The Republicans running for president have practically made careers out of skewering Obamacare — so when Ohio Gov. John Kasich makes his expected entry into the race, he’s likely to have a giant Obamacare target on his back.

Kasich says he is no fan of the president’s health care law. But he fought his own party to implement one of its core components and is now gearing up to face GOP primary voters who want to rip the health law to shreds. His decision two years ago to embrace Obamacare’s expansion of Medicaid to provide health coverage to low-income adults — a move that offered bipartisan cover to the White House during a tumultuous period — is likely to dog him in Iowa and New Hampshire.


Kasich made both a moral and economic case for covering the poor with mostly federal dollars. Many in his party disagree.

“We were deeply disappointed at Gov. Kasich’s actions on the Medicaid expansion battle in Ohio,” said Tim Phillips, president of Americans for Prosperity, a conservative think tank supported by the Koch Brothers. “Obamacare is a core issue at this point for so many Americans who will most likely be participating in primaries and caucuses. The question of expanding Medicaid is arguably the most important state-level aspect of Obamacare that’s in play.”

Strategists and political experts say the Medicaid issue alone isn’t fatal to a Kasich candidacy, but it certainly doesn’t help at a time when more than a dozen Republican candidates are groping to capture voters’ attention.

“When you have so many candidates to choose from, you could be for a governor with a good record that didn’t do that,” said New Hampshire Republican strategist David Carney. “There are 12 or 15 flavors. If you love maple walnut ice cream but there’s just too much maple, you go for something else.”

Other governors with 2016 aspirations have rejected Obamacare’s Medicaid expansion, including Wisconsin’s Scott Walker, Louisiana’s Bobby Jindal, and former Texas Gov. Rick Perry. And the Republican senators running for president — Rand Paul, Ted Cruz, Marco Rubio and Lindsey Graham — have all voted for repeal of Obamacare. New Jersey Gov. Chris Christie, who may still join the race, enacted Medicaid expansion in a state where he faced intense pressure to do so from a solidly Democratic Legislature.

Kasich, on the other hand, undertook an extraordinary maneuver to bypass his Republican Legislature to expand Medicaid to hundreds of thousands of people. In the fall of 2013, he lobbied an obscure state board to unilaterally increase the state’s Medicaid spending levels to accommodate the Obamacare program. Republicans howled and conservatives briefly targeted Kasich in a 2014 primary, but the furor died down.

His maneuver is unlikely to go unnoticed, however, in presidential politics. Kasich is fighting for the same center-right corner of the Republican base as former Florida Gov. Jeb Bush, who in 2013 actively lobbied lawmakers in his home state to reject Medicaid expansion even though the state’s current Republican governor, Rick Scott, supported it at the time. He’d enter the race as a long shot — he barely registers in early polls outside of Ohio — but he’s hopeful that early stumbles by Bush will give him an opening to win support in early voting states likes New Hampshire.

Critics of the expansion, which provides coverage to low-income individuals who make up to roughly $16,000 a year, say its costs will ultimately fall on the states, crowding out other priorities like education and public safety. Though Obamacare fully funds the cost of Medicaid expansion through 2016, states will gradually assume up to 10 percent of the cost.

In many states, including Ohio, Medicaid enrollment has vastly exceeded original projections, setting off alarm bells among conservatives who say the states and the federal government won’t be able to afford it. Nearly 540,000 Ohioans have been covered through the expansion already.

Kasich allies point out that the governor won a resounding reelection bid last year with 64 percent of the vote and scared off his one brief primary opponent, despite his association with the Affordable Care Act. They argue that his earnest commitment to the program is actually refreshing to voters, who crave his straight talk and willingness to take unpopular stances.

“What they see is someone who is willing to do what he thinks is right from a policy perspective and put politics to the side,” said spokesman Chris Schrimpf, who noted that nearly a dozen Republican governors have embraced the Medicaid expansion since Kasich did.

Kasich, however, was one of the few who supported a traditional Medicaid expansion, without the right-leaning policy elements that made the program more palatable to Republicans in other states, from Iowa to Arkansas to Indiana. His imminent candidacy comes as New Hampshire — where Kasich has been particularly aggressive — is in the midst of an intense partisan battle over the future of its own Medicaid expansion.

Kasich argues that he’s only bringing back funding that Ohio sends to the federal government, and that the Medicaid expansion has led to savings elsewhere for the state. And one of Kasich’s favorite defenses is that expanding Medicaid puts him in good company with the last Republican to expand Medicaid — Ronald Reagan. He’s also irked Republicans by justifying his decision as a moral and religious imperative.

“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,” he told reporters in Ohio in 2013.

That strategy works well in his home state and for independents, but it’s not likely to be a big winner among GOP primary voters, said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health.

“You just have to move onto other issues,” he said.

Kasich has long argued that the Medicaid expansion established by Obamacare is different than Obamacare itself. He has joined the chorus of calls for repealing the entire law while contending that it’s unconnected to Medicaid.

But that unusual semantic argument elicits scoffs from conservatives, too. The right has special hatred for Obamacare, but it also has separate qualms about Medicaid, arguing that the entitlement program has outgrown its original purpose of caring for low-income parents and people with disabilities.

Nearly all of the 21 states that haven’t expanded Medicaid since the Supreme Court made it an optional program in 2012 are led by Republican governors. Just this year, fights over expanding the program have roiled state politics in Alaska, Florida, Montana, Tennessee and Wyoming.

Though experts say a single issue isn’t likely to sink Kasich, it could diminish his appeal among the conservatives who animate Republican presidential politics.

“It’s not compassionate to take a failing program and expand it by dumping millions of Americans in it,” Phillips said. “For Gov. Kasich and others who have supported expanding this program, it’s going to be a difficult explanation.”