Ohio Gov. John Kasich speaks on the phone with staff after a 2011 vote in the state legislature in Columbus. (Melina Mara/ The Washington Post)

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 to 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.”

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 reexamination.

“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. Over 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.”