RICHMOND — Democrats determined to expand Medicaid cooked up a plan to flip a Republican in Virginia’s closely divided state Senate. They’d take one of Sen. William M. Stanley Jr.’s bills, aimed at reviving a shuttered hospital in his struggling rural district, and hold it hostage until the Republican got on board.
But one Democrat, a longtime friend of Stanley’s, was so bothered by the hardball tactic that he tipped him off and then persuaded fellow Democrats to approve the bill. To top it off, Stanley’s pal whisked him from Richmond to the North Carolina border, and there, on grounds of defunct Patrick County Hospital, signed the Republican’s bill into law.
Gov. Ralph Northam (D) is a pretty good guy, it seems, to have for a friend.
“Here he was — first week as governor — comforting me, and saying, ‘Buddy, don’t worry. I’m with ya, I’m with ya,’ ” Stanley said. “He didn’t have to spend that kind of political capital. . . . So I love the guy.”
The gesture is all the more stunning because Northam ran on the promise that he would expand Medicaid to about 400,000 uninsured Virginians. It’s his top priority in the legislative session that ends Saturday. And it will be the first big test of his young governorship, in a fight that could crescendo amid budget negotiations this week.
Northam has lots of friends in Virginia’s GOP-controlled General Assembly, where the former senator and lieutenant governor worked so well across the aisle that Republicans once wooed him to join their party. Particularly in the Senate, where the mild-mannered pediatrician pulled practical jokes, played on the chamber’s hapless basketball team and treated legislators stricken with flu, he enjoys goodwill that’s sorely missing from politics just across the Potomac.
The question is whether those bonds can translate into legislative victory.
Friendships might take Northam only so far. Consider Stanley, perhaps the governor’s best pal in the Senate, who has led opposition to Medicaid expansion for the past four years, convinced that the federal government would not keep its promise to pick up 90 percent of the $2 billion-a-year tab. His view has not changed simply because Northam is leading the charge now.
Late last week, Northam said he would resort to hardball if need be: If the legislature sends him a budget without expansion, he will add it as amendment — a procedure that gives him a stronger hand in the Senate.
In an odd twist, it is the Senate — traditionally the more moderate chamber, and the place where Northam’s personal ties are strongest — that stands in his way, not the House.
That’s due in part to a fluke of the election calendar: On the ballot with Northam last year were all 100 House of Delegates seats. A blue tidal wave shrank the GOP’s 66-to-34 majority to 51 to 49. A chastened House Speaker M. Kirkland Cox (R-Colonial Heights), seeking to rebrand Republicans as results-oriented pragmatists, came out in favor of expansion if work requirements, co-pays and other conservative strings were attached. Nineteen House Republicans joined Democrats to pass a budget bill that includes it.
But there has been no similar evolution in the Senate, which did not face voters last year. Senate Republicans saw the carnage in the House, but they either didn’t feel it or just don’t think the solution is embracing “Obamacare.” While voters called health care a priority in exit polls and Northam won on a promise to expand, some Senate Republicans say what crushed the House was an anti-Trump wave, not pro-Medicaid fervor.
Even Sen. Emmett W. Hanger Jr. (R-Augusta), a moderate who has voted for expansion in the past, has said he does not like the particulars of the House plan, including a tax on hospitals to cover the state’s 10 percent share. And so Senate Republicans, who lead that chamber 21 to 19, passed a budget that did not include Medicare expansion.
Now negotiators are trying to hash out differences in two wildly different budgets. The House version has about $420 million extra for teachers’ raises, Metro and other priorities because of savings the state is projected to realize if Medicaid is expanded. There is no easy way to split that baby.
Legislators could go into overtime if they do not reach a deal before adjournment Saturday. Or they could punt, sending Northam a budget without expansion, which he could send back with an amendment that adds it.
Going the amendment route gives Northam more muscle, thanks to procedural arcana related to when Lt. Gov. Justin Fairfax (D) is allowed to break ties. Northam would need to win over two Republicans to pass a spending plan with expansion because Fairfax, who presides over the Senate, is not allowed to vote on the budget. But the lieutenant governor is permitted to vote on amendments, so if the governor proposes expansion as an amendment, he would need only one Republican senator to join Democrats to pass the plan.
