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Meet John Kasich, the man who defended expanding Medicaid on the GOP debate stage

Andrew Prokop is a senior politics correspondent at Vox, covering the White House, elections, and political scandals and investigations. He’s worked at Vox since the site’s launch in 2014, and before that, he worked as a research assistant at the New Yorker’s Washington, DC, bureau.

The Republican presidential debate last Thursday began with the theme of "electability," and the moderators posed the candidates the toughest questions they had. Donald Trump was grilled on whether he'd run for president as a third party candidate, and on his history of sexist remarks. Ben Carson was asked about various "basic mistakes" he made in describing American and global politics. And Scott Walker was pushed to answer whether he'd "really let a mother die rather than have an abortion" — and how he could sell those views in a general election.

But when moderator Megyn Kelly came to Ohio Gov. John Kasich, she asked about a rather different sort of controversy in his past.

"You chose to expand Medicaid in your state," Kelly said, and "defended your Medicaid expansion by invoking God, saying to skeptics that when they arrive in heaven, Saint Peter isn't going to ask them how small they've kept government, but what they have done for the poor." So, Kelly asked, "Why should Republican voters, who generally want to shrink government, believe that you won't use your Saint Peter rationale to expand every government program?"

It's a question Kasich has faced for over two years, since he first decided to battle his own party to ensure Medicaid was expanded in Ohio. Other Republican governors had also signed on to the policy, since the federal government had promised to shoulder the vast majority of its cost.

But none had done so quite like Kasich, who suggested that not only was the decision the pragmatic thing to do, it was a Christian moral imperative. He made an argument rarely heard from a Republican politician — that Medicaid had to be expanded to help the poor. Indeed, when he spoke at a gathering of wealthy conservative donors hosted by the Koch brothers in April 2013, his answer on this topic reportedly led around 20 people in the audience to stand up and walk out on him.

A donor — Randy Kendrick, wife of the wealthy owner of the Arizona Diamondbacks — had quizzed Kasich about why he used that religious rhetoric to push the Medicaid expansion. "A lady was yelling at me, saying, 'You're using God against your people,'" Kasich later recounted.

But the irritated governor refused to backpedal. "I don’t know about you, lady. But when I get to the pearly gates, I’m going to have an answer for what I’ve done for the poor," he said, according to Politico's Alex Isenstadt.

That's when audience members started walking out, while the other governors on the panel — Bobby Jindal and Nikki Haley — rushed to emphasize their disagreement with Kasich. The governor later told the Wall Street Journal's Neil King Jr. that the incident was "unforgettable," adding, "I really shouldn't speak about it, other than to say, 'God bless people who go to those events.'"

The consensus of the modern GOP is that trying to help the poor through government spending is ineffective or even counterproductive. Republicans simply don't argue that more government spending is a good way to help people — that's viewed as something liberals say. "It's the sort of straw man that I think President Obama would be impressed by," says Jason Hart, an Ohioan reporter for the conservative site

So Kasich's enthusiastic adoption of moral and religious rhetoric to promote a key plank of Obamacare was extremely unusual — and he took it quite seriously. He said that year that his "most important mission" was to convince conservatives that "when some of us are doing better, it is essential that we begin to figure out how to help people who are not doing better." His own party, he told the New York Times, was waging a "war on the poor."

As he prepared for his presidential campaign this year, he didn't back off, instead arguing that his views are the truly conservative ones. "Read Matthew 25," Kasich said on Fox News a few months back. "Did you feed the hungry? Did you clothe the naked? If we're doing things like that, to me that is conservatism." He then bristled: "And you know what? I have a right to define conservatism as much as somebody sitting up in the stands down in Washington trying to tell us what we ought to do."

It's an agenda that's made Kasich — whose team didn't respond to requests for comment for this article — quite popular in Ohio. And his landslide reelection last year in one of the most important presidential swing states has made some think he could be a strong GOP presidential nominee.

But to supporters of government spending reductions, from the Koch brothers to Tea Party activists, rhetoric like Kasich's is quite dangerous. Because if you argue so passionately that federal spending programs really help people, those programs become quite hard to cut.

