In its decision last year on the constitutionality of the Affordable Care Act, the Supreme Court majority ruled that Medicaid expansion can proceed, but it must be entirely optional for states. Almost immediately, right-wing groups delivered a stern message to Republican governors: to accept expansion would be an outrageous betrayal of conservative principles.
Some GOP governors are doing it anyway, and yesterday, Ohio's John Kasich joined the group (video via ThinkProgress).
"I, as all of you know, am not a supporter of Obamacare," Kasich explained at a press conference. "But I think this makes great sense for the state of Ohio."
And in this case, the governor is correct. The way the Affordable Care Act is structured, Medicaid expansion is a great deal for states, and should be a no-brainer for governors who care about lowering health care costs, insuring low-income families, improving state finances, and helping state hospitals.
The only reasons Republican governors would balk is if (a) they're afraid of their party's base; (b) they plan to run for president and don't want this to be used against them in a primary; and (c) both.
But Kasich's decision still came as something of a surprise, largely because he's considered a darling of the far-right and a model of contemporary fiscal conservatism. Indeed, it's exactly what makes his decision so problematic for the right.
The governor is effectively ending the charade -- Democrats have been arguing for quite a while that Medicaid expansion is the only fiscally responsible path forward, and now their argument has been endorsed by Kasich, who happens to be a far-right governor, a former chairman of the House Budget Committee, and a former Fox News analyst.
No wonder the right is incensed.
That leaves Kasich, who built his political identity arguing for smaller government, at odds with the same movement conservatives who propelled him to victory in Ohio and have eyed him for a presidential run in 2016.
"I think it's definitely going to weaken him with the conservative base," said Chris Littleton, the Ohio director for American Majority Action. "It's not a good idea to expand your No. 1 budget item in the middle of this kind of instability. The conservative grass roots and average voters are not going to support this in any way, shape or form."
The issue for Kasich and others in his position is pretty straightforward: do they choose ideology or reality? For the right, the only thing that matters is fighting against "Obamacare" -- whether it makes sense or not from a policy perspective is irrelevant. The goal is to preserve the integrity of a right-wing philosophy that's entirely detached from practical considerations.
For governors, it's not as easy to ignore the substance. Unlike right-wing activists, governors actually have responsibilities.
Indeed, it's why Kasich isn't the only one -- the Ohio governor's decision to endorse Medicaid expansion comes on the heels of identical decisions from Republican governors in Arizona, New Mexico, North Dakota, and Nevada.
This is obviously good news for the residents of those states, but it further complicates the goals of far-right activists who still hope to persuade other Republican governors to turn down Medicaid expansion on principle. GOP governors who haven't decided now realize that if they follow orders from the base, their rationales will have already been debunked by John Kasich, Jan Brewer, Susana Martinez, Brian Sandoval, and Jack Dalrymple.