A prominent hospital association has picked former governor Robert F. McDonnell’s hard-charging transportation secretary to lead the organization as it continues to push House Republicans to expand Medicaid.

The selection of Sean Connaughton as the next president of the Virginia Hospital and Healthcare Association surprised and upset some people on both sides of the Medicaid debate.

Connaughton helped McDonnell (R) muscle through several highly controversial transportation projects, including a $1.4 billion highway planned for southeastern Virginia that Gov. Terry McAuliffe (D) recently suspended . He has no professional background in health care.

His selection suggests that the VHHA is preparing for a bare-knuckle fight with Republicans over whether to expand Medicaid under the federal health-care law known as Obamacare. Connaughton would bring to the battle his GOP credentials as well as a reputation as a brawler.

Connaughton comes to the job at a time when neither side in the Medicaid stalemate shows any sign of budging. Some observers suggested that the sort of forceful arm-twisting that he employed to help McDonnell secure a landmark transportation-funding deal might help break the deadlock, which threatens to shut down state government if it is not resolved by July 1.

Sean T. Connaughton, former Va. secretary of transportation and the new president of the Virginia Hospital and Healthcare Association. (Virginia Department of Transportation)

But some legislators who share the VHHA’s desire to expand the health-care program fear that Connaughton, who called legislators “idiots ” during a 2012 dispute over Metro funding, could actually turn off potential allies. Some Democrats who have clashed with Connaughton over road projects questioned whether he’d have credibility on health care.

“It’s going to take some time for me to trust him,” said Sen. Janet D. Howell (D-Fairfax), who supports expansion. “In 2012, he said that there was zero bonding capacity to give $300 million to the Silver Line and four months later found over $1 billion in bonding capacity for Route 460.”

Sen. L. Louise Lucas (D-Portsmouth), who also supports Medicaid expansion, called Connaughton “arrogant.”

“Just hope he does a better job for VHHA than he did as Transportation Secretary,” she said in a text message. Route 460 “cost us millions of [dollars] and we have nothing to show for our money. And please don’t get me started on tolls in Hampton Roads.”

Connaughton did not respond to messages seeking comment.

He will replace outgoing Laurens Sartoris, who is retiring after 26 years with the organization. Sartoris had little background in health care when he joined the organization as a lobbyist in 1977, although he had worked on a legislative commission on health-care services.

Even after he became president of the association in 1988, Sartoris maintained the unassuming style that he said he’d adopted in his lobbying days. He said he followed the advice that an “old lobbyist” had given him: “A lobbyist is a man who can walk through the woods on a fall day and the leaves don’t rustle under his feet.”

Connaughton, former chairman of the Prince William Board of County Supervisors and a one-time candidate for lieutenant governor, isn’t afraid of kicking up a few leaves.

Sartoris, who did not play a role in choosing his successor, thinks having a new leader with his own style could be a good thing given the growing importance of health-care issues in state government. The share of the state budget consumed by Medicaid was in the low single digits when Sartoris joined the association; now it approaches 25 percent.

“I think Sean will bring a different approach that will probably be right for the times,” Sartoris said.

Connaughton was picked for the job at a time when his tenure as transportation secretary is under new scrutiny.

What was hailed as one of his biggest feats under McDonnell — striking a deal to build a 55-mile highway despite the objections of the Army Corps of Engineers, environmentalists and transportation advocates who wanted the money spent elsewhere — now is steeped in controversy. Before McAuliffe suspended work, the state had spent $250 million on the new U.S. 460 project without securing permits or turning a single shovel of dirt.

An environmentalist recently suggested that the public-private partnership that sold bonds for the project downplayed the Army Corps of Engineers’ objections to investors. The current transportation secretary, who represented the interests of bond holders, has said that they were given sufficient notice of the Corps’ concerns.

While he ruffled feathers, Connaughton also got a lot done under McDonnell, notes Bob Holsworth, a former Virginia Commonwealth University professor and longtime watcher of Virginia politics. (Holsworth disclosed that he has given paid speeches to VHHA.)

“He’s generally perceived an extremely bright guy and . . . he was aggressive on the part of a governor who wanted to accomplish a lot in a limited period of time,” Holsworth said. “He’s a self-confident guy who’s perceived as very aggressive, very assertive about his beliefs.”

Holsworth said what’s most interesting about the appointment is that it has generated so much attention. He thinks that says more about the intensity of the Medicaid fight than about Connaughton.

“When a trade organization appoints somebody, at times there might be some murmurings, but it’s highly unlikely for that to become public,” Holsworth said. “It think it shows you how all Virginia politics right now is being viewed through this lens of the Medicaid expansion debate.”