Will Ohio reject half of health care reform? Or will voters reject all of it?

Well, that was a wild ride.  For politics junkies, yesterday was a huge fix -- the most anticipated, most important, most surprising Supreme Court decision since Bush vs. Gore, complete with a no-wait-yes reveal.

I was sitting in my doctor's office at 10:09 when CNN.com misfired and posted, "The Supreme Court has struck down the individual mandate for health care." I pulled it up on my phone. My doctor was mostly rooting for the health care law (he's from Canada), but even he got the breaking-news junkie gleam on his face when I told him.

I left and walked into the least boring waiting room experience ever, 20 Cleveland Clinic patients looking expectantly at a TV, reading the CNN captions.  Wait, CNN was saying by 10:16... some reporter was finally reading past page 2... not under the commerce clause, but under the power to tax... 

Thanks to Walter Dellinger, who should've earned thousands on InTrade for his prediction, I knew what that meant.

"Dewey Defeats Truman -- LIVE!" the Atlantic's Megan Garber called CNN's flub. 

The network flipped at 10:19. "Supreme Court upholds entirety of health care law," it announced.

That was pretty close.  But still not right.

The Court snipped one line out of the Affordable Care Act, but it's a big one.  It ruled the states can choose not to go along with the law's expansion of Medicaid. That could lead to a weird split in the country -- liberal states going along with all of health care reform, conservative states going along with half of it.

When I say half, I mean half.  You've heard that the new law will give 30 million people health insurance, right?  Well, today the New York Times ran a chart, based on Congressional Budget Office estimates, that says 22 million people will get health care coverage through new insurance exchanges, while 17 million will get it from the Medicaid expansion.  Now, that means 17 million would get it if their state goes along.

The Medicaid expansion will be 100 percent funded by the federal government -- for a few years.  Then 95 percent. Then 90 percent.  Even though it's a generous subsidy, conservative states that feel extra-cautious about their financial future (or, not as concerned about the uninsured as others) might decide to turn it down.  See this Washington Post story for more.

Gov. John Kasich and Lt. Gov Mary Taylor have strongly resisted the health care law. Yesterday they issued a statement saying they're "very concerned" about "a sudden, dramatic increase in Medicaid spending."

They're hinting that they might decide to turn down the federal money and not expand Medicaid to cover everyone in or near poverty in Ohio.  That could become a huge issue in state politics by next year.

But I'm a step ahead.  For now, the real question isn't, will Ohio's government say no to half of health care reform?  It's, will Ohio voters say no to all of it?

What I mean is, everyone says this election is about the economy and jobs.  But what if it's really about health care? 

The economy may decide the election, but the election will decide whether the health-care law stays or goes. Romney promises to repeal it.

Republicans in Congress think they only need 51 senators, not 60, to repeal parts of it. They need to pick up four Senate seats, and they have a shot.

Ohio's looking a lot like the ultimate swing state again.  It could clinch the presidency for Obama, or put Romney very close to winning.  So the future of the health care law may have passed from the Supreme Court's hands to Ohio voters'.

Kucinich will vote yes on health care

It was a moment of truth for Dennis Kucinich: Would he preserve his progressive purity by voting down the biggest progressive reform of our time?

No. He's changed his mind: He's voting yes on the president's health-care plan.

"This is not the bill I wanted to support," Kucinich said at a Capitol press conference this morning. "However, after careful discussions with President Obama, Speaker Pelosi, my wife Elizabeth and close friends, I’ve decided to cast a vote in favor of the legislation."

Notice how his wife ranks up there with the president and the speaker of the house? The health-care talks in the Kucinich household must've been as weighty as Dennis' high-pressure ride with Obama in Air Force One. The young, striking Mrs. Kucinich doesn't just help her husband by attracting press cameras and coverage. She's become his conscience, an adviser who reminds him what he stands for -- and tells him when compromise isn't a sell-out, but a wise strategy.

"In the past week it has become clear that the vote on the final health care bill will be very close," he said at a 10 a.m. press conference at the Capitol. "I know I have to make a decision, not on the bill as I would like to see it, but the bill as it is." (See the Plain Dealer and The Hill for more coverage. Or, read his full remarks here.)

After holding out for government-run health care longer than most anyone, Kucinich has accepted something Sherrod Brown has been reminding progressives for months now: Reform in America is almost always accomplished step by step, not all at once.