With an amendment, Northam might be able to reshape the plan to win over Hanger, perhaps by sparing rural hospitals like the one in Hanger’s district from the hospital tax. Northam noted last week — as a gentle warning — that he could strip out some of the conservative sweeteners if legislators leave it to him.
But clearly, Northam, who ran as a consensus-builder, would rather not ram through a measure as consequential as Medicaid. Which is why he has been courting lots of Senate Republicans, including Stanley.
Since before his January swearing in, Northam has been trying to gently twist Stanley’s arm — earnestly and privately, playfully and publicly. Hailing from deep-red Trump country, Stanley would not be the most obvious expansion ally but for his close bond with the governor.
“The governor and I have been friends since the first day I got here in 2011,” Stanley said. “His office, when he was a senator, was right across the hall from mine. And I just took a liking to him immediately. And he had no choice but to like me back.”
They are an unlikely pair — Northam, quiet and understated, and Stanley, the Senate’s charismatic class clown. One sits to the left of center, the other to the right. Yet both have sunny personalities, a love for silly pranks and independent streaks.
Stanley, an attorney who opened a practice with his widowed mother after encouraging her to pursue her dream of becoming a lawyer, is a conservative Republican. But he opposes capital punishment, champions animal rights and pushes legislation meant to break the cycle of poverty in a region that, as he likes to say, was “on the top of the economic food chain in Virginia just 30 years ago.”
Then came NAFTA, CAFTA, the EPA. Stanley rattles off the alphabet soup he blames for robbing his region of textile mills, furniture-making, tobacco and coal. He figures Medicaid expansion would be no better.
That has not stopped Northam from trying.
“He did in his good ol’ friendly way,” Stanley said. “He wasn’t going to hold anything hostage, like the Senate Democrats did, or use that kind of leverage. He simply was to me, ‘How do we get to ‘yes’? And I said, ‘Governor, you know where I’ve sat on this for years. I’ve sat on principle.’ ”
They had that conversation even before Northam was sworn in, when they met to talk about rural issues. They had it again just three days after inauguration, after Senate Democrats made good on a threat to kill Stanley’s hospital bill if he did not back expansion.
Stanley’s bill would have extended the state’s certification of the hospital, which closed in September, for another year — a measure meant to make the property more marketable. He said the hospital’s plight had nothing to do Medicaid. It mostly served elderly Medicare patients and made a profit, closing only because of mismanagement by its out-of-state owner, Stanley said.
But some Democrats felt the hospital bill was fair game given the big picture: Stanley was trying to expand access to health care in his region, something Medicaid could achieve statewide.
After Democrats killed his bill, Stanley filed an identical measure. As Northam was trying to persuade Democrats to pass that one, Stanley agreed to keep an open mind about Medicaid. Soon after, Northam dispatched his health secretary and Medicaid chief to Stanley’s office. They made their pitch, but also picked his brain: What would a Republican plan for Medicaid expansion look like, they asked, even if he could not support it? He talked about work requirements, which wound up in the House plan.
“I did that for Ralph, but also, I want to learn,” Stanley said. “And after that, the bill passed.”
Stanley’s hospital bill sped to Northam’s desk. He chose to sign it — his first as governor — at the hospital, a gesture bound to create more attention and goodwill. He invited Stanley to fly there with him — just days after sending a Valentine’s greeting to Stanley — and only Stanley — on the Senate floor.
It was a bumpy ride in rainy weather.
“I was convinced the governor was telling the pilot to shake it,” Stanley said, who through nervous laughter jokingly agreed to expand Medicaid if Northam could make it stop.
Back on the ground, though, Stanley was back to no.
“I think Ralph knows . . . how to make friends, and knows how to gain influence, and knows how to get support,” Stanley said. “I fully expect him to be talking to other people. I think he knows, though, I can’t vote for the House budget.”