"If it upsets Republicans in the Congress, I mean, that's life," Kasich told reporters.
Kasich's home state of Ohio is one of the handful of Republican-led states that expanded Medicaid coverage under the Obama health law; his plan would put the states in charge of that program, but leave the feds paying most of the costs.
But early indications from Capitol Hill are that won't float with the GOP Congress, as early plans would limit federal funds offered to states for Medicaid coverage.
As for Democrats, they were already slicing and dicing press reports about what the GOP wants to do with the Obama health law.
"Let me count thy ways that the leaked GOP ACA repeal plan will totally, completely, monumentally screw you," said Sen. Chris Murphy (D-CT), as it seems unlikely right now that Democrats will vote with the GOP on almost anything related to health care.
That means the GOP will have to keep Republicans on board in the Congress to insure their plans get approved.
And that means they may need people like Kasich on board, to help.
"I don't care what the Republicans do on this; if they do something that I think is wrong, I'm going to speak out," Kasich said.
Republicans in the House and Senate are still putting their repeal and replace plans together; it's still not clear when legislation will be made public, or when a vote will take place.
Speaker Paul Ryan has said he wants votes by the end of March.