Ohio Gov. John Kasich is lagging far behind in the race for Republican presidential nominee, but he hopes that accomplishments in his home state, like Medicaid expansion, will help knock Donald Trump from the road to presumptive nominee in a crucial primary Tuesday.
After decisive victories on Super Tuesday, Trump leads in the number of delegates among Republicans. His unpredictability, however, has led some in the party to consider how he could be stopped from moving on to the general election.
Most Ohio polls show Kasich either essentially tied with Trump or holding a slight lead over the national frontrunner. A win in his home state could bolster theories for somehow making Kasich the nominee at a contested convention.
Kasich has not shied away from his decision to expand Medicaid in Ohio under the Affordable Care Act. It granted coverage to potentially 454,000 people. He boasts of turning around the state's economy, although, some of that appears to be a result of the overall recovering economy.
A Kasich win would at least slow momentum for Trump, who, if he wins in Ohio and Florida, could be well on his way to securing a nomination. The Republican candidate receiving the most votes in those states is awarded all of the state's delegates.
Florida Sen. Marco Rubio appears to have less of a chance of overcoming Trump in his state. Ohio has 66 delegates, while Florida has 99. Also in play are Illinois, Missouri and North Carolina.
Patrick Willard, field director at Families USA, which supports Medicaid expansion, said it could affect some votes in Ohio, where people have been directly touched by the decision. But healthcare hasn't been much of a concern for Republican primary voters so far.
“(Kasich) is probably the only one who's talking about it,” he said.
At one of the early Republican presidential debates, Kasich defended his decision to expand Medicaid in Ohio, saying it helped treat the mentally ill and reduced the recidivism rate for prisoners with substance abuse problems.
“And finally, the working poor, instead of having them come into the emergency rooms where it costs more, where they're sicker and we end up paying, we brought a program in here to make sure that people could get on their feet,” he said.
Willard said states that have expanded Medicaid (PDF) have seen increased healthcare revenue and have lower per person spending in Medicaid now. Nineteen states continue to refuse to expand.
The ACA provided 100% federal matching funds for the expansion population from 2014 through 2016, with the match dropping off to 90% by 2020. In states that currently are considering expansion, including Alabama, South Dakota and Wyoming, Republican opponents argue that paying the 10% share will overburden their state's budget. Supporters say the new federal dollars would bring health and economic benefits that far outweigh the cost.