The Obamacare Dilemma for Republican Governors

John Kasich seemed to say the Affordable Care Act was here to stay, then quickly walked back his comments.

Can I change my answer just a little bit? (Samantha Sais/Reuters)

Pity the poor Republican governor.

Take John Kasich of Ohio. He's caught between a state budget that has to be balanced every year, one of the least healthy state populations in the country, a deep purple electorate, a Republican legislature, and his own presumed presidential aspirations in 2016. For a time, it looked like he might also face a stiff challenge to keep his office this year, though an improving economy and a catastrophically gaffe-prone Democratic nominee leave him in the catbird seat.

Kasich is no one's idea of a liberal, and under his leadership the Buckeye State rejected a state-level health-insurance exchange under Obamacare, meaning Ohioans buy insurance on the federally run But he fought hard to accept the expansion of Medicaid for citizens making as much as 138 percent of poverty level—those making too little for subsidies, but too much for traditional Medicaid. He did that even after a Supreme Court ruling made it optional, and he did it over the fierce objections of the Republican-controlled legislature, circumventing it with clever executive maneuvering. As Molly Ball has noted, Kasich was one of several GOP governors, especially in purple or blue states, to embrace the Medicaid expansion.

There's a straightforward appeal here, even for a dedicated small-government conservative like Kasich. It's free federal money for three years (with 90 percent federal funding after that) to get insurance for more than 285,000 lower-income Ohioans. That's especially relevant because Ohio lags the nation in key health indicators. Kasich also couched the move in religious terms: "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."

That's essential background for what Kasich told the Associated Press Monday when asked about repealing the Affordable Care Act. "That's not gonna happen," he said. "The opposition to it was really either political or ideological. I don't think that holds water against real flesh and blood, and real improvements in people's lives."

After fierce political reaction, Kasich walked the comments back Monday night. He called the AP back and said he was only talking about the Medicaid expansion and definitely, absolutely, unquestionably not about Obamacare overall. He told The New York Times he still assumed a GOP majority would repeal the law:

Mr. Kasich said he was working on his own replacement for Obamacare but did not offer specifics. “I’m in favor of repealing Obamacare,” he repeated. “That’s all I can tell you.’’

This has been a standard Republican dodge since the ACA passed—we're working on a replacement, and we'll tell you about it, um, sometime soon. (Jeff Young has a hilarious demonstration of this tendency here.) The substance of that replacement matters, needless to say—not least to the 285,000 Ohioans newly dependent on Medicaid expansion staying in place.

Maybe the AP got it wrong, or maybe Kasich regretted his blunt words. Giving Kasich the benefit of the doubt, it's not clear what he suggests is doable. Extricating the Medicaid expansion from the rest of the law, and leaving only the expansion in place, would be a difficult and potentially costly move, since the law involves an elaborate balancing of revenue and expenses. Other Republicans have suggested repealing the law but maintaining a ban on discrimination for preexisting conditions. That's politically savvy, since the ban is popular, but implausible, since the law pays for the ban by mandating that everyone hold insurance.

On the other hand, Kasich's original statement isn't so far off from what he said when he expanded Medicaid, and it's hard to argue with their logic. If Republicans win control of the Senate in November, they'll still be unable to bypass an Obama veto on any repeal. And even if they win the White House and maintain control of Congress in 2016, they will likely find that withdrawing a massive benefit for many Americans is politically impossible (as some conservatives, including Ted Cruz, have warned).

Even if Obamacare is irreversible, it's not politically tenable to say such a thing in today's Republican Party. Even if it's not clear that Kasich's hasty walkback makes a lot of sense as policy, it does seem—as Philip Klein notes—like another indication that Kasich would like to run for president in 2016. If he does, he'll continue to be caught in a vise by Obamacare. Candidate Kasich would wish to appeal to Democrats and moderates by pointing out that he successfully governed in a purple state and expanded healthcare for needy citizens; maybe comments like this could even position him as a bold truthteller, conservative but coldly realistic. Yet he'd also want to appeal to Republican primary voters who abhor the Affordable Care Act. Those are two hard masters to serve.

Pity the poor Republican presidential hopeful, too.