John Kasich broke with the GOP on health care, and he’d do it again

Outside the Hilton on a glorious morning, John Kasich pulls his buddies into a huddle so tight their temples touch. “Lord,” he begins, and then he gives thanks. He wants his men to be proud of this campaign, he says. He wants to raise the bar.

“Not too high that we can’t win,” says adviser Bob Rusbuldt. The navy-blazered huddle breaks apart with laughter.

“Amen,” Kasich says, and then it’s onto the rented campaign bus whose previous occupants were Ricky Martin and Kenny Chesney, men with much wider name recognition.

Kasich is in the bottom tier of Republican presidential candidates in the polls, but he’s burdened by more than poor numbers. As governor of Ohio he accepted the expansion of Medicaid, the federal health-care program for the poor, as part of health care reform — a choice that brands him as a moderate or, worse, a RINO (Republican in name only). In a competition hogged by political outsiders and fierce partisans, Kasich often looks like an also-ran.

But off the debate stage he has the vigor of someone who doesn’t quit, who won’t take no for an answer.

“If you don’t care whose toes you step on, it’s amazing how much progress you can make,” Kasich tells the Portsmouth Rotary Club over meat loaf after running through his 18 years in Congress and five as chief executive of Ohio.

From the crowd of 120, there is a question about health care. There is always a question about health care.

He doesn’t want a system of endless entitlements, he answers, but “we cannot take health-care coverage from people just for a philosophical reason.”

His decision, he knows, is a radioactive credential for a Republican seeking the endorsement of a base that wants to repeal the Affordable Care Act. As he would observe in a GOP debate several weeks later, “People have accused me of, at times, having too big a heart.”

Why Kasich approved the Medicaid expansion —and how — forecasts the type of president he would be: sometimes compassionate and often cunning.

Kasich didn’t agonize over the decision.

Obsessed with budgets

In a landmark ruling in 2012, the Supreme Court upheld the Affordable Care Act. But the justices also allowed states to opt out of the law’s Medicaid expansion, which uses federal dollars to widen the income eligibility for recipients. Twenty states, most run by Republican governors or legislatures, declined the largesse. Being tied to Obamacare, and to any kind of federal growth, was anathema to the GOP.

But Kasich wasn’t about to turn down an expected infusion of $13 billion. He is a man obsessed with budgets, and he believed Medicaid expansion was a step toward balance in Ohio.

His bookkeeping nature came from growing up in McKees Rocks, Pennsylvania, a suburb of Pittsburgh that was “hardscrabble, God-fearing, common-sense and conservative,” as he describes it. “It was a Democrat town where, if the wind blew the wrong way, people found themselves out of work.”

His grandfather was a coal miner. His father was a mailman. In their world, solvency mattered.

Kasich was already helping to write budgets in his late 20s, as a senator in the Ohio statehouse. As a congressman, he strafed what he deemed wasteful Pentagon spending on the House Armed Services Committee and helped broker a deal with the Clinton White House that resulted in the Balanced Budget Act of 1997 — the first time in a generation that the government had passed legislation to steady its books.

Even then, he had presidential ambitions. He briefly ran for the Republican nomination in 1999 but dropped out when he ran out of money. Then he dropped out of politics entirely to work at Lehman Brothers. That ended with the Wall Street firm’s collapse in 2008.

Ohio was circling the drain when Kasich jumped back into politics in 2010. The recession had chewed away 300,000 jobs. The state deficit was $8 billion. Unemployment cracked 10 percent. And Medicaid spending, the largest budget item in the seventh-most-populous state, was ballooning by an average of 9 percent each year.

Kasich in his first week as governor issued an executive order: All aspects of state-funded health care would be controlled by the new Office of Health Transformation. It would streamline services, vaporize redundancies and confront the costly nursing-home industry. It would modernize Medicaid by extending coverage to more low-income Ohioans while slashing its growth.

When the Supreme Court made Medicaid expansion optional, Kasich didn’t hesitate. He was in, and so was Ohio. This was billions that was going to sit in Washington, he said, or come back to Ohio to fast-track his health reforms.

Standing in his way was an entire branch of government.

‘I’m the CEO’

For Kasich to get his hands on all that federal Medicaid money, Ohio’s legislature had to approve spending it. Its Republicans, who were in the majority, refused to do so.

The governor didn’t care. The Clinton White House had worked with him in 1997; his own party was stopping him in 2013.

He barnstormed Ohio to sell his decision as good from a moral and money standpoint, building popular support for what he was about to do.

“Now, when you die and get to the meeting with Saint Peter, he’s probably not going to ask you much about what you did about keeping government small,” Kasich told a state legislator who opposed the expansion, according to Kasich’s account to the Columbus Dispatch in 2013. “But he is going to ask you what you did for the poor. You better have a good answer.”

There was one way around the legislature: the state’s Controlling Board, a seven-member panel created in 1917 and used to approve the spending of federal and state money. Kasich needed only four “yes” votes on the board. Two of the members were Democrats. Kasich needed Ohio’s speaker of the House, a conservative named William Batchelder, to use his authority to replace two anti-expansion board members.