As a congressman, John Kasich was a lot like Paul Ryan

In 1995, John Kasich (right) strategized with Senate Majority Leader Bob Dole (left) and House Speaker Newt Gingrich (center) over budget cuts.

(Richard Ellis / AFP / Getty)

There was little about Kasich's decades-long political career that suggested he'd boast such fervor for expanding Medicaid. Instead, he's only slowly transformed himself from the very face of Republican budget cutting — the Paul Ryan of his day — to someone who argues that supporters of limited government aren't doing enough to help the poor.

Kasich first rose to national prominence because he produced detailed spending reform plans that Washington deemed serious. When he joined the House Budget Committee in 1989 as a junior member, he immediately began drafting and releasing his own budget each year, complete with far more dramatic spending cuts than those proposed by the Bush White House budget. He built up so much credibility that, like the similarly young and energetic Paul Ryan, he leapfrogged several more senior colleagues to become the Budget Committee chair after the GOP retook the House in 1994. He was 42 years old — the youngest committee chair in the chamber.

By all accounts, Kasich was obsessively committed to the task of slashing government spending. The Associated Press called him "a divorced workaholic" who "subsists mostly on pizza and instant noodle soup," and Cox News Service wrote that he had "little personal life." When a spending cut bill he authored with Democratic Rep. Timothy Penny became famous in DC as the "Penny-Kasich" proposal, Kasich named his dog after it. But unlike Paul Ryan, whose political persona is unfailingly cheerful and polite, Kasich has always had a harsher edge. Words like "headstrong," "brash," and "argumentative," fill profiles of him. (He hasn't softened up as governor, where his prickliness has become the stuff of legend.)

As part of Kasich's effort to cut spending, he challenged some of Washington's entrenched interest groups — from defense hawks to protectors of farm subsidies and corporate tax breaks. He achieved only mixed success on those fronts, and his proposals for ambitious reforms of entitlements — like block-granting Medicaid — didn't get off the ground at all. But eventually, he helped broker the 1997 balanced budget agreement between President Clinton and congressional Republicans. The budget didn't stay balanced long, but it's an achievement Kasich still touts today.

Still, the ambitious young congressman wanted to rise even further. He announced in 1999 that he'd explore a presidential campaign, and spent months on the trail in early primary states. Once there, however, he concluded that his obsessive focus on budget cutting was misplaced, and that a Republican candidate needed a message with broader appeal to get elected. "The public is not yelling for spending cuts," he told the Associated Press. He tried to mention his faith and religious convictions more often, so he wouldn't be viewed as only a stingy accountant.

It didn't work. George W. Bush raised far more money, and firmly entrenched himself as the frontrunner in the polls. Kasich concluded he couldn't win, and quit the race that July. Term-limited out of his budget chairmanship, he also decided not to run for another term in the House. Recently remarried and expecting his first child, Kasich was ready for a break from politics. He said, modestly, "I accomplished everything I ever set out to accomplish in the House of Representatives."

But as he endorsed Bush, Kasich couldn't resist expressing some envy in response to Bush's campaign message. "This business of compassionate conservative," he said. "I wish I'd thought it up."

As governor of Ohio, Kasich started out looking like Scott Walker

In March 2011, his third month as governor, Kasich signed a major bill to roll back public sector workers' collective bargaining rights.

Melina Mara/ The Washington Post via Getty Images

But by the time Kasich finally returned to politics in 2010 — after an interim working at Lehman Brothers, as well as hosting a Fox News show — the Tea Party was in ascendance, and far-right economic policies were back in vogue. Since Ohio's economy was badly damaged by the recession, Kasich decided to take on the incumbent Gov. Ted Strickland. During the campaign, Kasich pointed to his own anti-tax, anti-spending record, saying, "I think I was in the Tea Party before there was a Tea Party."

He won, and when he was sworn in the next January, it looked like he was ready to govern from the right. Near the top of his agenda was a bill to roll back collective bargaining for public employees, like Scott Walker's platform in Wisconsin. "We're not going after anybody's rights," Kasich said at a press conference. "What we're doing is we're balancing, restoring some power with taxpayers." As hundreds of protesters flooded into the statehouse, Kasich lobbied reluctant state senators to back the bill and helped it pass, as reported by Henry Gomez of the Northeast Ohio Media Group in "Kasich 5.0," the definitive profile series on the governor.

