Ohio Gov. John Kasich has kicked up a political storm by circumventing his legislature to expand Medicaid under the Affordable Care Act. Conservatives don't like Obamacare, the expansion, or the techniques by which their determined Republican governor made it happen, and they're already challenging him in court. Yet Kasich may have strengthened his hand going into his 2014 reelection race. And should he decide to pursue higher ambitions, a solid victory next year in his purple presidential swing state could hasten forgiveness from GOP primary voters -- or a nominee in search of a ticketmate -- in 2016.
The Republican-controlled legislature in Ohio made clear it did not want to accept some $2.56 billion in federal money under the Affordable Care Act, even including in the state budget a provision that said Kasich could not enact the expansion without legislative approval. But Kasich excised that provision with his line-item veto – then asked an obscure seven-person panel appointed by legislative leaders, the Controlling Board, to approve acceptance of the federal money. The vote was 5-2, with a majority of two Democratic lawmakers, two Republican lawmakers, and an appointee from Kasich's office. The upshot is that some 275,00 low-income people will get health insurance through Medicaid, an expansion the federal government has pledged to underwrite 100 percent for three years and 90 percent thereafter.
Kasich has been making the case for the expansion for months, using multiple arguments. Like many governors, he says it will reduce uncompensated care at hospitals and keep health jobs in the state. Kasich also has repeatedly invoked a less common argument -- religious faith -- in calling for the expansion. He recently called it "a moral imperative." He once told a fellow conservative that St. Peter probably wasn't going to ask him what he did to keep government small, "but he's going to ask you what you did for the poor. You better have a good answer."
That's not a remark designed to win friends, and Kasich concedes the point. He told reporters in June that he was being "sometimes pleasantly persistent and maybe persistent without all the pleasantness" at times in pushing for the expansion. How determined was he? "I will not give up this fight 'til we get this done. Period. Exclamation point."
GOP strategists say Kasich is not taking much of a political risk with his Medicaid advocacy. A private poll of Ohio earlier this year found an overwhelming majority in favor of it, though Republicans were divided. Some don't trust the federal government to keep up its end of the financial bargain and others are holding out for reforms in the Ohio program, some of which are expected to pass. "It's too early to tell what kind of erosion he'll have in his base, because some people are irritated," says Republican Neil Clark, a Columbus lobbyist who has known Kasich since 1980. He predicted that Republicans will ultimately put this factor into perspective as part of a "total package" that includes tax cuts, job creation, education funding, and stabilized tuition fees.
More than three dozen Republican lawmakers formally protested Kasich's decision to go to the Controlling Board, and the tea-party infused 1851 Center for Constitutional Law on Tuesday filed a legal challenge at the Ohio Supreme Court on behalf of several of them. Maurice Thompson, executive director of the group, said it is less concerned about the Medicaid expansion than the principle of limiting the authority of the Controlling Board. "Our litigation is strictly about the separation of powers and the checks and balances in Ohio," he said this week. The lawsuit asks the board to reverse its decision.
Twenty-five states and the District of Columbia have now chosen to expand Medicaid under the Affordable Care Act to 138 percent of poverty level, which is less than $16,000 for an individual. According to the National Conference of State Legislatures, only four of the expansions are happening without legislative approval: West Virginia, Kentucky, Ohio, and Vermont (which already had expanded coverage and didn't need to change its law).
Kentucky Gov. Steve Beshear stirred controversy with his move, for instance, but has little at stake politically. He is 69, a Democrat more than halfway through his second term in a conservative state, and under state law cannot run for a third. He has not displayed any discernible interest in a national political career. Kasich, on the other hand, briefly toyed with a presidential run in 1999 and now leads one of the two or three states most coveted in White House elections.
The son of a mailman, he has stayed in touch with his blue-collar roots even after a stint as an investment banker at Lehman Brothers, before its collapse. That is part of what has colored his approach to Medicaid. In his extraordinary exchange with reporters in June, Kasich went from talking about St. Peter and his intent to fight, to this: "You know, because people are poor doesn't mean they don't work hard. Because people are poor … it sometimes means they couldn't pull themselves up by their bootstraps at some point in time. The most important thing for this legislature to think about: Put yourself in somebody else's shoes. Put yourself in the shoes of a mother and a father with an adult child that's struggling. Walk in somebody else's moccasins. Understand that, you know, poverty is real."
The remarks bring to mind Mitt Romney's monologue about the irresponsibility of the "47 percent." It's a stark contrast and one that could serve Kasich well if he decides, down the road, that 2016 is his time.