By Peter Sullivan - 02/13/16 12:00 PM EST
John Kasich has an ObamaCare problem.
The Ohio governor is facing a barrage of attacks over his decision to accept the Medicaid expansion under ObamaCare in the wake of his second-place showing in the Republican New Hampshire primary.
Jeb Bush, who is battling Kasich for the support of establishment Republicans, has amplified his criticism of the Ohio governor over the Medicaid expansion in recent days.
Kasich has fired back with a defense of his decision, trying to thread the needle of supporting the Medicaid expansion while opposing the healthcare law as a whole.
The fight is heating up as the candidates jockey for position in South Carolina, the next state on the Republican primary calendar.
“ObamaCare is a four letter word in the Republican primary in South Carolina,” said Richard Quinn, a longtime Republican strategist in South Carolina who supported Sen. Lindsey GrahamLindsey Graham56 memorable moments from a wild presidential race High anxiety for GOP NYC mayor: Trump sounds like ‘a third-world dictator’ MORE (R-S.C.) before shifting to Bush. “I think it’s going to be very difficult for Mr. Kasich … his politics are kind of suited to New Hampshire.”
Bush has started ramping up his attacks.
The former Florida governor told MSNBC’s “Morning Joe” on Wednesday that, while Kasich’s record might have played well in centrist New Hampshire, it won’t hold up in South Carolina.
The “telling thing” about Kasich, Bush said, is that “when he had a chance, he expanded ObamaCare through Medicaid.”
“Governors across this country had a chance to take a stand against ObamaCare, many did.”
“In Ohio it was expanded, and he’ll have to explain that down here, where ObamaCare, people want it repealed, they don’t want it expanded,” Bush added.
Similarly, an outside conservative group called the American Future Fund has launched ads calling Kasich an “Obama Republican” and highlighting the Medicaid expansion.
The group has filed a public records request for emails between the Ohio Medicaid agency and the Obama administration.
Kasich is not being shy about defending his record.
“He needs to start being more positive,” Kasich told reporters on Thursday, speaking of Bush’s attacks, according to the Columbus Dispatch. “I don’t know what he’s thinking. Does he realize the family legacy? Spending all your time being negative?”
“I am for repealing ObamaCare,” Kasich added. “But expanding Medicaid at this point, bringing our dollars back, is working. It’s saving money and it’s saving lives. And that’s what really matters at the end of the day.”
Like other supporters of the Medicaid expansion, Kasich argues his state would simply be leaving tax dollars in Washington by rejecting the expansion. That’s because the federal government picks up the entire cost of expansion for the first three years before eventually dialing back to covering 90 percent of costs.
But Kasich has angered the right by going one step further and making the case for the Medicaid expansion on moral grounds.
In 2013, the governor recalled discussing the Medicaid expansion with a legislator who supports small government.
“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. You better have a good answer,” Kasich said.
He has also tied the decision to vulnerable people in his state, saying the expansion had helped the mentally ill, the "drug-addicted" and the "working poor, so they don't live in emergency rooms.”
That argument hasn’t gone over well with conservatives.
Avik Roy, a leading Republican health policy expert now advising Sen. Marco RubioMarco RubioJuan Williams: When WikiLeaks leaked my cell number 56 memorable moments from a wild presidential race New York Times endorses Rubio's rival MORE (R-Fla.), wrote on Twitter in 2014: "Shorter John Kasich: Obamacare is bad, but expanding single-payer healthcare in Ohio is awesome; if you disagree, you hate Jesus."
Bush, for his part, argues that the cost of the Medicaid expansion is too high, even if it is borne by the federal government. He says the program needs to be reformed, not expanded.
His healthcare plan calls for capping federal Medicaid payments to states and giving states more freedom to make changes to the program. Democrats tend to argue that capping payments would mean cuts in Medicaid benefits.
Some other Republican-led states have expanded Medicaid, but the Obama administration is trying to urge Republican leaders in the 19 states that are still resisting to accept it, often touting the financial benefits to state budgets.
While Kasich has defended his decision to expand Medicaid, he knows full well that the law as a whole is toxic for Republicans, and has made moves to distance himself from it.
Kasich has argued that he “rejected ObamaCare” because he declined to set up a state-run ObamaCare insurance marketplace. And an ad Kasich ran in the closing days of the New Hampshire race touted that he “rejected ObamaCare without leaving anyone behind.”
Joel Sawyer, a Republican strategist unaffiliated with a campaign, said the Medicaid issue could be an Achilles heel for Kasich as the primary battle unfolds.
“It's a liability in as much as his opponents spend money to make it a liability,” he said.