On Monday, the Associated Press ran a story (since updated) containing an ambiguous quote from John Kasich that created the widespread, but mistaken impression, that Ohio’s Republican governor had essentially endorsed the entire Affordable Care Act as a law that has made “real improvements in people's lives."
If you're a supporter of the law, the truth turns out to be less satisfying. Kasich’s endorsement extends only to Obamacare’s Medicaid expansion. The law’s private-sector coverage provision, Kasich has clarified, should be repealed and replaced. That's been his position for a long time. “I have favored expanding Medicaid," he told Politico, "but I don’t really see expanding Medicaid as really connected to Obamacare."
Liberals are predictably reveling in Kasich’s contradiction—the Medicaid expansion was a huge piece of the Affordable Care Act's overall coverage scheme—and in the contortions he’s had to undergo to assure conservatives that his Obamacare apostasy extends only so far. But I don’t actually see much of a contradiction here. And more to the point, millions of poor Americans would be much better off if more Republicans adopted Kasich’s position that states should adopt the ACA's Medicaid expansion while tilting at windmills to topple its private sector program.
Unlike other GOP repeal plans, abolishing the ACA’s insurance exchanges, regulations, and subsidies while keeping the Medicaid expansion is a perfectly workable—though foolhardy—policy proposal. Contrast Kasich with Senate Minority Leader Mitch McConnell, who supports repealing Obamacare entirely and dissembles to voters that the Kentucky state government will somehow preserve the Medicaid expansion on its own, without the vast federal transfers that made it possible.
Kasich's stated vision, unlike McConnell's, isn't a complete fantasy. And if it became the GOP consensus, approximately five million poor people would be lifted out of the coverage gap and become insured almost immediately. The political fight over Obamacare would settle around the private sector coverage expansion, where there’s more room for horse trading, experimentation, and improvement. The potential damage a Republican president could do to the end of universal coverage would be greatly diminished.
There’s a rich, anti-conservative irony in Kasich’s position, which other Republican governors ostensibly share. He’s calling for a détente in the fight over what's essentially a single-payer program for the poor while advocating the abolition of a private-sector benefit for the middle class. But from a liberal perspective that’s a vast improvement over the standard incoherent nonsense most Republicans espouse.
There’s a chance, too, that Kasich’s acquiescence to the Medicaid expansion is indicative of a deeper squishiness: that if push came to shove, he'd also abandon his view that the law's private coverage expansion should be repealed. If that’s the case—if he's hiding the ball—then he and others like him will become crucial allies if the Supreme Court’s conservative justices decide one day to void Obamacare subsidies in states (like Ohio) that didn’t set up their own exchanges. If the court grants cert to the challengers in Halbig vs. Burwell, and rules in their favor, liberals will need at least some Republican governors pressuring Congress to restore benefits in their states.
If Kasich has presidential ambitions, he presumably set them back by chastising opposition to Medicaid expansion as "political or ideological" hijinks. But a guy like Kasich, who put up no resistance to Medicaid expansion in the first place, was probably going to drown in the cesspit of GOP presidential primary politics anyhow. That leaves us with a Republican governor of a crucial swing state who has called for exempting the Medicaid expansion from the fizzling ACA repeal campaign. Relative to the dismal state of Republican health policy in general, that’s a welcome development.