When the Republicans convene in Cleveland two years from now, there will be one extra elephant in the room.

The announcement of Cleveland as the recommended site for the 2016 convention came on Tuesday. Assuming the party apparatus ratifies the choice—and everybody seems to think it will—the problem won't be the choice of city per se. The issue will be the state and the debate about Obamacare and Medicaid that's played out there for the last year-and-a-half.

Under the Affordable Care Act, states can make Medicaid available to anybody whose household income is less than 133 percent of the poverty line, which for a family of three works out to about $31,700 a year. It's how Obamcare's architects envisioned the poorest people without insurance would get coverage under the new law. But conservative state officials have resisted taking that step, arguing that the expansion would place too great a burden on state treasuries, build on a flawed model for insurance, prop up a big government program, and so on.

Conservative Republicans in Ohio were among them and, because they control the state legislature, they were able to block expansion for a while. But one Ohio Republican saw things differently. While a bona fide conservative who opposed Obamacare, he figured that Medicaid expansion was still a good deal for his state. He knew that hundreds of thousands uninsured residents would eventually get coverage and the federal government would be picking up most of the additional cost, thereby infusing billions of dollars into the state economy. This Republican also realized that most of that money would go directly to hospitals and health care providers, whose growth had been a major factor in Ohio’s recovery from the recession. And this Republican understood that Medicaid expansion had strong support from Ohio’s business community.

Why does this matter? Because the Republican happened to be Governor John Kasich. And he made a huge issue out of it.