The Hill’s Peter Sullivan today covers a topic I mentioned yesterday — the impact of Medicaid expansion decisions on GOP primary politics.


Sullivan looks at the increasing fire directed at John Kasich, who expanded Medicaid in Ohio and last week finished second in the New Hampshire primary. For example, the above ad, from an outside conservative advocacy group, calls Kasich an “Obama Republican.”

I think that anti-Obamacare sentiment remains a strong enough passion among much of the GOP base that this will ultimately doom Kasich, who is doing the same dance that we’ve seen from Asa Hutchinson in Arkansas — he says he hates Obamacare but had to do what was right for his state.  


There’s actually a reasonable argument here — it’s possible to oppose the federal health care law but logically conclude as a state lawmaker that it serves the parochial interests of individual states to expand Medicaid so long as Obamacare is on the books. In order to pay for the coverage expansion, Obamacare does various things to raise revenues, such as cutting Medicare reimbursement rates and raising investment taxes on the wealthy. States are on the hook for the Obamacare pay-fors whether or not they accept Medicaid expansion — states that say no to Medicaid expansion pay in but get nothing in return. Under the circumstances, saying no to Medicaid expansion is just a terrible deal for state budgets and state economies, regardless of what you think of the national health care law.

That’s not so easy to explain in a campaign ad, however! And it’s unsatisfying to Tea Party purists who care about all-out resistance to Obamacare and the impact of Medicaid spending on the federal debt, not the parochial interests of Ohio. 


Here’s Sullivan on the increasing attacks on Kasich: 

Jeb Bush, who is battling Kasich for the support of establishment Republicans, has amplified his criticism of the Ohio governor over the Medicaid expansion in recent days.

Kasich has fired back with a defense of his decision, trying to thread the needle of supporting the Medicaid expansion while opposing the healthcare law as a whole.

The fight is heating up as the candidates jockey for position in South Carolina, the next state on the Republican primary calendar.

“ObamaCare is a four letter word in the Republican primary in South Carolina,” said Richard Quinn, a longtime Republican strategist in South Carolina who supported Sen. Lindsey Graham (R-S.C.) before shifting to Bush. “I think it’s going to be very difficult for Mr. Kasich … his politics are kind of suited to New Hampshire.”

Bush has started ramping up his attacks.

The former Florida governor told MSNBC’s “Morning Joe” on Wednesday that, while Kasich’s record might have played well in centrist New Hampshire, it won’t hold up in South Carolina.

The “telling thing” about Kasich, Bush said, is that “when he had a chance, he expanded ObamaCare through Medicaid.”

“Governors across this country had a chance to take a stand against ObamaCare, many did.”

“In Ohio it was expanded, and he’ll have to explain that down here, where ObamaCare, people want it repealed, they don’t want it expanded,” Bush added.  

Kasich has drawn extra ire from anti-Obamacare activists because he invoked his faith in explaining his decision to expand Medicaid: “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 isn’t running away from his heterodox position on Medicaid expansion and has generally approached debates and speeches in a manner that suggests he’s seeking to impress newspaper editorial boards and Democrats trying to decide who the least offensive GOP candidate is. It’s hard to believe that’s a winning recipe. But this year has been so unpredictable that I’m hesitant to write him off just yet. He’s going to do terribly in South Carolina, but the strategy here appears to be to continue tailoring his message to blue states, where a lot of delegates are still at stake. It’s worth noting that 31 states have expanded Medicaid, so there’s plenty of territory where that might not be anathema to voters. In a fractured field, if he could run up the score in liberal states, he might have a shot to make it to the convention with enough delegates to annoint him as the establishment choice if not immediately win outright. This is a 1-in-1,000 longshot strategy, but it’s what he’s got. Would be pretty wild if the Republicans nominated someone who expanded Medicaid under Obamacare after nominating the man who gave us Romneycare last time around. I’ll be interested to see how much talk of Medicaid expansion and Obamacare pops up in tonight’s debate. 

I’m sure Hutchinson is feeling some sympathy for Kasich. Hutchinson is in an impossible political spot — if the private option goes away, it blows a hole in the budget, devastates some of the most powerful stakeholders in the state, and rips health insurance from 250,000 citizens. It’s a political nightmare. But the more he fights to keep it, the more he infuriates the Tea Party base. 


It’s worth noting that the governor who took the opposite approach of Kasich was Bobby Jindal of Louisiana. He loudly and proudly rejected the federal Obamacare money, hoping that would help establish his conservative bona fides as he launched a bid for presidency. Instead, Kasich is still in the race while Jindal is long gone. Jindal’s antics in Louisiana made him hideously unpopular in the state and helped set the stage for the election of a Democratic successor in dead-red Louisiana. That new governor, John Bel Edwards, signed an executive order on his second day in office to expand Medicaid.