Advocates have been trying to get the Virginia Legislature to expand Medicaid for at least five years, and on Wednesday, lawmakers handed them a big win.
Four Senate Republicans joined all 19 Democrats, by a vote of 23-17, to pass a two-year $115 billion budget that includes Medicaid expansion. When state senators initially voted to add Medicaid expansion, only three Republicans joined. The Senate passed its $115 billion two-year budget on Wednesday, and later in the evening the House followed suit, by a vote of 67-31.
The bill now heads to Gov. Ralph Northam’s (D) desk, and he is expected to sign it into law.
The Republicans joining all 19 Democrats on first budget vote to expand Medicaid as part of caboose budget, HB5001, were Chafin, Hanger, Vogel and Wagner
— Max Smith (@amaxsmith) May 30, 2018
Virginia will likely join 32 states, as well as the District of Columbia, that have expanded Medicaid eligibility under the Affordable Care Act (ACA), providing health coverage to about 300,000 to 400,000 low-income residents.
The House passed a budget with Medicaid expansion in April — a reality many advocates likely couldn’t have predicted years ago. Republicans in Virginia’s General Assembly have resisted Medicaid expansion for years, despite the fact that 61 percent of residents supported it as early as September 2014.
Medicaid expansion was only possible after a record number of voters, largely mobilized by health care, elected more Democrats to the House last November. Going into the election, Republicans held a 66-34 majority, but now barely maintain control at 51-49. The turn of events was notable as poor health is associated with lower levels of voter turnout — but Medicaid has proven to be a galvanizing political force. (States that expanded Medicaid see higher voter turnout.)
The @Emmett_Hanger floor substitute to HB 5001 (Caboose Budget) adopting Medicaid Expansion is adopted 22-18. pic.twitter.com/ObWcJLLC0i
— Jennifer McClellan (@JennMcClellanVA) May 30, 2018
While the budget bill is a big deal for progressive advocates, there’s a catch. In addition to providing health care to thousands of low-income residents, some beneficiaries will likely have to jump through extra hoops to stay covered. The budget includes a provision which asks the federal government to approve work requirements for newly covered starting in January 2019. It would condition eligibility on 80 hours of reported work a month after 12 months of enrollment. If beneficiaries fail to meet the requirement, they’ll be locked out of coverage until the end of such 12-month period. Many newly covered beneficiaries will also have to pay premiums and copays.
In an interview with WTOP on Wednesday, Northam said work requirements were part of the “give and take on both sides,” adding that Virginia will “try to approach it with a carrot rather than a stick.” But it’s unclear how the state will do that.
Wednesday’s Medicaid expansion vote means many could be insured for the first time. Some 138,000 residents fell in the coverage gap, as they earn too much money to qualify for Medicaid, but too little to qualify for subsidized private insurance available on the Obamacare marketplace.
The Senate GOP leadership has been resistant, citing potential costs. The federal government pays for the bulk of costs associated with Medicaid expansion. By resisting Medicaid expansion, Virginia has given up approximately $142 million in federal funding every month.
during #VaSenate recess, ex-Sen Rick Santorum told GOP senators repeal of Obamacare is coming and expanding Medicaid now would hurt Va. now — question now: did he change Sen @Emmett_Hanger sen Frank wagner minds?
— Dave Ress (@DaveRess1) May 30, 2018
In a strange turn of events, former Pennsylvania Sen. Rick Santorum (R), who has a home in Virginia, paid a visit to the Virginia Legislature Wednesday, according to Daily Press reporter Dave Ress. He reportedly tried to dissuade Senate Republicans from voting for Medicaid expansion, claiming federal lawmakers are trying to repeal Obamacare. (Congress still doesn’t have the votes needed to pass Trumpcare.) But his efforts were apparently unsuccessful. And should Republicans successfully repeal the ACA, Virginia’s Medicaid expansion will end, under the bill’s language.
Virginia’s landmark vote comes on the heels of other recent Medicaid wins. On Tuesday, the Utah ballot measure aiming to expand insurance to 150,000 people officially earned enough signatures to be included on the November ballot, according to POLITICO reporter Rachana Pradhan.
This story has been updated to include news that the House passed the Senate’s budget later Wednesday evening, sending Medicaid expansion to the governor’s desk.