Ohio Governor John Kasich still has not announced official decisions on Obamacare exchange implementation or Medicaid expansion, major factors in the federal Goliath’s reach into the Buckeye State. With President Obama reelected and no chance of Patient Protection and Affordable Care Act (PPACA) repeal, choices left to the Republican administration by the 2010 law are more important than ever.

In a November 9 column at National Review Online, Cato Institute health policy expert Michael F. Cannon explained why no state should create PPACA exchanges or expand Medicaid eligibility. Ohio is one of 14 states where state-run exchanges would be illegal due to PPACA’s coverage mandates, and neither exchanges nor Medicaid expansion would be affordable for the state’s taxpayers.

Media Trackers contacted Ohio Department of Insurance (ODI) Communications Director Chris Brock on November 7 to inquire about Kasich’s decision on exchange implementation.

“We’re still leaning toward letting the federal government run the exchange in Ohio,” Brock replied. “The deadline for telling HHS what Ohio will do is Nov. 16 and we will have more information by then.”

Although the administration appears to be waiting until the last minute to officially refuse calls from the U.S. Department of Health and Human Services (HHS) to create state-run exchanges, Lieutenant Governor and ODI Director Mary Taylor has been a consistent critic of PPACA.

On June 28, immediately following the U.S. Supreme Court decision upholding most of PPACA, Taylor expressed her belief that creating a PPACA exchange would be a mistake.

“At this point, the governor and I don’t see how it is in the best interest of Ohioans to have a state-run exchange,” Taylor told reporters on a conference call.

“Quite frankly, we don’t even see where the additional money would come from in order for us to run that exchange,” Taylor added. “We estimate, based on the reports that were issued last year by the Department of Insurance, that it would be an additional $43 million new state money, on an annual basis, in order for us to run a state-based exchange.”

In the months following the Supreme Court ruling, Kasich’s administration has been hounded by progressive groups for its failure to embrace PPACA.

Asked about expanding Medicaid eligibility up to 133 percent of the federal poverty line as the bill calls for, Eric Poklar of the Governor’s Office of Health Transformation told Media Trackers on November 8, “at this point we’re trying to determine how Ohio will pay for the ACA’s extra $700 million in Medicaid costs in 2014 and 2015.”

“We haven’t made a decision on expansion yet,” Poklar said.

On the same June 28 conference call where Taylor spelled out reasons why the state did not plan to construct PPACA exchanges, Medicaid director John McCarthy noted that Ohio lacked the funds to pay for higher Medicaid enrollment even without raising the threshold for eligibility.

“All of the reforms that we’ve been doing in the last budget, trying to get savings, we haven’t come close to getting $369 million in savings to cover that cost,” McCarthy said.

Nonetheless, Governor Kasich refused to take a firm position against expanding Medicaid in an August 2 interview on conservative podcast Coffee & Markets.

“I’ve instructed my staff to begin to talk to Democrat and Republican staff members for governors to see if there’s a way that we can carve something out here,” Kasich said – even while repeating McCarthy’s warnings about the staggering increase in Medicaid expenses that will result from PPACA mandates.

Unlike the fast-approaching November 16 deadline to inform HHS which exchange path Ohio will take, taxpayers could be left waiting for answers about Medicaid expansion for years. A federal Medicaid official recently told The New York Times “there is no deadline” for expanding eligibility, though federal assistance for the expansion will start to decline three years after PPACA takes full effect in 2014.

With national debt now exceeding $16.2 trillion, the federal government cannot afford to pay for either Medicaid expansion or federally-run exchanges. At publication, 11 states have refused to implement state-run PPACA exchanges and 20 more have made no decision.

As Independent Women’s Forum senior policy analyst Hadley Heath told Media Trackers in July, “What [HHS] would have to do, ultimately, if they were going to abide by what they put into the statute would be to go into many states and create the federal exchanges there – and they simply don’t have the money.”

Cross-posted from Media Trackers Ohio.