medicaid costs.
If legislative Republicans now are able to override Kasich's veto, the state would have to seek a waiver from the Trump administration for these major changes, said John Corlett, president of the Center for Community Solutions and a former Ohio Medicaid director. So far the CMS has not approved any waivers for partial Medicaid expansions.
Corlett estimates that the changes could cause 420,000 of the state's 640,000 expansion enrollees to lose coverage.
Republicans say an override is possible, and Republican Senate President Larry Obhof has said he would support it to freeze Medicaid expansion enrollment.
House Majority Leader Bill Seitz, a Cincinnati Republican, said he wasn't aware of strong support within the Republican caucus for overriding Kasich on the issue.
"I frankly doubt it," he said. "With a new administration coming in, there are those that believe we should make that decision in consultation with the new administration. Of course, that could change."
Legislative Republicans were angered by Kasich's 2013 maneuver to sidestep them and implement Medicaid expansion. And they were annoyed by his recent vetoes of bills on abortion, guns, and legislative pay raises. In addition, Republicans jockeying to become the new House speaker may see an override fight as improving their standing with conservative colleagues.
But it's not clear they have the votes to override Kasich's veto of the Medicaid changes, which would cause major upheaval for many Ohioans.
"Our messaging really is that Medicaid expansion has worked exactly as everyone hoped it would," said Amanda Wurst, who speaks for a coalition of 200 organizations that support the expansion. Among them are doctors and other health care professionals, consumer advocates and businesses.
And it's not clear that an override would have the support of incoming Republican Gov. Mike DeWine, who has said he wants to keep the state's Medicaid expansion and add a work requirement.
The state is awaiting CMS approval of its work requirement waiver request, which the legislature demanded.
Corlett said changing Ohio's expansion program to cover only people receiving mental health or substance abuse treatment likely would mean the state would lose large amounts of federal Medicaid funding and would involve a major administrative effort to redetermine the eligibility of tens of thousands of people. Plus, it probably would be challenged in court.
"This would throw a political hot potato in the new governor's lap," Corlett said.
Kasich also rejected a Republican-backed bill that broadened gun-owner rights and one that outlawed abortion at the first fetal heartbeat. Overrides are being considered on both.
The Associated Press contributed to this report.
