The [Virginia] state Senate approved expanding Medicaid to cover 400,000 low-income residents, putting an end to years of Republican intransigence and opposition. As health-care advocate Topher Spiro put it: “This is a major victory that will transform the lives of thousands of families.”
Wednesday’s decision is a tribute to the power of voting and the resistance to President Trump, which flipped 15 seats in Virginia’s House of Delegates from Republican to Democrat in last fall’s state elections. The expansion is attached to the state budget, which Gov. Ralph Northam (D) — who campaigned for office last fall on a promise to expand Medicaid in Virginia — is expected to sign as soon as it reaches his desk.
Achieving Medicaid coverage for 400,000 additional people is a mammoth victory for Democrats in a state that has been trending blue for years, but now seems firmly in that party’s column. The vote holds multiple lessons for both parties.
(1) Republicans have made the mistake of treating Medicaid as a budget issue — a piggy bank to be raided — not a health-care issue. They’ve had ample opportunity to reform the program but, aside from a few waivers to allow states to innovate, whenever Medicaid comes up in GOP circles the topic is usually about limiting coverage and cutting cost.
(2) This is a victory for the Affordable Care Act, no question. Obamacare made Medicaid expansion possible and, whatever you think of the efforts by the administration and Congress to chip away at the ACA, an expansion of this size suggests President Barack Obama’s health-care legacy is on firmer footing than Democrats feared when they lost the White House, as well as their majorities in the House and Senate.
(3) This will be a big issue in November when multiple states (Utah, Idaho, Nebraska) will vote on Medicaid expansion, which delights Democrats. Democrats are returning to their bread-and-butter issues (e.g., wage stagnation, lack of access to health care) as they remind voters which party defended the ACA, and which party voted to eliminate it without an adequate replacement. The Medicaid issue will help the Democratic Party turn out its base, which is already pumped up to cast a symbolic vote against Trump.
(4) The Medicaid issue affects nearly every state and federal race. Democrats will argue that Republicans “want to take away health care” while Republicans will be forced to defend their votes and take a stance on expansion. That’s a problem given how popular Medicaid expansion has become. (“A poll conducted late last year by Public Opinion Strategies and the Virginia Hospital and Healthcare Association found 83 percent of the state’s residents supported the expansion, including a majority of self-identified Republicans. . . . Polls show that two thirds of Utah voters support the Medicaid expansion in their state. So it’s unlikely to be close,” The Post report continued.) Meanwhile, Maine’s controversial Republican Gov. Paul LePage is being sued for failure to expand Medicaid after a state referendum approving it passed with 59 percent of the vote.
(5) Virginia will be the 33rd state (along with the District of Columbia) to approve Medicaid expansion. Medicaid expansion appears here to stay, and despite the best efforts of the GOP House and right-wing pundits, has widespread, bipartisan support in every geographic region, with the exception of the Southeast (which includes some of the poorest states) and the Great Plains (although Nebraska and Idaho could join Virginia). “In a nutshell, Medicaid is the absolute star of the Trump presidency despite every effort on their part,” said Andy Slavitt, the former head of Centers for Medicare and Medicaid Services, who served during the Obama administration. “By the end of his term, you could see five more states expand. And there is a tipping point for the hold out states at that point. The irony of course is that this is a far more Democratic idea than exchanges, a Republican idea [originating at the Heritage Foundation].”
(6) For all the talk of democracy’s dysfunction the 2017 elections in Virginia showed how the system worked. Democrats ran on expanding Medicaid, voters overwhelmingly chose Democrats, and now Virginia voters got what they wanted. (By the way, it may surprise political watchers who focus solely on Washington to learn that a lot of state governments are responsive to and demonstrate bipartisan cooperation.)
(7) Democrats are seeking to make health care the top issue in November while Republicans want to wave the bloody shirt on immigration (which will hurt them in states with large numbers of Hispanic voters) and to tout tax reform (which has not impressed many voters). Democrats have the advantage on the issue mix — and likely should heed House Minority Leader Nancy Pelosi (D-Calif.), who warned to talk about health care and jobs, not Russia and impeachment.