“I will not sign a budget in Virginia unless it includes the Medicaid expansion,” McAuliffe said this summer in an interview with AARP. He made a similar comment at a dinner with Loudoun County Democrats, the Loudoun Times reported in June.
Given overwhelming opposition to expansion in the GOP-dominated House of Delegates, that campaign promise amounts to a threat to hold the state budget hostage to McAuliffe’s Medicaid goal, some Republicans say. Critics say it also shows that McAuliffe, who has billed himself as a bipartisan consensus builder, would take a highly partisan, autocratic approach to governing.
“Terry McAuliffe wants to paint himself as a bipartisan problem-solver, but he’s already drawing red lines and threatening Washington-style government shutdowns here in Virginia,” said House Speaker William J. Howell (R-Stafford).
McAuliffe’s campaign said he was not threatening a shutdown, just expressing the importance he places on expansion.
“Medicaid expansion is a top priority for Terry and a goal shared by mainstream Republicans in Virginia and across the country,” McAuliffe spokesman Josh Schwerin said in an e-mail. “Nobody is arguing for a government shutdown. Terry hopes to work in a bipartisan way to get this mainstream accomplishment done.”
Under the federal Affordable Care Act, states have the option to open their Medicaid programs to people with incomes that are up to 138 percent of the national poverty level — about $32,000 for a family of four — with the federal government paying the entire cost for the first three years. The federal share gradually declines to 90 percent. Virginia would initially receive about $2 billion a year from Washington if it expands the program, which serves the poor, elderly and disabled.
Some Republicans, including Gov. Robert F. McDonnell and Attorney General Ken Cuccinelli II, who is running against McAuliffe, doubt that Washington has the money to make good on that promise.
The politics of Medicaid expansion have not always broken neatly along partisan lines in Virginia, where moderate Senate Republicans favor expansion, or across the country, where some conservative Republican governors have opted to take the money. But the issue reveals one of the starkest contrasts between McAuliffe and Cuccinelli.
McAuliffe supports expansion for its own sake and also invokes the money it is expected to save the state. When asked how he would bankroll his broader platform, which includes higher teacher pay, lower college tuition and more spending on pre-K and K-12 education, he often cites the Medicaid money.
Cuccinelli, on the other hand, was the first attorney general in the nation to sue the federal government over Obamacare. Even after his suit was thrown out in 2011 and the U.S. Supreme Court upheld the law in a different case, he pledged to fight on.