Will Ralph Northam Break His Campaign Pledge to Expand Medicaid?

It is time to put politics aside and do what is right—from both a moral and business perspective,” wrote Ralph Northam, Virginia’s Democratic Governor-elect, in an op-ed during his campaign, “and expand Medicaid for up to 400,000 hardworking Virginians.” That proposal was not an insignificant part of what propelled Northam to a decisive nine-point victory over his Republican opponent in November. Medicaid expansion is broadly popular in the state, but it has been blocked for years by Virginia’s Republican-controlled state legislature. Northam’s victory, combined with a number of other Democratic wins that put the legislature on the brink of flipping blue, created a new opening to finally deliver.

It was a surprise, then, that in an interview with The Washington Post published Sunday, Northam seemed to temper his support for the expansion. According to the Post, “Northam said he has no plans to try to force Republicans to accept a broad expansion of Medicaid.” Instead, he talked about making deeper reforms to the Medicaid program out of concerns about costs, and used what sounded more like Republican talking points about ensuring people insured through the program have “skin in the game” and that those who could work, did.

The vague remarks set progressives on edge. “We’re unsettled by even the implication that Northam would consider not doing what he promised, what he ran on, what Democrats across the state ran on,” said David Singerman, one of the organizers of Indivisible Charlottesville. “As he’s said many times, this should not be a tough call.” With Virginia voters clearly in favor expansion, it was “baffling,” Singerman said, that Northam wouldn’t press as hard as possible to fulfill his promise. “I can’t imagine what the upside would be from any angle to not pushing for the expansion.”

In response to backlash, Northam reaffirmed his support on Twitter, writing, “I have and will continue to advocate for Medicaid expansion because it is a no-brainer for Virginia families, our budget, and our economy”—but muddied the waters yet again by adding, “We can also come together on smart policy choices that will allow us to deliver better care at lower cost.” (Northam’s press team did not respond to a request to clarify what sort of reforms to Medicaid he’d support.)

A charitable view suggests Northam is trying to lure flies with honey; perhaps the few Republicans necessary to pass the expansion will see it as key to their political survival, and Northam’s suggestion of “reforms” will give them political cover to defect. “There’s a difference between process and policy. I read the governor’s comments as more of, ‘Here’s our process, and we’re not going to coerce people into voting our way,’” said Sam Rasoul, a Democratic delegate from Roanoke, and a strong advocate for Medicaid expansion. “It’s very clear to me that, while he doesn’t do a great job of articulating it, [Northam] is solidly behind Medicaid expansion as we move forward. And this is coming from someone who is pretty far left on health care—I believe in single payer and all that good stuff.”

Still, Rasoul pointed out, 400,000 Virginians need health insurance right now—they needed it years ago, really—and anything besides a straight-forward expansion will take months, if not years. “Any kind of waiver negotiation right now could be completely stymied and hijacked by this presidential administration,” said Rasoul, referring to the process by which some states have been allowed to add special requirements to their expanded Medicaid programs, such as making recipients pay a partial premium. “It’s looking like at least 12 to 18 months to get a waiver approved, and that’s if you do [get approval]. Virginians really can’t wait that long.”

Jill Hanken, a health attorney at the Virginia Poverty Law Center, echoed that sense of urgency. Hanken described the governor-elect’s interest in bipartisanship as “useful,” but clarified that a straightforward Medicaid expansion was necessary “to get coverage started, since people have been waiting for years. I think after expansion begins we can talk about ways to evaluate the program, ways to improve it, reform it, make it more cost efficient,” she said. “Perhaps down the road there can be consideration of those types of proposals, but right now we need expansion to happen as soon as possible.”

Northam needs to court only a few Republicans: At the time of publication, the result of a recount—decided by a single vote—appeared to bring the state House into a 50-50 split, with the Republicans controlling the state Senate 21-19. His comments serve as a reminder that progressive advocates have more work to do even as Democrats win tough races in purple states. “This will be a huge test—when groups have to put pressure on Democrats we helped to elect,” said David Singerman. “We’ve already been planning to push for Medicaid expansion actively before this news story, and we’ll just redouble our efforts.”

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