Virginia’s Medicaid expansion is a big deal

Democratic members of the Virginia House of Delegates reacted to the voting board in the House chamber as the new Virginia budget passed, with Medicaid expansion as a provision.
Democratic members of the Virginia House of Delegates reacted to the voting board in the House chamber as the new Virginia budget passed, with Medicaid expansion as a provision.(Bob Brown/Richmond Times-Dispatch via Associated Press)

As Joe Biden put it a little differently when Barack Obama signed the Affordable Care Act eight years ago, Virginia's expansion of Medicaid on Wednesday is a big dang deal. And not just because 400,000 low-income citizens will now have access to government health insurance.

It's another nail in the coffin for efforts to repeal Obamacare and a fresh reminder of how difficult it is to scale back any entitlement once it's created. Many Republicans, in purple and red states alike, concluded that Congress is unlikely to get rid of the law, so they've become less willing to take political heat for leaving billions in federal money on the table.


Years of obstruction in the commonwealth gave way because key Republicans from rural areas couldn't bear to deny coverage for their constituents any longer, moderates wanted to cut a deal, and, most of all, Democrats made massive gains in November's off-year elections.

As President Trump steps up efforts to undermine the law, from repealing the individual mandate to watering down requirements for what needs to be covered in ''association health plans,'' the administration's willingness to let states impose work requirements on Medicaid recipients has paradoxically given a rationale for Republicans to flip-flop on an issue where they had dug in their heels.

Effective Jan. 1, Virginia will join 32 other states and the District in expanding Medicaid coverage under the ACA. There are indications that several more will soon follow.

Maine became the first state to expand Medicaid by ballot initiative last fall, but Republican Governor Paul LePage has blocked funding for its implementation and continues to fight the will of the voters in court. But he's term limited and deeply unpopular, and it seems more likely than not that his successor will open the door for 70,000 poor Mainers to get insurance.


Utah will vote on a referendum in November to further expand Medicaid to an additional 150,000 residents. The measure officially qualified for the ballot on Tuesday.

Enough signatures have been submitted to qualify a ballot measure in Idaho. They're now being reviewed by elections officials to make sure they meet that state's strict requirements.

Nebraska's governor opposes Medicaid expansion, but there is a grass-roots campaign underway to get enough signatures to put the measure on the November ballot. Organizers say they're on track to get what they need before the deadline.

In blue states, meanwhile, Democratic governors are taking steps to protect the expansion. Wednesday in New Jersey, Governor Phil Murphy, a Democrat, signed a law creating an individual mandate for people in his state to offset the repeal of the federal mandate (which was included in the December tax bill). This will help keep insurance markets stable in the Garden State.

Expanding Medicaid in Virginia wasn't easy. Four Senate Republicans defected to allow the measure to pass 23-17 in a special session. Then the House of Delegates, which passed its own version of expansion earlier in the year, approved the Senate's measure 67-31.

There were 10 hours of procedural moves in the Virginia capitol on Wednesday. Police had to separate protesters who got into a shouting match. Former senator Rick Santorum, Republican of Pennsylvania, of all people, even held a news conference to speak out against expansion. The majority leader of the state Senate tried a last-ditch parliamentary gambit to pigeonhole expansion during a Finance Committee hearing on Tuesday. But that was nothing compared to the five years of steadfast GOP obstruction.