That approach — backed by House Speaker M. Kirkland Cox (R-Colonial Heights) but rejected by the rest of the House GOP leadership — would not only tap federal funds to provide health care to as many as 400,000 uninsured Virginians, but also would allow the state to take more than $420 million currently devoted to health care and spend it on other priorities.
On the other side of the Capitol, the Republican-controlled Senate seemed to stand more firmly than ever against expansion. That forced the upper chamber to cut $420 million from the budget proposed last year by then-governor Terry McAuliffe (D), who included expansion in his plan.
The proposed cuts came in areas that no one seemed to relish, including reparations owed to a wrongly imprisoned man and mental-health fixes backed by a senator who lost his son to suicide.
“We’ve cut education, both higher and public [K-12] education,” said Sen. Janet D. Howell (D-Fairfax) during a six-hour debate on the Senate floor. “We’ve cut student aid, public safety, mental-health programs, programs for the disabled, programs to have a reliable election system. And why have we made these cuts? We’ve made them to deprive low-income people of health care.”
Senate Majority Leader Thomas K. Norment Jr. (R-James City) acknowledged that the body had been forced to make “excruciatingly painful decisions.” But he said the state cannot rely on Washington’s promise to pay 90 percent of the $2 billion-a-year cost of expansion.
“There are utterances coming out of this [Trump] administration about significant adjustments that may take place in Medicaid reimbursements,” Norment said. “What we have chosen to do is undertake a fiscally conservative and responsible approach.”
The House passed its budget on a 68-to-32 vote, with 19 Republicans joining all 49 House Democrats in support.
Cox, who assumed the speakership this year, once staunchly opposed Medicaid expansion but softened his stance after Democrats nearly won control of the chamber in state elections last fall. He said he would accept expansion if work requirements, co-pays and other strings were attached.
In the House, Republican support for expansion was limited, with more than half of the 51-member Republican caucus voting against. Even so, what GOP support was there represented an abrupt about-face in a chamber that has vigorously opposed expansion for the past four years.
There was plenty of angst in the lower chamber, as Republican leaders explained why they were either breaking with the speaker or breaking with GOP orthodoxy on Medicaid.
His voice choked with emotion, Del. R. Steven Landes (R-Augusta) explained his opposition to expansion, saying it made him sad to vote against the wishes of Cox, Appropriations Committee Chairman Del. S. Chris Jones (R-Suffolk) and Del. Terry G. Kilgore (R-Scott).
“I know it was not an easy decision to go down this path,” Landes said. “Unfortunately, it is not right for the long-term fiscal health of our commonwealth and its citizens.”
Saying it was the first time he had ever voted against a budget in his 23 years in the House, Landes said there are ways to provide health care to more residents “without entangling Virginia with a failed federal policy and the strings that come attached to it. . . . I’m sad that with this vote . . . we are becoming more like Washington and moving farther away from the Virginia way.”
Del. Benjamin L. Cline (R-Rockbridge), who is running for Congress, said the move would put Virginia’s fiscal health “at risk.”
“We can hardly sustain our own Medicaid program as it currently exists,” Cline said.
On the other side of the Medicaid divide stood Del. Glenn R. Davis Jr. (R-Virginia Beach). He said he had intended as recently as the day before to oppose the measure, but changed his mind.
“The problem we’re having, Mr. Speaker, is — well — elections have consequences,” Davis said.
There was a time when the GOP majority was big enough to hold firm against such policies. Republicans controlled the House by a 66-to-34 margin before an anti-Trump wave nearly erased it. In the aftermath, Davis said, “we negotiate.”
Del. T. Scott Garrett (R-Lynchburg) said he supported expansion because of the work requirements and other restrictions.
“There have been a lot of conversations, there’s been a lot of emotion and there are some politics associated with what’s before us today,” he said. But “in my opinion this is not Obamacare Medicaid expansion” because it creates a process for an orderly expansion.
Jones responded that expanding Medicaid under the Trump administration is different from doing it under former president Barack Obama, because now it will be easier to get federal waivers to require recipients to seek work and other requirements that will make the system more fiscally prudent.
And if the federal government reduces its share of funding, the plan calls for Virginia to end the program. Approving it under these conditions “is going to make a difference for many, many Virginians,” Jones said.
“I do believe the product before us reflects a path for Virginia that we can all be proud of,” Jones said.
When some House Democrats clapped and cheered after the two-year budget passed, they were scolded by their party leaders.
“This budget is hard for some of those guys,” Minority Leader David J. Toscano (D-Charlottesville) said later, referring to Republicans. “I think we have to respect their strongly held views. I think we have to convince those who were reluctant that it’s ultimately going to help their constituents.”
But this vote was only the first skirmish, Toscano said. “We have to get something out of the Senate. We’re going to have to fight for it because right now the Senate is not budging.”