At a John Kasich town hall meeting in Watertown, New York, in April, a questioner from the audience was having a difficult time formulating his question. He was able to get out that he suffers from autism and is college educated with two master’s degrees, but said he has a difficult time finding employment. It seems that employers are often put off by his bad social interaction skills and are worried about his potential ability to fit in with other employees. Because of problems like this, the young man told Kasich, adults suffering from autism have very high unemployment rates.

Kasich moved closer and leaned in, clearly both agitated and consumed by the man’s problems. The 600 people in the room could see that Kasich knew what this guy was talking about—not in terms of the specific symptoms of autism, maybe, but in a personal and emotional way. Because if there is one thing John Kasich understands, it is not being understood. Everyone agrees he is bright and likeable, but not everyone agrees that he brings a sense of what we constitute as normalcy.

He has been described as flaky, mean, cheerful, ornery, sullen, distant, and enthusiastic. Someone who is honest but not forceful about his spirituality who often spouts crazy-uncle idioms, who sometimes lectures instead of discussing, and who is always impressed with his own jokes. In a 1995 Washington Post article, the then Ohio congressman was described by those with whom he worked as someone who needed both Ritalin and Valium for his own mental balance to balance the federal budget. The writer also observed that Kasich’s eyes blinked thirty-six times in a minute, compared to just two blinks in the same period by “the more inert” Texas Congressman Dick Armey. “[Kasich] radiates so much energy that colleagues in the Ohio delegation, weary and looking for sleep, dread the thought of getting seated near him on flights back to the Midwest,” the article said. The Post story also declared Kasich to be a “wiry and fidgety politician.”

But on this day in Watertown, his eyes seemed to blink slower as he settled the young man down and addressed disability and mental health issues. “When it comes to developmentally disabled—and we have to come up with a better term—we just need to integrate people into our system to the level they are able to perform,” he said. “We just need to let people know about these issues. It’s not hard to bring people in. What the heck, I’d hire you.”

This exchange took place at almost every Kasich town hall meeting before he suspended his presidential campaign in April. This was where the presidential candidate told the crowd that we must all—government, private businesses, neighbors—take care of the “people in the shadows,” which, in Kasich code, means the developmentally disabled, the mentally ill, the drug addicted, and the impoverished. The ones we may have a hard time understanding because they are not like us.

Republicans have hammered Kasich’s 2013 decision to expand Medicaid in Ohio, accusing him of being friendly to President Barack Obama’s health care reform initiatives and warning that the expansion “would be a disincentive to work.” In other words, any health program that is not provided by the private market or a charitable entity—even government-led mental health initiatives—is nothing more than just another welfare entitlement for the poor.

Though he made the decision not to make his brother a part of the campaign, John Kasich has not shied away from the main reason he expanded Medicaid in Ohio.

But buried a bit deeper in all the political wrangling is a simpler reason why Kasich expanded Medicaid: more mental health treatment and accessibility for everyone had long been at the top of his policy wish list, and he saw expanding Medicaid as the best way to get it. This was driven by three main factors in the John Kasich belief book. He thinks physical and mental health programs must be conjoined for either to be effective, his Christian beliefs are clearly based in helping the less fortunate, and he’s familiar with mental illness issues thanks to family experience. Even with these three driving factors, it’s been no easy task.

“When I started out as a judge more than forty years ago, the first thing I noticed was that my docket was full of people with mental health issues, and they kept coming through again and again,” says Evelyn Lundberg Stratton, a Republican who served as a justice on the Ohio Supreme Court from 1996 to 2012. “They were recycled inmates. And the sheriffs who ran the jails were saying that incarcerating the mentally ill was consuming most of their resources.” John Kasich, Stratton continues, “has been a courageous governor in bucking his own party on this issue, and as a result he has saved many lives.”

It was the new allocation of resources that attracted Kasich initially to the Medicaid expansion. Even before he was elected Ohio governor in 2011, states had to reformulate their Medicaid programs to get them more in line with federal mandates as part of the initial Obamacare changes. So eighteen months before he was elected, Kasich assembled a team—some of whom had worked with him in the 1990s in Washington on the federal budget—that would look at ways to integrate mental health programs into the revised Ohio Medicaid system. “He joked that he was getting the band back together again,” says Greg Moody, who worked on the U.S. House Budget Committee in the 1990s and is now the director of the Ohio Governor’s Office of Health Transformation.

