I am currently in the middle of a series devoting full Fontenotes to each Presidential candidate’s platform on health care, with commentary and questions voters might want to ask.
Having already addressed Bernie Sander’s single-payer proposal as well as Donald Trump’s position, this week I will look at where John Kasich stands on this important issue.
What The Kasich Campaign Says
Four of the current Presidential candidates, including John Kasich, list health care as an issue on their campaign websites, with specifics on how they would change our system (or not) if they are elected president (Ted Cruz is the exception). You can access John Kasich’s page on health care here, but I will summarize:
John Kasich wants you to know he “believes Obamacare must be repealed and replaced with efforts that instead improve access by actually lowering health care costs without interfering with Americans’ personal health care decisions or imposing punishing burdens on job creators.”
Citing two published studies, Mr. Kasich points to the financial incentive physicians had to over treat patients which were common in 2009 and the number of Americans that were foregoing necessary treatment in 2003. His conclusion: “The time has come for leadership to fix [these problems].”
Specifically, Mr. Kasich wants to create a primary care system that promotes wellness rather than reacting to sickness, and he wants to pay hospitals and physicians based on the quality of care they provide, not the quantity.
Seeking to promote a market-based health care system, John Kasich states he will “put in motion real solutions that will work to improve health care access by holding down costs and help Americans live healthier lives.”
The only other hint at a Kasich Administration policy is that he would return “full control of insurance market regulation to states,” which is in opposition to Donald Trump’s vow to allow insurance companies to compete across state lines.
How Does the Kasich Proposal Differ from The Affordable Care Act?
While the referenced studies mentioned are certainly reputable, they are also 7 and 13 years old and are the same studies that were core to the development of the ACA (and other attempts at health care reform).
Because of reforms by the private market and the ACA, we have all witnessed significant changes in our health care system in the last 5 to 10 years. However, in this position paper, John Kasich does not acknowledge any of that, for good or bad, and seems to base his proposals on pre-ACA data.
More specifically, the Kasich platform does not appear to recognize that promoting “long term good health instead of just reacting when someone gets sick” is the core principle behind Accountable Care Organizations [ACOs], the Medical Home Model, and the current surge toward Population health.
Similarly, we are 5 years into a revolution in health care reimbursement (for all providers) called Value Based Purchasing, which is “rewarding value instead of volume.”
Lastly, the ACA Exchanges providing insurance options to people not otherwise insured were designed to provide individuals with the same economies of scale that groups and large employers always got when purchasing insurance. This was applying “America’s market-based principles” to insurance, which is why Exchanges are also called “Marketplaces.”
John Kasich may be completely opposed to Obamacare, and committed to repealing it, but there is nothing on his website which tells us what he would do as President that is different than what we are already doing under Obamacare.
Mr. Kasich’s History with Obamacare
From the very beginning of this election, John Kasich stood out from all the other Republican candidates, because he acted in opposition to GOP policy regarding the Affordable Care Act.
In 2012, the US Supreme Court made Medicaid expansion under the law optional for each state. Not only did then Governor Kasich proceed with expansion in Ohio, he did so by vetoing a bill to the contrary passed by his own Republican-controlled state legislature, and circumvented that body even further by placing control for the spending with a controlling board, “a little-known panel in charge of routine budget adjustments” after installing two Kasich allies as Board members.
Defending his actions, Mr. Kasich points to the financial benefits of expansion, which brought $13 million to his state, and the impact those funds have on Ohioans in need: “we cannot take healthcare coverage from people just for a philosophical reason.” [Washington Post]
John Kasich’s support for, and managing of, Medicaid expansion led to much criticism from Republican leaders at the time, both in Ohio and across the nation.
Current Commentary About Mr. Kasich’s Health Care Platform:
Controversy in Republican circles over Mr. Kasich’s leadership in expanding Medicaid in Ohio has followed him on the Presidential campaign trail. Many will remember it was the very first question he was asked in the initial Republican debate last August.
As was true in Ohio, Mr. Kasich has won some followers but lost others justifying his position in terms of good and evil. “People have accused me of, at times, having too big a heart,” he said in one debate.
As the campaign has worn on, Mr. Kasich has at times backed down from his assertion that the Medicaid expansion was one of his greatest accomplishments. On the eve of the New Hampshire primary, he claimed to voters that as a Governor he had “rejected Obamacare without leaving anyone behind.” That struck many as – at best – a stretch.
More to the point of this review, Mr. Kasich’s history with the Affordable Care Act opens more questions about what he would do differently to change our health care system as President. Unfortunately, his website is also devoid of answers.
John Kasich might hate Obamacare, but it is hard to know why, or how he would replace it.
Want to Know More?
We will be getting back to all of the remaining Presidential candidates, but in the interim here are their position statements on health care, as listed on their own websites [in alphabetical order]:
In addition, Ted Cruz has made some statements about health care, but it is not listed as an issue on his website. A review of quotes and comments by the candidate on the subject are listed here.