Medicaid is the government's healthcare program for low-income Americans who cannot afford any health insurance, and states have broad leeway in determining who is eligible for coverage.
In the near term, this positions the first-term governor well for his 2014 reelection bid. Kasich has done plenty of things to make moderate and liberal voters angry, including signing several abortion restrictions into law this summer, and signing restrictions on collective bargaining rights that were ultimately repealed by voters. But he's also toned down his rhetoric, on issues ranging from unions to gay rights.
By accepting federal funds for the state's Medicaid funding, Kasich bolstered the economic argument he can make for his reelection bid. The move was supported by the Cleveland Clinic, a major economic engine in the state, and an Ohio State study suggests it could bring an additional $1.4 billion to the state over the next nine years in addition to the direct federal funding.
He also framed the decision in terms of compassionate conservatism, saying, "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."
Other Republican governors in swing states up for reelection, such as Michigan's Rick Snyder, have made a similar decision to expand Medicaid with funding under Obamacare.
But that doesn't mean that the more conservative wing of the GOP -- which plays an outsized role in the party's presidential primary process -- will look at Kasich's decision kindly. On Monday the Ohio Liberty Coalition, which is aligned with the tea party, tweeted: “Amazed here at the amount of hubris displayed by the Kasich administration to bypass both the people and the legislature.”
And Maurice Thompson, a lawyer for the conservative 1851 Center for Constitutional Law, said he will file a lawsuit challenging the move on the grounds that it did not reflect the General Assembly's legislative intent. He told the Columbus Dispatch that some House Republican lawmakers would “most likely” join him, though he declined to identify them.
In other words, Kasich made a smart move this week if he wants to stay in the governor's mansion for another four years. But if he's eyeing 1600 Pennsylvania Avenue, he may have to do a little explaining to the GOP base.