On March 31, 2011, Kasich signed the reforms into law — and in many ways, the final package went further than Walker's. While Ohio public employees could still bargain over wages, they could no longer bargain over health care or pensions. "Ohio’s law also gives city councils and school boards a free hand to unilaterally impose their side’s final contract offer when management and union fail to reach a settlement," the New York Times's Steven Greenhouse wrote. And the bill applied to police and firefighters, who were exempted from Walker's law. "No one has tried this level of reform, that I’m aware of in the country, including Wisconsin," Kasich bragged.

The backlash was swift and severe. Kasich's approval-disapproval rating plummeted to 30-46. And unlike in Wisconsin, the union countermobilization in Ohio was actually successful. In the Badger State, there was no way unions could get the law itself put up for a statewide vote of approval or disapproval. But Ohio's constitution allowed them to do so, if enough signatures were gathered — a task they soon accomplished. Though Kasich campaigned in favor of the law, when the state's voters cast their ballots in November 2011 he lost overwhelmingly, 61 to 38.

Kasich's signature first-year achievement had been wiped out. "It's time to pause," he said at a news conference. "The people have spoken clearly." Asked what they said, the governor responded: "They might have said it was too much too soon."

Kasich embraced Medicaid expansion with a convert's zeal

Over a year later, when Kasich announced that he'd expand Medicaid, he sounded like a new man. "I'm not a supporter of Obamacare," the governor said when he announced his decision during his 2013 State of the State address. But, he continued, "my personal faith in the lessons I learned from the Good Book" is "very important to me — not just on Sunday, but just about every day."

During his speech, delivered at the Veterans Memorial Civic Center in Lima, Ohio, the governor argued that the working poor, the mentally ill, and the addicted — the people who need help most — would benefit from his decision. "They can't afford health care. What are we going to do, leave them out in the street? Walk away from them, when we have a chance to help them?" He continued: "For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them."

When the US Supreme Court had effectively made the Medicaid expansion optional for states in 2012, governors across the country were faced with a choice about whether to accept federal dollars to expand Medicaid to everyone whose income was lower than 138 percent of the federal poverty line. In Kasich's case, this number was estimated to include 366,000 Ohioans.

Supporters of the Medicaid expansion argued that it would be the only affordable way for many low-income people to obtain health insurance. That's because Obamacare's design creates a coverage gap — people with incomes below the federal poverty level made too little money to qualify for subsidized private insurance from the exchanges, but didn't qualify for traditional Medicaid.

It was the percentage of the expansion that would be paid for by the feds, though, that was most relevant to many governors concerned with their bottom line. For three years, states would pay nothing at all — and the federal government would pay 90 percent or more of the expansion's cost afterward. Furthermore, states seemed to get nothing out of saying no — if a state refused to participate, its residents' federal tax dollars would still go toward funding the expansion elsewhere.

To many governors and policy wonks across the country — including Kasich — the expansion seemed to be a no-brainer. And the governor believed he could implement it in a free market way. He proposed to apply for a special waiver from the federal government, so Ohio could give the new beneficiaries private — not government — insurance. To him, the right thing to do also appeared to be the smart thing to do.

When his own party resisted, Kasich rammed through the expansion

But within days of Kasich's announcement, Ohio Republicans and Tea Party groups started lining up to oppose his plan. "There is no free money," Josh Mandel, the Republican state treasurer and a conservative favorite, wrote in a letter urging state legislators to vote against the expansion. "In the long term Ohioans will have to repay the debt." Soon, two dozen Tea Party groups in the state wrote a similar missive. "Borrowing taxpayer dollars to pay for an expanded entitlement program does not solve the long term problem of affordable health care," Marianne Gasiecki of the Ohio Tea Party Patriots told the Associated Press.

Nationally, many conservatives had turned against the Medicaid expansion too. Some critics objected that the federal government couldn't be trusted to deliver on its generous funding promises, and that states might be stuck footing more of the bills in future years. Others argued that Medicaid provided inferior insurance that should be reformed rather than expanded — or that federal spending simply shouldn't be expanded at all.

