Virginia Democrats near victory on Medicaid expansion

Powered by last year’s electoral victories and emboldened by GOP defections, Virginia Democrats are on the cusp of winning an expansion of Medicaid — something they’ve been seeking since Obamacare first passed eight years ago.

Former Gov. Terry McAuliffe, a Democrat, was never able to get it done, stymied by a GOP-dominated legislature. But new Gov. Ralph Northam is on track to get it done in a special legislative session that begins Wednesday, after two key Republicans said they’ll back the expansion under certain conditions.

State Sens. Frank W. Wagner and Emmett W. Hanger Jr. say they are willing to offer two critical GOP votes for the effort as part of budget talks, though they’re prodding Mr. Northam to require able-bodied recipients to work as a condition of benefits.

Mr. Wagner also said he wants to use money from a provider tax on hospitals to offer a tax credit for middle-class people who earn too much for Medicaid but struggle to pay there premiums, co-pays and deductibles.

“Expand Medicaid and cut taxes on working families? It can be done,” Mr. Wagner said.

Mr. Hanger, though, doesn’t want to impose the hospital tax at all, highlighting some of the hurdles that await the special session, which will also try to break a budget impasse.

Mr. Northam said Tuesday he’s optimistic.

“We’ve had some good discussions with folks in both the Senate and the House. They’ve been hard-fought negotiations, a lot of compromise,” the governor told the John Fredericks radio show. “I came in with a plan for what I would call a straight Medicaid expansion. We negotiated some things that I wasn’t really in favor of.”

Mr. Northam signaled those concessions involve a “work search” program to satisfy Republicans like Mr. Wagner and Mr. Hanger.

President Barack Obama’s sweeping 2010 health reforms called on states to vastly expand enrollment to those with incomes up to 138 percent of the poverty level.

More than 30 states have bought into the expansion, accepting federal funds. But 18 states have refused, saying they fear being left with an increasing tab for the coverage as the federal share shrinks.

Virginia Republicans repeatedly thwarted Mr. McAuliffe’s attempts to expand the program in prior years, citing costs and the GOP’s push to undo the federal law.

But the GOP suffered catastrophic defeats in Virginia’s elections last year, with Democrats nearly taking control of the House and sweeping all three statewide offices, upending the balance of power.

Exit polls suggested that health care was a leading topic for voters who rebuked the GOP in November.

“I think it looks like it’s going to happen. The takeaway for me is that elections matter,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

The Old Dominion could be the first to implement expansion under Mr. Trump.

Maine voters approved expansion last year, though Republican Gov. Paul LePage is stymying the effort until the state legislature finds a way to fully pay for its share.

Utah is also forging ahead with a “partial expansion” of Medicaid right up to the poverty level, though the Trump administration hasn’t said whether such a move would violate the law. Earlier this year, it punted on the question by approving Arkansas’ push to apply work requirements to Medicaid but rejecting its push to reel in eligibility for its expanded program, saying it needs more time to study it.

Conservative pressure groups want state-level Republicans to hold firm against expansion, saying the program was designed for pregnant women and the frail and that expanding it to the able-bodied will stretch state budgets.

“Here’s the bottom line — there isn’t a Medicaid expansion proposal that can get through both chambers and also the governor,” said Lorenz Isidro, spokesman for the Virginia chapter of the Americans for Prosperity. “Passing a clean budget without Obamacare’s Medicaid expansion remains the only viable option to avert a shutdown.”

But Mr. Northam says Virginia needs to take the federal matching funds, saying the money will bolster hospitals and the state economy.

“We just cannot, from a business perspective, leave money on the table,” Mr. Northam said.

Mr. Hanger struck on similar themes in voicing clear support for expansion, saying the has no intention of voting for a final budget “that does not include a plan to access the additional dollars that are available to us currently under Medicaid.”

“After all,” he said, “those dollars came out of the pockets of Virginia taxpayers and we need to put them to use, particularly in rural Virginia.”

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