"If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform," he said today.

At the last moment, on the verge of either making himself irrelevant at a moment of great change or actually scuttling it, Kucinich proved that even he knows how to compromise.

Obama pressures Kucinich in Strongsville, on Air Force One

Dennis Kucinich flew to Cleveland on Air Force One with Barack Obama yesterday, and the president spent the flight pressing stubborn Dennis to vote for his health-care reforms. Up on the podium in Strongsville, Obama turned up the pressure with a smile. He name-dropped Kucinich, an audience member shouted, "Vote yes!" and Obama turned and said, "Did you hear that, Dennis?"

But Kucinich has already said he's voting no on the Democrats' health-care bill. {See update below.} His Sunday Plain Dealer op-ed lays out his reasons why: Forcing people to buy private health insurance, without giving them a publicly-run option, risks exposing more people to insurance-company abuses.

Kucinich is taking a huge risk. Voting no will preserve his reputation as a champion of government-run health care -- and his self-image as a solitary hero. But it'll anger his progressive allies and donors across the country. They'll see what many Clevelanders saw in 2007 when I wrote my Kucinich profile, "The Missionary": His solitary far-left stands can make him irrelevant when progressives try make real but incremental change. Markos Moulitsas, founder of the left-wing blog Daily Kos, says Kucinich should face a Democratic primary challenge in 2012 if he votes no and the bill goes down.

Last night on MSNBC, Rachel Maddow was interviewing U.S. Sen. Sherrod Brown, and she mentioned Kucinich in her question about a public option. Without talking about his colleague, Brown drew a distinction between Kucinich's approach and his.

"You understand how progressive movements work," Brown said. "When Social Security was passed in the '30s, it wasn’t all that great at the time. When Medicare was passed, it was good but not great. So much of what we’ve done on abolishing child labor, on safe drinking water and clean air, worker’s compensation and minimum wage: We passed a decent bill and improved on it decade after decade."

Check out this video, with Obama making his case in Strongsville at 0:30 and pressuring Kucinich at 3:38, and Maddow's question to Brown at 8:32.

{Update, 3/17: The pressure worked. Kucinich will vote yes.}

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Brown helps forge Senate Democrats' health care deal

Sherrod Brown is one of five liberal Democrats who helped craft the U.S. Senate's latest health care deal, which would allow people age 55 to 64 to buy into Medicare. This New York Times analysis (registration required) says a lot about Brown's new role as negotiator.

Brown is one of the Senate liberals who fought hard to create a "public option," a government-run health care plan for the uninsured. But several moderate Democrats don't like the public option, and these days it takes 60 votes to pass anything in the Senate. So Brown became part of the "Team of 10," the five liberals and five moderates who met to try to forge a compromise all Senate Democrats can vote for.

The new deal would only create a public option as a fallback if other health care reforms fail to meet a goal of insuring a certain number of people. But the Team of 10 also propose a new idea: letting people buy into Medicare starting at age 55. That would advance the liberals' goals of insuring more people and creating more not-for-profit competition with private insurers.

"To satisfy the liberal Democrats, including Sherrod Brown of Ohio," the NYT story adds, "the agreement calls for the creation of a new menu of national insurance plans, modeled after those offered to more than eight million federal workers, including members of Congress, and their dependents."

Sounds like one of Brown's ideas caught on. He refuses to accept congressional health-care benefits, as a protest against the number of uninsured people in the country. Last week he signed onto a Republican dare, agreeing with them that if Congress creates a public option, all congresspeople should have to use it for their health-care coverage. Now the Team of 10 has jumped on the idea that congressional health care and new health care plans for the uninsured should look the same.

The deal still has to get 60 votes. Then, senators will have to negotiate with the House, which passed a different bill. But it's interesting to watch how Ohio's Democratic senator is wielding influence on the year's biggest issue.

Update, 12/15: Looks like Joe Lieberman, the stubborn independent and former Democrat, refuses to be the 60th vote for expanding Medicare. Senate liberals may be stuck with no replacement for the public option. They could still try to get Olympia Snowe, the Maine Republican, to go for the public option as a backup -- or "trigger," as the buzzword goes. But it looks like the president wants to make a deal with Lieberman instead.