"The Medicaid expansion was supported by all the business groups and the unions," says Hart, the reporter who has frequently criticized the governor. "So Kasich and his supporters describe the opposition as just ideological — and to an extent, that's true. People who believe in limited government, people who believe we shouldn’t spend more money than we have, were opposed to it. Because we saw it as a bad policy that would increase the spending problem we had at the national level."

Ohio Rising, a Tea Party group, soon launched an ad campaign with "TV, radio, direct mail and online advertising to urge Republican primary voters in key legislative districts to press lawmakers to oppose the expansion plan," as reported by Jackie Borchardt of the Dayton Daily News. "We sincerely believe this is really bad for Ohio and really bad for the long-term financial stability of Ohio," Chris Littleton, the group's head, told her.

The result? By April, House Speaker William Batchelder (R) said 20 members of his caucus "might shoot themselves" rather than vote for Medicaid expansion. He ended up dropping Kasich's Medicaid plan from the budget entirely, and the state Senate decided not to include it either.

But when faced with this opposition, Kasich only grew more obstinate and determined. "I will not give up this fight till we get this done. Period. Exclamation point," he told reporters. "I'm not gonna give this up. I will not. I don’t care how long it takes."

So the governor soon launched a remarkable public pressure campaign aimed at the recalcitrant legislators. At one rally, he said, "You must rally your friends and family to go and see them, and to make it clear that saying ‘no’ is not an option." At another: "Kick them in the shins if they're not going to vote for this." To reporters: "Because people are poor doesn't mean they don't work hard. ... 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 poverty is real."

All this was to no avail — by the fall, it was clear that the legislature wouldn't budge. So Kasich simply moved ahead without them.

In October 2013, the governor announced that he would bypass the full legislature and expand Medicaid through a highly unusual maneuver. He'd go to a state body called the "Controlling Board," which was created to handle adjustments to the state's budgetary flow, and ask them to simply decide to let the federal Medicaid money come in. (This tactic forced him to drop his attempt to use private insurance to cover the new beneficiaries, which would have required legislative approval.)

In an op-ed explaining his decision, Kasich wrapped himself in the banner of a conservative hero: "Reagan was fiscally responsible, but he was also pragmatic and compassionate," he wrote. "When we consider what Reagan would do, let's also remember what he did do — expand Medicaid."

But activists like Tim Phillips — the head of Americans for Prosperity, a free market group founded by and closely tied to the Koch brothers — pushed back hard. "We think it’s pretty outrageous that a governor would then go around the elected representatives of the people and go to an unelected board," Phillips told the Los Angeles Times.

The Controlling Board, staffed by one appointee from the governor and six others appointed by the legislative leadership (four Republicans and two Democrats), was a convenient — if legally questionable — vehicle for ramming the expansion through. It was typically used for much more minor projects. Yet the votes of Kasich's appointee and the two appointees from Democratic leaders were never in doubt. And when the two appointees from Speaker Batchelder looked like they'd vote no, Batchelder simply replaced them. The final count was 5-2 in favor.

As with many things related to Obamacare, the new policy soon became entangled in legal wrangling. Two conservative groups and six Republican legislators filed a suit arguing that Kasich's maneuver was illegal and overstretched the Controlling Board's authority. But though the case went to Ohio's Supreme Court, the governor's move was upheld. "Obviously, we're pleased with the court's ruling," Kasich's spokesperson Rob Nichols said at the time, "and glad that Ohio can now move forward."

Kasich had won. The expansion was implemented, and by the end of 2014, it had let hundreds of thousands more Ohioans get Medicaid. At the same time, Kasich's popularity rebounded — in one poll, 55 percent of Ohioans approved of his job performance, and only 30 percent disapproved. And while campaigning for reelection in 2014, he was also fortunate enough to have his Democratic challenger implode in scandal. It was a landslide year for Republicans everywhere, but especially for Kasich — he ended up with a massive 31-point victory.

"I am so excited about the fact that we have been able to reach out to many people who had been forgotten," Kasich said in his victory speech. "Whether they're the mentally ill, or whether they're the drug addicted, or whether they're the working poor."

