John Kasich's Mysterious Plan to Repeal Obamacare but Save the Medicaid Expansion

The Ohio governor's bank shot on health insurance.

Ohio Gov. John Kasich speaks during the Republican National Convention at the Tampa Bay Times Forum on August 28, 2012 in Tampa, Florida.

Photographer: Win McNamee/Getty Images

The presidential flirtations of Ohio Governor John Kasich provide yet more proof that Jeb Bush cannot clear the Republican primary field. It's one thing to say a candidate like Kasich starts in "single digits." It's something else if Bush, who has received the coverage of a presidential frontrunner, is in single digits himself. (His 9 percent showing in the new Fox News national poll is five points below the lowest Mitt Romney ever pulled in that poll.) 

"Of all the people thinking about it, I am the most experienced," Kasich said at a conference Thursday in Washington, according to a story by Bloomberg's Kim Chipman. He sounded more like a candidate than the Balanced Budget Amendment troubadour he had been for most of the year.

Yet conservatives shudder at some of Kasich's experience. He is one of the still-rare Republican governors who accepted the Medicaid expansion offered by the Affordable Care Act, after the Supreme Court allowed states to skip it. In the Washington Examiner, Managing Editor Phil Klein wrote that Kasich should be "punished" for his cave-in, his rationale being "built on a mountain of lies" about how the expansion was funded.

"By punishing Kasich for expanding Medicaid," wrote Klein, "conservative primary voters would be sending the message to state-level Republicans everywhere that if they choose to advance big government healthcare solutions, there will be consequences — and they will have no chance of rising to higher office."

That would be a complete contrast with the welcome Republicans have given Scott Walker. Kasich has called opponents of Medicaid expansion "hard-hearted or cold-hearted." Walker, in denying the money, has accused Democrats of wanting people to be dependent on government while he wants to "find a way to get them into the workforce." (Two-thirds of people eligible for the expansion are in families where at least one person works.)

Last weekend, I asked Kasich if he could pass a conservative litmus test. If it were Jan. 21, 2017, and the Republican Congress gave President Kasich a bill that fully repealed the ACA, would he sign it?

"Yes," said Kasich. "I'm not for Obamacare. I have expanded Medicaid, because I wanted to bring Ohio dollars back to Ohio. We've been able to apply it to bring significant change, and our ultimate goal is that so all of these people who have been hurt can be in a position to get on their feet and move forward."

Kasich launched into a comparison between preventative health care and drug treatment. "Look, if we treat the drug addicted, like we do in our prisons, and we get in contact with them outside the prison, we don't think they're gonna be back in prison again," he said. "If you ignore them, the drug dealer's outside the prison waiting for them." This was his way of explaining that shunting money to Ohio was perfectly conservative. "Running our health care system from the top down is not working. We have programs in Ohio called value-based payments, where we say we ought to be working to keep people healthy. There ought to be total transparency in terms of what everything costs. We've done this with Medicaid."

The Medicaid expansion, of course, is a component of the ACA. When pressed, Kasich insisted that the expansion could continue even if the law was shredded.

"Look, Ronald Reagan expanded Medicaid," he said. "All this stuff about Medicaid, everybody hyperventilates. When I was first trying to do it, it was very controversial. Now it seems like everybody's trying to jump in the pool."

Kasich seemed to be laying a marker for a possible primary argument, based on the reality of the Medicaid expansion. "Obamacare" is phenomenally unpopular with Republican voters, but expanded health coverage is not. Just two months ago, when Tennessee's Republican governor, Bill Haslam, was attempting to accept the Medicaid expansion, he conducted a poll that found 85 percent of the state's dominant Republican voters opposed to "Obamacare." Only 16 percent of them opposed "Insure Tennessee," his branding for an increased coverage plan. There was a good reason why Americans for Prosperity and other conservative groups campaigned against "expanding Obamacare" whenever Medicaid came up.

In a potential campaign, Kasich might argue for the repeal of the ACA in tandem with a big-hearted expansion of Medicaid, based on the wants and needs of states. He would need to cohere that with the Republican Congress's current enthusiasm for turning Medicaid into a block-grant handover to those states–and with his overarching campaign for a federal balanced budget amendment. 

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