The Washington PostDemocracy Dies in Darkness

How a reshaped Virginia legislature learned to love Medicaid expansion

Senate Minority Leader Richard L. Saslaw (D-Fairfax), from left, Sen. Emmett W. Hanger Jr. (R-Augusta) and Senate Majority Leader Thomas K. Norment Jr. (R-James City) discuss Medicaid expansion on the floor of the Virginia Senate.
Senate Minority Leader Richard L. Saslaw (D-Fairfax), from left, Sen. Emmett W. Hanger Jr. (R-Augusta) and Senate Majority Leader Thomas K. Norment Jr. (R-James City) discuss Medicaid expansion on the floor of the Virginia Senate. (Bob Brown/AP)

RICHMOND — Virginia’s vote to expand Medicaid last week was a striking turnaround for a Republican-controlled legislature that had fought expansion for four straight years.

Although November’s election added Democrats to the House of Delegates, that alone doesn’t explain the shift. So many Republicans swung over to support Medicaid expansion that — mathematically, anyway — it could have been done even without the new bloc of Democrats.

Virginia General Assembly approves Medicaid expansion to 400,000 low-income residents

Instead, the outcome was the result of a political evolution that puts Virginia in an unusual position. At a time of polarized national politics, Virginia’s legislature has found a tentative equilibrium.

The diverse class of 16 freshmen Democrats in the House got a huge boost from the Medicaid win but does not seem poised to pull Virginia further to the left. Republicans are still in charge, and there is little momentum for a progressive agenda on gun control, abortion rights or organized labor.

The Medicaid deal itself was a triumph for old-school negotiating among veteran lawmakers. It culminated months of quiet meetings that began shortly after the elections.

Republican House leaders knew that some in their own caucus — especially those in high-poverty, rural districts — wanted to expand health-care coverage. They moved quickly last fall to broker a deal and a close relationship with new Gov. Ralph Northam (D).

Though some Republicans wound up feeling betrayed by the final deal, the connections built during Medicaid negotiations created a new template for the legislature. It could set the stage for agreement on transportation, tax changes, education and mental-health care.

“There are some places, now that we have put this fight behind us, where we have even greater opportunities to cooperate,” said Del. David Toscano (D-Charlottesville), the House minority leader.

'Deals are being made'

House Speaker M. Kirkland Cox (R-Colonial Heights) is an unlikely ally for Virginia’s new Democratic governor.

Taciturn and deeply conservative, Cox is not a politician who seems open to hobnobbing with Democrats. But Northam has always been friendly with Republicans; they tried to recruit him to change parties earlier in his career.

Why the Trump administration made it easier for Va. Republicans to expand Medicaid

Shortly after he was elected, Northam began meeting with Cox in his transition offices in Richmond’s Old City Hall. They talked baseball. Northam played in high school. Cox was a coach.

Northam made clear he wanted Medicaid expansion, something that eluded his predecessor, former governor Terry McAuliffe (D).

But Northam is considerably gentler than McAuliffe, and Cox knew the dynamics had changed after the Democratic victories. As time went on, Cox acknowledged that Medicaid expansion might be possible under certain conditions, such as requiring that recipients seek employment. Northam said he was open to that.

The pair also reached deals to raise the state’s felony larceny threshold, increase requirements that felons repay their victims and cut some regulations.

Both sides say there was no quid pro quo — no deals for votes. But there were gestures of good faith. Northam pledged not to upset the GOP’s narrow majorities in the legislature by appointing Republican lawmakers to his Cabinet, while Republican leaders quietly quashed socially divisive bills on abortion.

The two formed such a bond that Northam joked about it at a recent event.

“Deals are being made. . . . New relationships are being formed,” Northam said, teeing up a string of one-liners in his best Eastern Shore twang. “In fact, Speaker Cox — I call him Kirk — and I were talking while we were brushing our teeth this morning. And we agreed that it’s a new day here in Virginia. Kirk actually picked out my tie for me this morning. He said it really brings out my eyes.”

With Cox and Northam on such good footing, the way was clear for another powerful Republican — House Appropriations Committee Chairman S. Chris Jones (Suffolk) — to begin the nitty-gritty work of building a state budget that included Medicaid expansion.

Jones, a pharmacist, had an even deeper relationship with Northam, having teamed with him in 2009 in the bipartisan push to ban smoking in Virginia restaurants.

A few weeks into this year’s General Assembly session, Jones had his staff draft three budgets — one with Medicaid expansion and a tax on hospitals to cover the state’s 10 percent share of the cost (the federal government pays the rest); another with expansion and no tax; and a budget without expansion.

The day before the House was to unveil its budget, Republican leaders surveyed their caucus. A sizable chunk, enough to swing the chamber, wanted expansion and the hospital tax.

Cox put away any lingering doubts, backing expansion and the tax. “I felt like we had to govern,” he said. “You couldn’t just think about yourself. . . . You need to get things done.”

The deal was on.

'A unique opportunity'

Negotiations were always trickier on the Senate side. Not having faced voters last year, senators were less convinced that the public wanted Medicaid expansion.

The greatest obstacle was Sen. Thomas K. Norment Jr. (R-James City), the majority leader and co-chairman of the Senate Finance Committee, who was adamant that expansion was fiscally irresponsible.

Norment said he knew in December that the House was going to support it and dismissed the shift as sheer politics. “They felt that they had to make a significant change in direction in order to try and attract constituencies to support them in the 2019 election cycle,” he said.

