Virginia Senate Republicans just torpedoed the state’s Medicaid expansion

Virginia is inching closer to expanding Medicaid, underscoring the fact that state house races matter.

RICHMOND, VA- JANUARY 9: Virginia State Capitol building at night on Wednesday, January 9, 2013. (Photo by Tracy A. Woodward/The Washington Post via Getty Images)
RICHMOND, VA- JANUARY 9: Virginia State Capitol building at night on Wednesday, January 9, 2013. (Photo by Tracy A. Woodward/The Washington Post via Getty Images)

Just four months ago, Virginia’s gubernatorial race saw historic voter turnout — as casting ballots at the time meant extending Medicaid coverage to 400,000 people. On Thursday, voting paid off.

Virginia is currently one of 18 states that has not expanded Medicaid under the Affordable Care Act (ACA) despite a majority of residents’ support. But the state is inching closer to expanding Medicaid insurance: The Republican-controlled House on Thursday overwhelming voted for Medicaid expansion, in a 69-to-31 vote. Notably, 20 Republicans signed onto Medicaid expansion, after rejecting it for years:

But just down the hall, the Senate torpedoed efforts to expand Medicaid, at least for now. The Senate GOP rejected an effort to add the House’s Medicaid expansion plan to its budget, in a 21-to-19 vote.


“So much for the Virginia House of Delegates being the hyper-partisan, far-right chamber while the Virginia State Senate is supposedly the body of more ‘moderation,'” wrote Blue Virginia’s Lowell Feld. “At this point, it seems like the roles have been reversed, if anything.”

Perhaps it’s because Democrats made big gains in the House of Delegates. Going into the 2017 election, Republicans held a 66-to-34 majority, but now barely maintain control, at 51-to-49. All 40 Senate seats are up for election in 2019.

Now, Medicaid expansion comes down to a Senate-House conference. These negotiations are especially critical to roughly 400,000 Virginians that fall into a “coverage gap,” which refers to uninsured people who make too much to qualify for Medicaid, but too little to meet the minimum income requirement for subsidized insurance on the Obamacare exchanges.

“This is not going to cost Virginians. Under this plan, it’ll be paid for by the hospitals, ” said Virginia Sen. Janet Howell (D), as she pushed to include Medicaid expansion in the Senate’s budget on Thursday. The House’s version would pay for the state’s financial share of Medicaid expansion through a provider tax, or a tax on hospitals — a point of contention for some Senate Republicans. But provider taxes aren’t unusual. In fact, Oregon voters recently approved provider taxes to pay for Medicaid expansion, and eight other states already doing this.

Howell added that Medicaid expansion would end if Republicans in Washington, D.C. successfully repeal Obamacare.

The Virginia House budget also includes work requirements for some Medicaid beneficiaries, a move that would add more red tape and lead to coverage loss. For this reason, Thursday’s House budget falls short of perfection for health activists.


“It’s not a perfect plan,” a communications official for Planned Parenthood Virginia said on Twitter. “We remain concerned about the proposed work requirements. Access to healthcare is a right and shouldn’t be restricted to those who are able to work.”

By rejecting Medicaid expansion, Virginia “forfeits $142 million of federal funding every month”, according to Indivisible. Additionally, adding work rules costs the state funds: Gov. Ralph Northam says it’ll cost Virginia $100 million for the first two years to implement such program. Moreover, work rules are cruel and unnecessary (as most Medicaid beneficiaries work), which is why Virginia advocates are reluctantly applauding the Virginia legislature.

“This conversation around work requirements is yet another way to stigmatize and demonize people who are trying to make ends meet,” Anna Scholl, of Progressive Virginia, recently told ThinkProgress.