In June, John Kasich repeated his pledge about expanding Medicaid. The governor told reporters: “I just want to make it clear: We will not give up this fight until we get it done — period, exclamation point!”

The past three months, he has continued to press the case, and now a pivotal moment has arrived. Lawmakers return to work this week, the window of opportunity narrowing, the new health insurance exchange launching in two days, the Affordable Care Act kicking into high gear at the start of the new year.

Will the state expand Medicaid, extending health coverage to an additional 275,000 Ohioans with low incomes, up to 138 percent of the poverty level, or $15,415 a year for an individual, $31,809 a year for a family of four?

Since June, Republicans in charge of the legislature have been repeating their own message. They reject the idea of expansion, even coming from the governor, their fellow party member. They pitch “reform,” changing the program to slow rising costs and promote personal responsibility.

What they fail to appreciate are the many advances already made on this front. Greg Moody, the director of the Governor’s Office of Health Transformation, and John McCarthy, the head of the state’s Medicaid program, have put into place an array of changes aimed at doing just what lawmakers claim they want.

Few states have been as aggressive or as clever in the cause. On Tuesday, the state will take a leap forward, triggering the replacement of a three-decades-old system for determining Medicaid eligibility. The new system will bring accuracy and simplicity to an obsolete regimen with an error rate of 60 percent in assessing eligibility. The improvements will benefit caseworkers, taxpayers and those served by Medicaid.

More, the new technology will allow for the equivalent of a one-stop evaluation of eligibility for the range of income-based programs, including welfare and food assistance. The system also will communicate with the health insurance exchange, together serving as a navigation component, directing those without coverage to the proper place, Medicaid or the exchange, helping them to sign up.

Count on glitches surfacing early. Bet safely, too, that here is a platform for making Medicaid much better.

The lack of legislative appreciation extends further. The Republican majorities have paid little heed to the concerns of hospitals.

The Affordable Care Act assumes that with more people having health insurance, the federal government will not spend as much helping hospitals with the cost of uncompensated care. A state that fails to expand Medicaid puts hospitals in a financial bind, amid other tumultuous changes in health care. The tab for uncompensated care will be left with hospitals, budgets squeezed tighter, the effect rippling through local economies.

Chambers of commerce have warned about harming the business climate if the state fails to expand Medicaid, small firms, especially, struggling with offering coverage or paying penalties. Yet this concern also has made scant impression with the Republican majorities.

Neither has the argument for widening opportunity. Expand Medicaid, and the state opens the way to early and thorough intervention for those suffering from mental illness. Proper treatment leads to productive lives, benefiting all of us, every dollar invested yielding seven in return.

What does concern Republican lawmakers is the bottom line for the state and federal budgets. They argue that the expansion is unaffordable. They worry about getting stuck with the bill if the federal government reneges on its commitment to cover 100 percent of the expansion cost for three years and then to 90 percent.

Put aside that the governor has a provision that would allow the state to withdraw if the federal government made such a move. Know that if the state does not go forward with the expansion and those eligible move into the insurance exchange, the federal government will pick up the cost, anyway, via the subsidies it would provide for health coverage.

And if those eligible do not qualify for the exchange, which is how things stand, the feds thinking they would receive Medicaid? The expensive and distorted system we have now endures, the cost of uncompensated care shifted to the rest of us, in part, through higher premiums.

Medicaid cannot escape what troubles the health-care system as a whole. That said, the program has been a better performer, delivering improved health outcomes, its per-beneficiary costs lower than private insurance and its costs increasing more slowly than employer coverage.

This is a program worthy of expansion, especially in a state that has reduced income tax rates by roughly one-third the past decade, largely benefiting wealthier households. Expansion is something the state can afford, the increased spending negligible, Greg Moody and John McCarthy at work engineering savings.

John Kasich long has understood all of this, so much so that the governor may push ahead without full legislative approval, relying instead on a legislative subset, the State Controlling Board. That carries risk, politically and legally. It also reflects how much the state stands to gain. Too bad so many Republican lawmakers have yet to appreciate it.

Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514, or emailed at