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Ohio Gov. John Kasich / The Enquirer/Liz Dufour
Rep. Ross McGregor, R-Springfield, says he'll vote 'yes' on Medicaid expansion, 'barring any unknown information that would change my mind.'

Who gets to vote?

The fate of Medicaid expansion in Ohio currently rests in the hands of these seven Controlling Board members.
Rep. Ross McGregor, R-Springfield: New member as of Monday. Expected to vote “yes.”
Rep. Jeff McClain, R-Upper Sandusky: New member as of Monday. Expected to vote “no.”
Rep. Chris Redfern, D-Catawba Island: Expected to vote “yes.”
Sen. Chris Widener, R-Springfield: Considered a “maybe.”
Sen. Bill Coley, R-Liberty Township: Expected to vote “no.”
Sen. Tom Sawyer, D-Akron: Has said he’s a “yes” vote.
Randy Cole, Kasich adviser: As the Kasich appointee, will vote “yes.”

Rep. Jeff McClain, R-Upper Sandusky, says he'll vote 'no' on Medicaid expansion.

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COLUMBUS Live updates from Chrissie Thompson

Gov. John Kasich appears to have gotten his fourth and deciding Medicaid expansion vote this morning, amid drama in the Republican party as a GOP member of the Controlling Board refused to be replaced for the controversial vote.

Speaker Bill Batchelder, R-Medina, planned to put both a “yes” and a “no” vote on the seven-member board set to meet Monday afternoon. He wanted to substitute for the two regular members of his caucus, who both happen to be running to replace him as speaker, because of concerns that the controversial vote could affect that race.

But Rep. Ron Amstutz, R-Wooster and chair of the House Finance Committee refused to be absent as the board considers whether to accept federal money to expand Medicaid in Ohio under the Affordable Care Act. Wanting to keep things even for the speaker’s race, Rep. Cliff Rosenberger, R-Clarksville, said he also declined to miss the meeting.

Talk to your government: Tell Kasich what you think about Medicaid expansion

So Batchelder has made permanent replacements for both Amstutz and Rosenberger, according to GOP caucus spokesman Mike Dittoe. The state representatives both were expected to vote against Kasich’s request. In their place are Rep. Ross McGregor, R-Springfield, who says he plans to vote in favor of the governor’s plan, and Rep. Jeff McClain, R-Upper Sandusky, who is the required replacement for Amstutz as vice chairman of the House Finance Committee. McClain told The Enquirer he plans to vote against the proposal.

The decision to appoint McGregor as a replacement gives Kasich the four votes he needs to make Ohio the 25th state to expand Medicaid under President Barack Obama’s health care act.

“Barring any unknown information that would change my mind, I plan to remain consistent in my support of expanding Medicaid,” McGregor told The Enquirer Monday morning. “I have publicly stated that I’m in favor of expansion and obviously would have preferred to have done this legislatively, but I am certainly open to the Controlling Board route to kind of get the ball rolling.”

After Republicans in the Legislature declined to bring Kasich’s Medicaid-expansion plan to the floor for a vote, Kasich this month announced he would seek permission to accept the money through a board made up of six legislators and one Kasich adviser. The governor’s appointee and the panel’s two Democrats are expected to support his proposal, leaving him in need of one vote from the GOP.

As of Monday morning, he’s got it – and maybe one more. Sen. Chris Widener, R-Springfield, is considered a “maybe.”

Kasich would become the eighth Republican governor to oversee Medicaid expansion, much to the dismay of many in his party. Speaker Batchelder appeared to be in that group, repeatedly saying Ohio needed to “reform” Medicaid, not “expand it.” Last week he and McClain joined 39 House Republicans, including all 11 state representatives from the Southwest Ohio delegation, in signing a protest saying Kasich’s Controlling Board move is illegal.

Yet on Monday, Batchelder replaced Rosenberger, a “no” vote, with McGregor, a “yes” vote. The speaker’s spokesman said he would release a statement later today explaining his decision to replace both of his caucus’ Controlling Board members.

“I’m a little taken aback by it,” said Rosenberger, saying the speaker originally asked him to miss the board meeting because he didn’t want the speaker’s race clouded by the Medicaid vote. “I had the same concerns as Representative Amstutz. If Representative Amstutz wouldn’t (miss the meeting), nor would I.”

Amstutz said he has no hard feelings against the speaker, who has the authority to replace Controlling Board members. But he’s disappointed that Kasich is putting Medicaid expansion before the Controlling Board, changing course after months of trying to get the full Legislature to vote on the issue.

“There will be some relational problems here that are going to make it difficult to work together,” Amstutz said of the Legislature and the governor’s office, highlighting a divide in the GOP over Medicaid expansion. “It’s just saddening that there was a level of impatience here.”

Some of Kasich’s GOP opponents say he is leading a charge to saddle taxpayers with the responsibility of paying for health care for hundreds of thousands of additional Ohioans.

“I think that we need to be controlling costs,” McClain told The Enquirer Monday. “This is the federal example of just throwing billions at (a problem).”

In addition, the constitution lists the General Assembly, not the Controlling Board, as the state’s only legislative body, the state representatives’ protest letter said. And Ohio law prohibits the Controlling Board from going against “the legislative intent” of the General Assembly, which the lawmakers say they made clear in anti-Medicaid-expansion clauses passed in the state budget this spring.

Kasich continues to say Medicaid expansion is “just the right thing to do.”

“The morality of a human being who’s been blessed, helping a human being who has challenges, is a moral imperative in our lives. It just is,” Kasich said last week of Medicaid expansion. He spoke of offering drug-addiction and mental-health coverage through Medicaid. “The ability to get our dollars back from Washington, to rehab these people and restore their lives, has to be done.”

If Ohio were to approve the expansion, the state would need a few weeks to activate online enrollment via www.benefits.ohio.gov for the new population of potential Medicaid members. New members would start receiving coverage on Jan. 1.

About 330,000 low-income adults without any option for subsidized insurace would be newly eligible, according to the Kaiser Family Foundation, a group that analyzes health policy. That’s the number of uninsured Buckeyes who are disqualified for coverage under the current Medicaid system and whose income is too low to qualify for federal tax credits designed to subsidize insurance on the new Obamacare exchanges.

Meanwhile, Kasich’s expansion move would almost certainly to draw lawsuits, especially from conservatives wanting to argue against the legality of using the Controlling Board for what is essentially a policy decision. Medicaid supporters argue the Controlling Board has the authority to approve an increase in federal money for state agencies. ■

This story will be updated throughout the day.

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