The four other Republican governors to back the Medicaid expansion are Brian Sandoval of Nevada, Susana Martinez of New Mexico, Jack Dalrymple of North Dakota and Jan Brewer of Arizona. About a dozen GOP governors from red states have rejected the expansion; others from mostly blue and purple states have yet to decide. Democratic governors have broadly embraced it.
It's an enticing deal: the expansion would extend Medicaid eligibility to their residents up to roughly 133 percent of the poverty line. The federal government would cover the full cost of the new beneficiaries in the early years and 90 percent after 2020.
"The net effect is 270,000 Ohioans coming into the [Medicaid] program," said Greg Moody, the director of Ohio's Office of Health Transformation. "Over two years the state of Ohio will have saved $235 million as a result of the decision to extend coverage."
Kasich's decision could influence other undecided Republican governors -- such as Chris Christie of New Jersey, Tom Corbett of Pennsylvania and Scott Walker of Wisconsin -- who are caught between wanting to improve the lives of their constituents and to remain in good standing with the conservative movement, which detests the Affordable Care Act in general and wants leaders to turn down the Medicaid expansion in particular.
Conservative opponents of extending Medicaid coverage fear that the federal government won't come through with the funds and will eventually force states to cover the cost.
If implemented in full, the Medicaid expansion is projected to provide insurance coverage to some 17 million new Americans over a decade. But the Supreme Court ruling and decisions by Republican governors to turn it down could substantially reduce that figure.
Kasich and Moody noted that Ohio has refused to implement the state-based exchanges, another part of the Affordable Care Act, and intends to retain autonomy over its insurance regulations.