Batchelder had met the future governor decades ago when he was a young representative and Kasich was a statehouse intern who was “almost incapable of asking simple questions.” Batchelder was suspicious of Medicaid expansion and of the Controlling Board.

Expansion “looked to me like too big of a challenge, one bridge too far,” says Batchelder, who has since retired. “The governor and I talked about it a lot. His concern for poor people was very genuine.”

And so ...

“I don’t like the Controlling Board,” Batchelder qualifies. “The irony is I voted against its continuation. I thought the whole House should vote on those kinds of things, but it was not possible at this point, in my opinion.”

And so ...

“So I took people off the Controlling Board.”

Batchelder was won over by Kasich’s conviction that this was the right thing to do, especially for a state in extremis fiscally. The move infuriated many of their colleagues, who saw hubris bordering on illegality. The board approved the federal funds by a vote of 5-2.

“He jams through Medicaid expansion at the same time he’s saying, ‘Join me in repealing the Affordable Care Act,’ “ Tom Zawistowski, an Ohio tea party leader, told the Columbus Dispatch. “It’s schizophrenic.”

“You guys are practically spooning, you and President Obama,” Laura Ingraham said in a Fox News interview with Kasich in November 2013. “That’s amazing. Are you BFFs for real?”

“I’m the CEO of this state,” Kasich responded. “I have a chance to bring [$13 billion] out of Washington to me, to the people here in my state who need this help.”

‘Heart got opened’

Then and now, the governor talks about people in the shadows: the poor, the mentally ill, the drug-addicted. His compassion is rooted in the trauma of losing his parents in 1987, when their Oldsmobile was hit by a drunk driver as they pulled out of a Burger King not far from home.

You have a window of opportunity here, his parents’ pastor, the Rev. Stu Boehmig, told the distraught 35-year-old congressman. A life-shaking event creates the space for personal re-examination.

“People’s hearts either get hardened and cold and shriveled and angry and bitter, or they get soft and open and pliable and moldable,” says Boehmig, who remains a part of the governor’s life. “And I think John’s heart got opened.”

From that moment, Kasich was transformed. With the curiosity and fervor of the Catholic altar boy he once was, he joined a Bible study group in Washington. He went searching for God and found him: in the Anglican Church. In his wife, Karen. In his twin daughters. In a brother dealing with mental health issues. In the triumphs and struggles of his constituents.

He can be less compassionate on other issues, some Ohioans say. He restricted food-stamp access and slashed education funding. He opposes resettling Syrian refugees in Ohio. He supports a state bill that would defund Planned Parenthood.

But on Medicaid expansion, he was certain he was right. More than half a million low-income Ohioans — including children, the mentally ill and the drug-addicted — now have access to health insurance.

Using the Controlling Board “was a brilliant move,” says Democrat Gayle Channing Tenenbaum, a child-and-family advocate who has navigated Ohio politics for 40 years. “We have always respectfully disagreed about two or three things, a tax policy being one of them. But there’s nothing made up about his faith and why he believed we should do Medicaid expansion.”

‘No one gets cut out’

Now, running for president, Kasich uses the same pearly-gates rationale to explain his decision: Accepting the federal expansion was a way to help the poor and forgotten, and a way for Ohio to have more control over its own services. It brought power to the state and health care to people who desperately needed it.

“I can run health care better than someone in Washington,” Kasich says at the Portsmouth Rotary Club.

The Medicaid decision might make Kasich an appealing candidate for a general election, but it makes him a flawed competitor in a presidential primary greased by ideological purity.

Ohio now has a $2 billion surplus and an unemployment rate of 5 percent. Among the state’s residents, Kasich boasts an approval rating of more than 60 percent.

Lounging in the back of his campaign bus, Kasich voices no regrets.

“Oh I went all in for it,” Kasich says, peeling the wrapper off a Twizzler. “I didn’t care about the political implications. I mean, you can’t do that in this business.”

In person, Kasich exudes authenticity, energy and a sense of mischief, from his constantly shifting feet to his Dennis-the-Menace hair. On television, during prime-time debates, these things can make him look irritable and erratic. On the trail, he looks indefatigable, using his scant downtime to walk city blocks or parking lots with his advisers. In either setting, though, it’s clear that Kasich is not a patient man.

He is man who really wants to be president.

“You know, one of the most frustrating times for me is when I get put in a situation where I can’t lead,” he says. “And it’s just part of who I am.”

He’s hoping his message of unity — especially when set against Donald Trump — propels him upward.

“You’re an American before you’re a member of a political party,” he says to a group of students. “We do not forget the people in the shadows” as we prosper, he says at a town-hall event.

Democrats “worry about me more than anybody else in the race,” he insists before addressing a class of fourth-graders visiting the stately foyer of the statehouse in Concord. He’s trailed by activists from Planned Parenthood who hold signs that say “Don’t Take Away Our Care.”

Follow your dreams, Kasich tells the fourth-graders. Be a good reader. Listen to your teachers.

“And promise you’ll make sure everybody gets included,” he says, “and no one gets cut out.”

This story was originally published March 8, 2016 at 1:28 PM with the headline "John Kasich broke with the GOP on health care, and he’d do it again."