"Nothing good is ever lost," Kasich continued. "Anything you ever do to lift someone else, to give them a chance, to improve their lives, to give them some hope — if it's just one person — it will be recorded in the book of life. And will follow you through eternity."

Kasich's challenge to the GOP: What will you tell St. Peter?

Kasich speaks at the Faith & Freedom Coalition conference in June 2015.

Al Drago/CQ Roll Call/Getty

What Kasich did will certainly follow him through the Republican primaries, where he's begun the campaign as a serious underdog. He's currently ranked in 10th place in national polls — barely managing to qualify for the first debate — and hasn't yet topped 5 percent in a single one.

On paper, though, Kasich appears to present an appealing profile for any Republicans seeking an accomplished but less polarizing alternative to Jeb Bush and Scott Walker. Ohio is a key swing state, and Kasich remains quite popular there, fresh off his landslide win. He also has some financial support: An outside group supporting him has raised $11.5 million so far — not Bush money, but enough for a healthily funded pro-Kasich ad campaign to start airing in New Hampshire, aimed at driving up his numbers in the early primary state that's most crucial to his chances.

Additionally, Kasich would be one of the only candidates seriously suggesting that the GOP moderate on economic issues. After the 2012 elections, party elites quickly concluded that their problems could be solved by moderating on immigration policy — but commentators like Ross Douthat and David Frum pointed to the GOP economic agenda instead, arguing it was too oriented toward the wealthy. Kasich's approach may not be quite what they had in mind, but if his success in Ohio is any indication, swing voters might like it.

The risk for a candidate like Kasich is that he could end up like Jon Huntsman, the former Utah governor and 2012 presidential candidate who couldn't restrain himself from repeatedly pointing out how wrong he thought the Republican base was about everything. Huntsman's campaign, unsurprisingly, went nowhere. (Two key consultants for the infamously dysfunctional effort have now joined Kasich's team.)

The danger is real, because there's already some serious resentment for Kasich and his tactics among conservatives. If Kasich runs for president, the Washington Examiner's Philip Klein wrote earlier this year, "it will be important for conservative voters to punish him for his expansion of President Obama's healthcare law." Klein continued: "Just like a liberal demagogue, he portrayed those with principled objections to spending more taxpayer money on a failing program as being heartless."

Conservative health wonk Avik Roy concurred. "He’s really calling into question the character and the motivation of those who disagree with him on the Medicaid expansion, pretty much literally saying that you’re going to rot in hell if you didn’t agree," Roy told the Columbus Dispatch in March. "I would say that it’s highly probable that many conservative Christians will be offended [to hear] that they’re not good Christians if they don’t support a massive expansion of government health care." (Roy later took a job with Rick Perry.)

"I think it's pretty offensive, frankly," says Hart, the reporter. "He's expanding this federal welfare program, taking more money from taxpayers, funneling it through the government, and running it through this pretty ineffective Medicaid program. And he's treating it as if it’s morally and practically the same thing as taking your own money and choosing to give it out in your community where you see a need."

These critics are correct that there's an element of incoherence to Kasich's argument, when viewed in philosophical terms. It seems to not really gel with his overall, decades-long project of slashing government and taxes — and, of course, with his continued advocacy for the repeal of Obamacare. It's also not entirely clear, for instance, whether the moral imperative to help the least fortunate only kicks in if the federal government happens to be footing the bill for your state.

But by acknowledging that Obamacare's Medicaid expansion really does help a great many people, Kasich sees himself as recognizing an obvious fact that other conservatives contort themselves to deny. And he's also contradicting the widely held belief on the right that government can't do anything good.

The pointed sales pitch he described himself making to a legislator in 2013 — and which Kelly cited at the debate — doubles as his challenge to the GOP as a whole:

I said, "I respect the fact that you believe in small government. I do, too. I also happen to 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.  "

Yet not everyone appears to be buying what Kasich is selling. Charles Koch announced in April that he'd winnowed the burgeoning GOP field to five main contenders. Kasich, unsurprisingly, wasn't among them.

And as for wealthy Koch donor network events like the one Kasich caused such a stir at? He hasn't been invited back.

This article was originally published in July 2015. It has been updated.


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