The Medicaid expansion brought about 600,000 Ohioans into the program; more than half of them worked (or had spouses who did) and another 30 percent didn’t work because of chronic disabilities. About half of those with chronic conditions had associated mental health issues. “We have found through numerous studies that most of the mentally ill lose their jobs because of health problems, mostly because getting physical health treatment becomes difficult for them to take care of with the other issues plaguing them,” says Terry Russell, director of the Ohio chapter of the National Alliance on Mental Illness.

The Kasich administration has instituted numerous programs that make Medicaid spending more efficient in integrating mental health into the equation—from increasing childhood access to mental health treatment to changes in opioid addiction treatment polices to spending $316 million in fiscal years 2016 and 2017 to help Ohioans with developmental disabilities, including programs to find better housing and jobs. “We seem to ignore these people,” Kasich said during a campaign speech in Georgia last year. “Now, I don’t know how many of you know people who struggle with these illnesses, but if you’ve got problems with schizophrenia and you find yourself in prison? It’s a disgrace in this country.”

Selling that line of thinking has been difficult, especially in the evangelical Christian community. According to a 2013 study by Lifeway Research, a Tennessee-based Christian church research group, 48 percent of evangelical, fundamentalist, or born-again Christians believe that prayer and scripture study alone can overcome mental illness. (Interestingly, eighteen- to twenty-nine-year-olds in those groups are more likely to believe in Bible and prayer treatment than those between the ages of fifty-five and sixty-four.) So while Kasich has been adamant about trying to bring better mental health treatment options to the poor, he is facing a strange battle of sorts within the GOP power base. Not only do many Republican conservatives believe that mental health care provided under the Medicaid umbrella is repackaged welfare, many also believe that prayer is all that’s needed.

Some observers think that may be changing. “There may be some pastors and Christian counselors with platforms who remain very skeptical of mental health professionals and the modern concept of mental illness, but I can’t imagine my evangelical friends rejecting a candidate who strongly supports better funding of mental health research or access to mental health services on that basis, especially if they were demonstrably committed to other issues of interest to evangelicals . . . sanctity of life, religious liberty, school choice, the persecuted church,” says Stephen Grcevich, a psychiatrist in Chagrin Falls, Ohio, who works with church groups on religious and children’s disability issues. Evelyn Stratton thinks that what Kasich has been doing politically—trying to hold down costs while providing services to the mentally ill—will work “because everyone has a mother, father, sister, or brother who has a mental illness problem.”

In Kasich’s case, this is true. His younger brother Rick, fifty-nine and a former postal worker like their father, told the Columbus Dispatch in a 1999 interview that “he takes medication and sees a counselor for emotional problems.” The problems were, he said, “‘chemical in nature. . . . I could give you a diagnosis, but I’d rather not.’”

The family went through horrific tragedy in 1987, when the brothers’ parents were killed by a drunk driver. There was some disagreement about how the estate would be divided, according to the Dispatch story, and bad blood developed between them. Rick Kasich said his brother’s “life can’t be reconciled to me in any degree. . . . I have a low view of him. I really don’t want to get involved with him.”

While the two have since reconciled, according to an April story in the New York Times, Rick’s opinion hasn’t changed much. “He doesn’t have much to do with me, and I don’t have much to say about him,” he told the Times. His older brother’s campaign told the paper, “We love Rick deeply and have shared the struggles that his disease brings with it,” and called for his privacy to be respected.

Though he has made the decision not to make his brother a part of his political campaigns throughout the years—and not to use Rick as an example of why policy changes are needed when lobbying the state legislature in Columbus—John Kasich has not shied away from the main reason he expanded Medicaid in Ohio. During one of the early debates last summer, he was asked why he’d done it: “I had an opportunity to bring resources back to Ohio to do what? To treat the mentally ill. Ten thousand of them sit in [Ohio] prisons. It costs $22,500 a year [for each one].”

Very simple: Save government money. Practice what you preach. And, more importantly, learn from personal experiences, however painful they may be.

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Daniel McGraw

Daniel McGraw is a freelance writer and author living in Lakewood, Ohio. He is a former senior editor with U.S. News & World Report and his work has appeared in Politico, Pacific Standard, the New Republic, Next City, the Guardian, and others.