John Kasich's mysterious plan to repeal Obamacare but save the Medicaid expansion

“Yes,” said Kasich. “I’m not for Obamacare. I have expanded Medicaid, because I wanted to bring Ohio dollars back to Ohio. We’ve been able to apply it to bring significant change, and our ultimate goal is that so all of these people who have been hurt can be in a position to get on their feet and move forward.”

Kasich launched into a comparison between preventative health care and drug treatment. “Look, if we treat the drug addicted, like we do in our prisons, and we get in contact with them outside the prison, we don’t think they’re gonna be back in prison again,” he said. “If you ignore them, the drug dealer’s outside the prison waiting for them.” This was his way of explaining that shunting money to Ohio was perfectly conservative. “Running our health care system from the top down is not working. We have programs in Ohio called value-based payments, where we say we ought to be working to keep people healthy. There ought to be total transparency in terms of what everything costs. We’ve done this with Medicaid.”

The Medicaid expansion, of course, is a component of PPACA. When pressed, Kasich insisted that the expansion could continue even if the law was shredded.

“Look, Ronald Reagan expanded Medicaid,” he said. “All this stuff about Medicaid, everybody hyperventilates. When I was first trying to do it, it was very controversial. Now it seems like everybody’s trying to jump in the pool.”

Kasich seemed to be laying a marker for a possible primary argument, based on the reality of the Medicaid expansion. “Obamacare” is phenomenally unpopular with Republican voters, but expanded health coverage is not. Just two months ago, when Tennessee’s Republican governor, Bill Haslam, was attempting to accept the Medicaid expansion, he conducted a poll that found 85 percent of the state’s dominant Republican voters opposed to “Obamacare.” Only 16 percent of them opposed “Insure Tennessee,” his branding for an increased coverage plan. There was a good reason why Americans for Prosperity and other conservative groups campaigned against “expanding Obamacare” whenever Medicaid came up.

In a potential campaign, Kasich might argue for the repeal of PPACA in tandem with a big-hearted expansion of Medicaid, based on the wants and needs of states. He would need to cohere that with the Republican Congress’s current enthusiasm for turning Medicaid into a block-grant handover to those states–and with his overarching campaign for a federal balanced budget amendment.