It seemed like a pretty big political moment last night: Ohio Gov. John Kasich, a rumored 2016 Republican presidential candidate, telling the Associated Press that Obamacare repeal wouldn't happen. Except Kasich later said it didn't happen that way. He still supports full repeal, putting him in line with the rest of his party. He just thinks that the law's Medicaid expansion should go forward regardless.
Kasich is one of nine Republican governors who have already accepted the Medicaid expansion and the billions in federal funding that comes with it. Besides Jan Brewer in Arizona, it's hard to think of a Republican governor who pushed as hard for the Medicaid expansion last year. And it's impossible to think of a Republican governor who spoke about it more passionately than Kasich, who used his faith to make the case for expansion. Here's Kasich quoted in the Columbus Dispatch in June 2013:
I had a conversation with one of the members of the legislature the other day. I said, ‘I respect the fact that you believe in small government. I do, too. I also know that you’re a person of faith. ‘Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.’
Kasich used an executive maneuver to expand Medicaid last October over the objections from Republican majorities in the state legislature. But his support for expansion started earlier than that. After President Obama's reelection in 2012, Kasich quietly started working with Obamacare supporters to build the case for expansion. When it became clear last year that Republican lawmakers wouldn't approve it, Kasich used an executive Controlling Board to accept $2.5 billion in federal funds through 2015 to expand coverage to about 330,000 low-income residents — a move that was panned by critics as illegal.
Kasich said he keeps the Medicaid expansion separate from the ACA — except that's a hard logical leap to make. If every state opted into the program, it would account for about half of the expected coverage gains under the law.
Under a repeal bill, “there’s got to be an accommodation” for the Medicaid expansion, Kasich told Politico on Monday night. It's hard to imagine a Republican replacement plan offering Medicaid the same level of financial support under the ACA, which increases federal funding for the program by $792 billion over the next decade, according to the most recent projection from the Congressional Budget Office.
Of course, states could still pursue coverage expansions, but they'd be on a much smaller scale. Take Virginia, for instance, where Gov. Terry McAuliffe (D) has offered a plan to cover about 25,000 residents after Republican state lawmakers blocked Medicaid expansion, his top priority. By comparison, the Medicaid expansion in Virginia would cover about 400,000 residents.
The Kasich flap also highlights that Republicans still struggle to answer how they'd ensure those who got coverage through Obamacare would be able to keep it. You see that in Kentucky, where Senate Minority Leader Mitch McConnell says he backs Obamacare repeal but thinks his state could keep its health-care enrollment "Web site" — without saying what would happen to the federal subsidies that make the coverage more affordable. In Arkansas, Republican Senate candidate Tom Cotton has likewise struggled to say what would happen under repeal to the 200,000 people who gained coverage through the state's Medicaid expansion.
Four years after its passage, the health-care law ranks behind a handful of other issues voters will consider this fall, as the new Kaiser Family Foundation's health tracking poll this morning shows.
But Obamacare is still an issue that fires up the Republican base. So if Kasich and New Jersey Gov. Chris Christie, who also expanded Medicaid, are indeed 2016 presidential candidates, it's going to be interesting to watch them make the case for repeal while also defending their own support for a major chunk of its coverage expansion.