2017 election victory bears fruit in Virginia Medicaid expansion
Danica Roem, the first transgender woman elected in 2017 to the Virginia house of Delegates, played a leading role in the fight to expand Medicaid coverage in the state to at least 400,000 poor people. | Steve Helber/AP

After a long and sometimes frustrating struggle, the Virginia General Assembly (state legislature) has become the 33rd state legislature (plus the D.C. City Council) to approve expansion of Medicaid to a larger group of low income residents, forty percent more than are currently covered. The new program will get underway on January 1, 2019.

The vote, which will help up to 400,000 low income Virginians to access health care, took place in the Virginia Senate on Wednesday May 30, with a comfortable 23 votes in favor to 17 opposed.  On Wednesday evening the Virginia House of Delegates once more voted for the expansion, by a margin of 67 to 31.  The Democratic governor, Ralph Northam, has committed to sign the legislation, which is part of an overall budget package.

The House had approved the Medicaid expansion and appropriated money for the state’s share of the costs earlier this year. However, the Senate did not.  Because the Senate did not include anything to cover the cost of the expansion, it was not possible for the House bill simply to be voted on in the Senate.   A budget has to be approved by July 1, or there would be a state government shutdown. So Governor Northam convened this special legislative session to give passage of Medicaid expansion another try, resulting in Wednesday’s breakthrough.

The vote will allow Virginia to access $2.5 billion in federal funds under the Affordable Care Act (“Obamacare”), expanding Medicaid eligibility to people making up to 138 percent of the federal poverty rate (this comes to $16,643 for a single individual under the new plan, far above Virginia’s current cutoff of $6,900.

Able-bodied single, low income adults will be eligible for coverage, which is not the case at present.   It does require some state funding.  In the first year, the expansion will be supported by federal money to the tune of 94 percent of the cost; the federal share goes down to 90 percent in 2020 but does not drop any further.  So the Virginia treasury will never have to pay more than 10 percent of the cost of the expansion.

Other economic benefits include the fact that a healthier population is more productive at work, and that low income sick people not currently eligible for Medicaid end up having to be treated under other government programs anyway, often racking up higher expenses than would have been the case had they been able to afford medical attention earlier.

Up until now, the Republican Party’s majority control of both the Senate and the House of Delegates made Medicaid expansion impossible, even though the Democrats and former Governor Terry McAuliffe had tried to get this done for several years. The idea is hugely popular, with up to 83 percent support according to public opinion polls.

But in last year’s state legislative elections, that Republican legislative majority was almost destroyed by a Democratic Party surge all over the state.  Fifteen House of Delegate seats flipped from Republican to Democrat, mostly because of a radically higher turnout of the Democratic Party’s social base.  The Virginia House now has 51 Republican delegates and 49 Democrats, up from 66 Republicans and 34 Democrats before the election (the Senate has 21 Republicans and 19 Democrats)  The demand to expand Medicaid was very much part of the Democratic Party’s appeal in that election, in spite of heavy handed Republican propaganda which portrayed Obamacare as nothing short of high treason.

In the vote in the Senate, four Republicans joined all Democrats in crossing the aisle and voting for the budget bill that included the Medicaid expansion.

The right and the leadership of the Republican Party argued that Medicaid Expansion would be a budget buster and would increase the waiting time for people already on Medicaid, causing some to die.   Another reason that they gave was that Trump and the Republicans in Congress are planning to abolish “Obamacare,” so the State of Virginia would be left holding the bag without the promised federal funds, a budgetary disaster.   However, the fact that most of the money was coming from the federal treasury and that this would free up Virginia taxpayers’ money for other purposes, and that so far GOP efforts to kill off Obamacare have not succeeded, were arguments successfully employed to get the legislation passed.

The four Republican senators who joined with all the Democrats to vote in favor of Medicaid expansion were Emmett Hanger Jr., of the 24th denatorial district, Frank Wagner of the 7th District, Ben Chafin, of the 38th District, and Jill Vogel of the 27th Senatorial District.

The situations of the population in each of those districts gives a clue as to why these three were willing to defy party orthodoxy and cross the aisle on this issue.  Chafin’s 38th District, even though almost completely white in racial demographics, is one of the poorest in Virginia.  It includes towns and villages in a rural Appalachian belt where a large proportion of the population lives below the poverty line.  In the town of Blacksburg in this district, for example, 43.2 percent of the population is below the poverty line.  Other towns and rural settlements in Chafin’s district are in even worse shape.  Wagner’s 7th district includes the fairly well off city of Virginia Beach, but also the majority-minority port city of Norfolk, where 19.4 percent of the population is below the poverty line.  Hanger’s 24th District is somewhat better off and Vogel’s 27th district considerably more so, but both also include pockets of extreme poverty.

In both the Senate and House, the Democrats made some concessions to win over enough Republican votes to get the legislation passed.  These included a work requirement for able bodied recipients of Medicaid. However, a very large proportion of the beneficiaries of the plan are already working in low paid jobs, so will not be affected, and other categories of people can get waivers from the state government, e.g. if their health condition prevents them from working, if they are caring for a sick child, if they are attending classes or if they are involved in significant “community engagements.”  Organized labor and other citizens groups in Virginia did not see this work requirement as sufficiently onerous to poison the legislation.     In addition, there will be a small co-pay and a tax levied on hospitals.  These concessions, and some smoke-filled-room horse trading, were enough to convince the Republican House leader, Kirkland Cox, to back off opposing the legislation.

The greatest immediate beneficiaries of the new program will be African-Americans and other minorities, working poor people of all races, and all people who find that severe or chronic health problems not adequately covered by insurance or personal funds would otherwise leave them destitute.

Another benefit will be the encouragement this state of affairs gives to those who want to go beyond AC and other current programs and aim higher—for single payer health insurance, for example.

There is another legislative election, for both Senate and House of Delegates, in 2019.

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Emile Schepers
Emile Schepers

Emile Schepers is a veteran civil and immigrant rights activist. Born in South Africa, he has a doctorate in cultural anthropology from Northwestern University. He is active in the struggle for immigrant rights, in solidarity with the Cuban Revolution and a number of other issues. He writes from Northern Virginia.