Meet Virginians who would be helped by Medicaid expansion

At the other end of the spectrum was Sen. Emmett W. Hanger Jr. (R-Augusta), Norment’s co-chairman on the Senate Finance Committee, a kind of bleeding-heart conservative who sees caring for the poor as a Christian imperative. For years, he had wanted to expand Medicaid.

Hanger told House Republicans he would back their plan, if the governor worked with him on some modifications.

But the Senate Finance Committee, with Norment and Hanger splitting time as chairman and at odds over the central issue, failed to produce a budget. The legislature wrapped up its regular session in March without a spending plan.

In the weeks before the General Assembly would reconvene to try again, Northam pulled out the stops. He dined at the Executive Mansion with business leaders, including Dominion Energy Chairman Tom Farrell and Northern Virginia Technology Council President and CEO Bobbie Kilberg, and urged them to contact Republicans about Medicaid.

He met often with Sen. Frank W. Wagner (R-Virginia Beach), an iconoclast who had run for governor on a promise to raise taxes. And Northam went to work on Sen. Ben Chafin Jr. (R-Russell), whose district in the state’s far southwest coal country is among the poorest and most in need of help with health care.

The governor signed a package of coal tax credits to benefit the southwest and set up a bill-signing in Tazewell County alongside Chafin. When Northam’s plane was unable to land in Tazewell because of bad weather, he diverted to Danville and joined Chafin at the bill-signing via speakerphone.

Meanwhile, Norment continued to delay the Senate’s consideration of a budget. A spending plan had to pass by July 1 to avoid a government shutdown. Virginia’s treasured AAA bond rating was at stake.

An unusual, separate set of negotiations began. Jones, the House Appropriations chairman, met with Hanger to see whether they could come up with a budget that expanded Medicaid and satisfied both the House and Senate.

They met twice with staffers from the House and Senate money committees. On the third day, Hanger showed up alone. Norment had told him not to use Senate staffers.

The move sent ripples around the Capitol, where lawmakers pride themselves on decorum. But Norment said he simply didn’t want staffers caught in the crossfire between the co-chairmen. He said he told the staff “not [to] prepare a Senate budget without talking with me.”

This was how much things had changed in Richmond: Senate Republican leaders were feuding, and House Republican leaders allied with Democrats.

Jones and Hanger eventually sculpted a budget that expanded Medicaid. Much like the original House plan, it used the money freed up by federal dollars to increase the state’s reserve funds, pay for state employee raises, boost mental-health programs and increase teacher pay.

“The additional revenue presented a unique opportunity,” Jones said. “At the end of the day, my job as chairman is to solve problems, not play politics.”

On the eve of the vote, Norment made a last-gasp effort to kill the plan with an arcane procedural move in the Finance Committee. But two other wily veterans, Sens. Richard L. Saslaw (D-Fairfax) and George Barker (D-Fairfax), realized what he was up to and headed him off.

On Wednesday, after 10 hours of debate and repeated attacks from opponents, the Senate passed the budget with Medicaid expansion. It won four Republican votes in addition to all 19 Democrats: Hanger, Chafin, Wagner and Sen. Jill Holtzman Vogel (Fauquier).

It went straight to the House, which quickly approved it 67-31.

More common ground?

The 16 freshmen House Democrats were giddy. Most had little success with their own legislation during the session, but with Medicaid they had fulfilled their central campaign promise. Several had even watched debate from the Senate gallery — a slight breach of protocol.

That night, as weary lawmakers filed out, Del. Danica Roem (D-Prince William) encountered Cox outside the House chamber. One of the highest-profile new delegates, Roem was insulted in January when Cox did away with the tradition of addressing legislators as “gentleman” or “gentlewoman.” Roem took it as an effort to avoid referring to her — the nation’s first openly transgender state lawmaker — with a female pronoun. Cox’s spokesman said the old terms were simply outdated.

But now, in the Capitol rotunda, Roem approached Cox with a sense of gratitude.

“ ‘Mr. Speaker, I just want to thank you because this was a really special moment today,’ ” she recalled telling Cox. They shook hands.

“I just wanted to be that freshman to have a human moment with the Speaker of the House,” Roem said. “He came at the issue from a different angle than I did for sure. . . . The fact remains that in the end, it was a compromise.”

The compromise left some Republicans fuming.

Sen. Mark D. Obenshain (R-Harrisonburg) seemed incredulous that so many colleagues had flipped. “We counted on our friends in the House and Senate to adhere to their long-held positions,” he said. “And we were let down.”

For the freshmen Democrats, the Medicaid deal raised hopes that they can find more common ground with Republicans. Roem wants to build on the momentum to solve transportation issues.

“I understand that there are some issues we’ll never agree on, but let’s talk about things we can do,” said Del. Jennifer Carroll Foy (D-Prince William), naming transportation and education funding as examples.

Still, that sunny outlook only goes so far. Gun control, a Democratic priority in a state with some of the most lax gun laws in the country, remains elusive. “Oh, absolutely not,” Foy said, when asked about its prospects.

Northam, who said the Medicaid deal “sets the stage for us to be able to do some really good things working together,” agreed that gun restrictions might not be among them. “I certainly don’t want to have any false hopes,” he said.

One freshman delegate bristled at the idea that future goals are less ambitious than Medicaid expansion. Del. Chris Hurst (D-Montgomery) said his new priority is education funding — especially teacher pay, where Virginia severely lags other states.

“Medicaid expansion had more glitz to it,” Hurst said. But while expanding Medicaid will help about 400,000 people, “teacher shortages, and not paying teachers what they should be paid — that affects all 8.9 million Virginians.”