By Laura Vozzella and Gregory S. Schneider | Washington Post
RICHMOND, Va. – The Virginia Senate voted Wednesday to make government health insurance available to 400,000 low-income residents, overcoming five years of GOP resistance. The decision marks a leftward shift in the legislature and an enormous win for Gov. Ralph Northam, D, the pediatrician who ran on expanding access to health care.
The House of Delegates still must vote on the Senate’s plan, but it was not expected to have trouble clearing the lower chamber as soon as Wednesday evening. Virginia would join 32 other states and the District in expanding Medicaid coverage. It is expected to take effect Jan. 1.
Wednesday’s vote, by a margin of 22 to 18 with three Republicans splitting with their party to join Democrats, was the product of several shifts in Virginia politics. The unpopularity of President Trump in Virginia spurred some Republicans to switch their vote who might not have done so if Hillary Clinton had become president, said Stephen Farnsworth, a political scientist at the University of Mary Washington. And the power of the state’s wealthy suburbs has fueled a surge in support for Democratic issues.
“The fortunes for the Republican party in Richmond were not good if the party stood mainly for divisive issues like no Medicaid expansion, no abortion and no restrictions on guns,” he said. “That’s a losing trifecta in suburban Virginia, and that’s where the votes are.”
Despite Republican efforts to tear it down, the Affordable Care Act “has become more popular than it ever was, and the opportunity to balance the state’s budget with an influx of federal funds became an increasingly popular choice,” he said.
Under the Affordable Care Act, Washington allows states to open their Medicaid rolls to people making up to 138 percent of the federal poverty level, which is $16,643 for an individual. The federal government pledged to pay at least 90 percent of the cost, which in Virginia would amount to about $2 billion a year.
The Republican-controlled state legislature refused it for years. Leaders in the House and the Senate said they feared the federal government would renege on its funding promise, sticking Virginia with an unbearable tab. Some expansion critics also objected to opening an entitlement program to “able-bodied” Virginians.
But opposition in the House crumbled after Democrats nearly won control of the chamber in November, amid a blue wave widely viewed as a rebuke to President Donald Trump. A chastened House Speaker Kirkland Cox, R-Colonial Heights, seeking to rebrand Republicans as results-oriented pragmatists, came out in favor of expansion if work requirements, co-pays and other conservative strings were attached.
Nineteen of the 51 Republicans in the House joined Democrats in February to pass a budget bill that expanded Medicaid, apparently concluding that they have more to fear from energized Democrats and independents than from potential primary challengers on the right.
Easing their evolution was Northam’s assumption of the governorship in January. The former state senator and lieutenant governor, a soft-spoken pediatrician and former Army doctor once wooed by Republicans, has close friends on both sides of the aisle. His predecessor, Terry McAuliffe, D, argued in favor of Medicaid expansion for four years but did not enjoy the same respect and trust from Richmond Republicans.
It also helped that Republicans in Washington had failed to “repeal and replace” the ACA.
In an odd twist, it was the Virginia Senate – traditionally the more moderate chamber and the one that had backed expansion in previous years with help from two now-retired moderate Republicans – that remained dug in.
The standoff forced the legislature to adjourn its regular session March 10 without a budget. Legislators needed to pass a budget by July 1 to avoid a government shutdown.
Virginia’s existing Medicaid program is one of the least generous in the nation. To be eligible, a disabled individual can make no more than $9,700 a year. The cutoff for a family of three is $6,900. Able-bodied, childless adults are not eligible, no matter how poor.
Under the Affordable Care Act, states can raise those income limits, and the federal government will pick up 90 percent of the cost. The income ceiling would rise to $16,750 a year for a disabled person or able-bodied adult, and $28,700 for a family of three.
The leanness – some say stinginess – of the current Medicaid program partly accounts for Virginia’s reluctance to expand. The current program covers 1 million, so adding 400,000 represents a 40 percent increase – a much bigger leap for Virginia than for most states.
Republican hold-outs in the Senate saw the carnage last year in the House, but they did not feel it themselves, since they were not on the ballot last year. And some doubted that embracing “Obamacare” would help their party, which has not won a statewide election since 2009. While voters called health care a priority in exit polls, some Senate Republicans blamed the GOP losses in November on an anti-Trump wave, not pro-Medicaid fervor.
They fought up to the moment of the vote Wednesday, with a series of procedural moves, passionate floor speeches and an appearance by former U.S. Sen. Rick Santorum, the Republican from Pennsylvania, who left office in 2007 and has been out of politics since his unsuccesful run for the presidency in 2012. In a Senate meeting room, he warned that Obamacare could be killed by Congress.
“We are picking up some momentum, I feel very, very good” that legislation repealing the ACA will advance in Congress, said Santorum, who now lives in Virginia. “That means that everything that happened here will be for naught, in fact you’ll create something that you’ll have to get rid of in a matter of two years.”
Santorum’s appearance was organized by Americans for Prosperity, the conservative activist group funded by the Koch brothers. People wearing green Americans for Prosperity shirts and holding signs calling for “No Medicaid expansion in Virginia” lined the meeting room. Expansion supporters waited in the hallway outside, their signs reminded individual senators of the percentages of voters in their districts who favor expansion.
Capitol Police stayed on hand to keep the peace, at one point separating the two factions when they got into a shouting match, a rarity in the marble corridors where a Capitol staffer regularly scolds anyone who speaks above a whisper.
Senate Majority Leader Thomas Norment Jr. lamented the tone of the debate surrounding the Medicaid vote and what he called repeated departures from custom and behavior and a decline in civility.
“In the years I have been in the Senate, I have never been treated more disrespectfully by some of these advocacy groups,” he said in a lengthy floor speech. “Lying down in front of my office.. with made up tombstones, asking people to blow their horns when they go past my law office. The verbal abuse I took yesterday, just walking from the Pocahantas Building was unbelievable.”
The moment was an irresistible opportunity for Corey Stewart, the Prince William County supervisor running for the Republican nomination for U.S. Senate, to descend on the Capitol and denounce the “weak” Republicans who voted with Democrats to expand Medicaid.
“This is what happens when you elect Republicans who don’t have a backbone, who don’t stand up for anything,” Stewart said. “I think this is a major disaster for our party and for the commonwealth of Virginia.”
In the end, three Republicans broke with their party to support expansion: Emmett Hanger Jr., Augusta, Frank Wagner, Virginia Beach, and Sen. Ben Chafin, Russell.
Wagner argued that all Virginians would benefit from Medicaid expansion because when uninsured people turn to hospital emergency rooms for care, the costs are absorbed by health systems and, in turn, to the general population in the form of higher premiums.
“This is not just about helping this group of people,” Wagner said. “This is about getting out there and helping to bend the cost of health care for every Virginian…..It is the number one issue on our voters’ minds. By golly, it ought to be the number one issue on the General Assembly’s mind.”
Sen. Mark Obernshain, R-Rockingham, countered that one aspect of the bill, a hospital tax to fund the state’s portion of expansion, was tantamount to an increase in the income tax “That’s a $600 million a year tax increase that is going to get passed straight through,” he said. “This is going to be added to the bottom line of insurance bills all over the state of Virginia and is a tax increase as sure as raising the income tax.”
Virginia Senate votes to expand Medicaid