Kasich could face challenges distancing himself from Obamacare

COLUMBUS, Ohio — John Kasich likes Obamacare’s expansion of Medicaid to more low-income Americans.

He wants to ensure insurance coverage for people who have pre-existing conditions. He likes insurance exchanges. And he thinks everyone should have health insurance – even young, healthy people who need an incentive to sign up.

Yet he says he’d push to repeal President Obama’s health care law and replace it with something else – something better, he says – if his presidential campaign were to prove successful.

The “repeal” position is essential for Kasich’s GOP presidential candidacy. Indeed, many in the party are skeptical of his support for Medicaid alone. Candidates in Fox News’ bottom-seven debate this month even fielded questions about why Kasich “got it wrong” in expanding Medicaid in Ohio. Kasich had to defend his Medicaid move in his first question in the prime-time debate.

Kasich’s ideas about health care illustrate the difficulty the Ohio governor may have distancing himself from a law that so many of his fellow Republicans detest.

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When asked for specifics by TheEnquirer about his plans, a common theme emerged: accomplish many of the goals of Obamacare, sometimes by similar means, but without many of the federal mandates.

First, Kasich isn’t backing off his support for expanding Medicaid.

As a governor, he’s consistently said he was bringing Ohio taxpayers’ money back into the state to help provide health care for Ohioans who are poor or have mental illnesses or drug addictions.

Kasich has insisted he wouldn’t cut back on the expansion of Medicaid to more low-income Americans. Instead, he says, he’d want to send the federal money back to states, with more freedoms on how to implement the program.

“I’d like to have fewer strings,” Kasich said last month.

Probably the biggest change to Obamacare that Kasich has clearly endorsed: He’s all but said he’d scrap the controversial (and, thus, delayed) mandate that businesses with at least 50 employees provide coverage for their full-time employees.

“I think it’s very, very difficult to do something like that,” he told The Enquirer this summer. “What we really need to do is make it easier for businesses to group together, to offer insurance.”

From there, it gets a little vague, except for Kasich’s clear discomfort with the idea of mandating just about anything.

“There is an element of personal responsibility. If you’re a young person, and you get in a motorcycle accident, and you don’t have insurance, we’re all paying for it,” Kasich told The Enquirer. But “if in fact there was a mandate, I have no idea how it would be enforced. Is the government going to come around, go into everybody’s office asking?”

Kasich also thinks people should be able to shop for health insurance on an exchange, though not necessarily a federal one, promoting the free-market concept of competition.

Tell Kasich this sounds remarkably like Obamacare, and he demurs.

“Look,” Kasich told The Enquirer. “Insurance costs have been going up, they have disrupted a very robust market here, and I just don’t think that there’s any answer (in Obamacare). The biggest issue is cost, and it doesn’t deal with it.”

In Ohio, some insurance prices have increased. The state insurance department reports an 80% increase in the average cost of individual and small-group insurance policies from 2013 to next year’s proposed prices.

Nationally, Obamacare generally has pushed up the costs of insurance for young, healthy people and made coverage more affordable for those who are older or sicker, said Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan health-policy analysis group.

“If you allow people who are sick to get insurance, someone has to pay for it,” he said.

Kasich says a deregulated market, or individual states, should be the vehicle for establishing the facets of Obamacare that he likes, with difficult agreements brokered by a hypothetical Kasich administration, but not mandated by law.

But scrapping the system in place – thanks to Obamacare – and relying on the free market seems impractical to some. “I don’t know that the health care industry wants a return to the pre-(Affordable Care Act) world,” Levitt said. “Insurers and hospitals have both been doing quite well.”

“So what?” Kasich told The Enquirer, in response to a similar statement by a reporter. “I’m not opposed to challenges. I’d rather have a better system than what we have now.”

Still, conservatives will ask, Can you really trust Kasich to get rid of the hated Obamacare?

“You’re going to hear the phrase ‘Obamacare-lite,’ ” said John Pitney, a politics professor at Claremont McKenna College and former research director for the Republican National Committee.

For instance, Wisconsin Gov. Scott Walker used the point to hit Kasich Thursday in an interview with WMUR, a TV station in early-primary New Hampshire.

“I didn’t take the Medicaid expansion under Obamacare,” he said. “I think that’s important to a lot of Republicans – that I didn’t further Obamacare.”

Kasich’s pledge to “repeal and replace” Obamacare is probably good enough for most Republican voters, Pitney said, even if his solution ends up resembling Obamacare in many ways. For starters, elements of Obamacare – such as the mandate to cover people with pre-existing conditions – are popular.

“You’re not going to do away with it entirely. It’s already taken root,” Pitney said. “Obamacare is a pre-existing condition.”

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