CLEVELAND The Republicans gathering inside the Quicken Loans Arena dont care too much about the nitty-gritty of policy. But if theres one substantive issue that generates passion among convention delegates and party leaders, its Obamacare .

They think it crushes freedom. They think its a handout. And they think its a policy disaster.

At the Neighborhood Family Practice , which serves a racially diverse, low-income area about six miles west of downtown, the clinic staff has a slightly different perspective.

For them, the Affordable Care Act isnt an ideological abstraction, to be loved or hated for what it represents. Its a part of their daily lives, a program that has dramatically changed the way they conduct business. And they say its been a godsend.

The main reason is the part of Obamacare thats been most controversial in Ohio: the expansion of Medicaid eligibility. Republican Gov. John Kasich exercised that option over the strong objections of conservative activists and even his own Republican legislature.

Before the Affordable Care Act became law, the Medicaid program in Ohio looked like the Medicaid program in most other states back then. It was available only to certain categories of poor people, like children and pregnant women. Today, with the law in place, states receive generous federal support if they choose to drop the old restrictions and make Medicaid available to basically everybody in a household where the income falls below 133 percent of the poverty line, or $26,313 for a family of three.

To the surprise of many, Kasich made a passionate moral case for taking up the federal governments offer, arguing that the state had an obligation to help those in need. He overcame the final political and legal hurdles in 2013, allowing enrollment in the expanded program to begin the following January.

Since that time, Ohios Medicaid rolls have swelled by more than 600,000, significantly exceeding initial projections.

Those numbers anger and frighten the programs conservative critics, who decry the programs cost. But the extra spending on Medicaid, most of which is coming from the federal government and not Ohio, is just one component of the Affordable Care Act a program that, nationwide, has cost less than anticipated and projections suggest is actually reducing the federal deficit.