RICHMOND — The failure of Congress to repeal and replace Obamacare has emboldened Gov. Terry McAuliffe (D) to renew his stalled crusade to expand Medicaid in Virginia. On Monday, he proposed an amendment to state budget language to give him power to set an expansion in motion, and called on the Republican-controlled General Assembly to immediately begin making plans.
But Republican legislators were unmoved by the plea, saying they would reject the amendment and that they stood firm against expanding Medicaid.
McAuliffe, though, said national momentum is on his side. He pointed to three other Republican-controlled states — Kansas, North Carolina and Utah — that are considering an expansion of the federal health program for the poor and disabled under the Affordable Care Act, and said Virginia can’t afford to be left behind.
“It is clear that the ACA is now the law of the land and here to stay. It is not going to be repealed. That is what the president of the United States said on Friday, that is what the speaker of the House said on Friday,” McAuliffe said during a news conference at the state Capitol. “There are no excuses anymore.”
Under Obamacare, states have the option of expanding Medicaid to a greater population of recipients. Thirty-one states have done so. The federal government pays 100 percent of the cost to expand Medicaid through next year for states that opt in, then will pay 90 percent through 2020, with states paying the remainder.
An estimated 400,000 Virginians could be covered under an expansion of Medicaid, according to the McAuliffe administration. That translates to $6.6 million in federal money per day, or $10.4 billion total so far, that Virginia has declined, officials said.
“We have worked on this for many years. I would ask . . . that we do the common-sense thing to bring this money back to care for our citizens,” McAuliffe said.
Virginia Republicans have resisted every attempt to join the expansion, which has been one of McAuliffe’s priorities since taking office in 2013. They argue there is no guarantee the federal government will continue to reimburse at 90 percent after 2020, potentially leaving the state on the hook for hundreds of millions in costs.
After failing to get an expansion in a budgetary showdown during his first year in office, McAuliffe has tried numerous tacks, but this year he had all but surrendered. In the budget he submitted in January, he included language that said the governor could begin implementing Medicaid expansion if the ACA was still in place by Oct. 1, when the new fiscal year begins.
Hanging over that was the assumption that President Trump would follow through with his campaign pledge to kill Obamacare. Republicans who control the state legislature’s money committees made clear they’d never give McAuliffe that power even if the ACA was repealed, and they stripped the language out of the budget they sent to his desk last month.
On Monday, McAuliffe revived that language as an amendment to the budget. He also called on the General Assembly to immediately convene a special joint committee that had been created to assess the impact that repealing the ACA would have had on Virginia.
The legislature will gather April 5 to consider the governor’s amendments and vetoes, but leaders said Monday that McAuliffe’s new budget language stands no better chance this time.
In a joint statement, the Republican leadership of the House of Delegates said expanding Medicaid would lead to increased costs and eventually blow a hole in the state budget.
“The lack of action in Washington has not changed that and in fact, the uncertainty of federal health policy underscores the need to be cautious over the long term,” the leaders, including House Speaker William J. Howell (R-Stafford) and the man selected to replace him as speaker when he retires next year, Del. Kirk Cox (R-Colonial Heights), said via email.
“Virginians can barely afford our current program, much less an expansion,” they said. “Every federal dollar not spent on expanding a broken program is a dollar not borrowed from future generations.”
McAuliffe said he had notified the Republicans over the weekend that he intended to make this case, but that he had spoken only with Cox. The governor declined to characterize his discussion, saying he doesn’t negotiate in public.
“This just happened on Friday,” McAuliffe said, suggesting that the issue needs more time. “There are no more excuses. If you just don’t want to do Medicaid expansion because you’re afraid of the tea party or for some other reasons, that’s a different issue. . . . It’s really up to the Republicans in the legislature.”
Not all Republicans have been so ironclad in their opposition.
Even before the failure of Congress to come up with a replacement for Obamacare, conservative radio host John Fredericks labeled McAuliffe “Gov. McGenius” for continuing to push for Medicaid expansion.
On his March 13 program, Fredericks noted that even the Republican alternative would have continued to provide federal funding to states that expanded Medicaid — suggesting that there is little risk that Virginia would be left on the hook for the cost of expansion.
“You were right, I was wrong,” Fredericks said.