RICHMOND — Del. Terry G. Kilgore did an about-face on Obamacare this year, voting to add up to 400,000 poor, uninsured Virginians to the state’s Medicaid rolls after years of steadfast opposition.
“Tell Kilgore to get Obamacare out of the budget,” they said.
The calls never came, even in a part of Virginia that supported Donald Trump overwhelmingly in 2016 and seemed immune to the blue wave that swept over much of Virginia last year.
“No calls, no comments,” said Kilgore, who contends his struggling coal-country district wants the “hand up” as long as Medicaid recipients are required to work and make co-pays.
“I’ve been to Republican mass meetings. I’ve been out and about, ballgames, this and that,” Kilgore said. “What I’ve heard people say is, ‘Hey, what you said made sense. We don’t mind helping people if they’re helping themselves.’”
The backlash that 19 House Republicans braced for after their surprise flip on Medicaid has been milder than many had expected. That’s a stunner given that Republicans in Virginia and around the country have used resistance to Obamacare to drive voters to the polls for nearly a decade, including elections just last fall.
But AFP and other expansion foes contend that legislators who perceive only mild pushback just aren’t listening. One legislator in favor of expansion has already drawn a 2019 primary challenger, who declared his candidacy Thursday.
“Politicians usually pay a price when they ignore their constituents,” said Lorenz Isidro, spokesman for AFP’s Virginia chapter. “Our activists have been contacting their representatives, and to say otherwise is outrageous and denigrates their efforts. . . . Our activists are engaged as ever and are ready, willing and able to hold these folks accountable.”
While the intensity of the fight is in dispute, one thing is clear: It’s not over. Enough House Republicans teamed up with Democrats to pass a state budget bill that would expand Medicaid, but Senate Republicans blocked passage in that chamber, which, like the House, is under narrow GOP control. The standoff forced the legislature to adjourn March 10 without a budget. Legislators need to pass a budget by July 1 to avoid a government shutdown.
Gov. Ralph Northam (D), who won election last year on a promise to expand the federal-state health-care program, has ordered the General Assembly to return April 11 for a special session. Until then, both sides in the Medicaid fight are trying to pressure legislators while they are back home in their districts, with public meetings, protests and ad campaigns.
Pro-expansion forces have taken their cues from Northam, a soft-spoken pediatrician and former state senator whose approach is more honey than vinegar. Rather than blasting Senate holdouts, they have run newspaper ads with an expansion plea signed by hundreds of faith leaders.
AFP has been more hard-hitting, with Facebook ads that plaster a smiling Obama beside pro-expansion delegates. It runs phone banks to call voters, tell them their delegate might shut down the government for Obamacare, then patch them through to the legislator’s office.
At least so far, pro-expansion House Republicans have shown no signs of buckling. But there may be movement in the Senate, where only one Republican has been openly supportive of expansion during the session. But recently, two more have sounded squishy.
Virginia’s existing Medicaid program is one of the least generous in the nation. To be eligible, a disabled individual can make no more than $9,700 a year. The cutoff for a family of three is $6,900. Able-bodied, childless adults are not eligible, no matter how poor.
Under the Affordable Care Act, states can raise those income limits, and the federal government will pick up 90 percent of the cost. The income ceiling would rise to $16,750 a year for a disabled person or able-bodied adult, and $28,700 for a family of three.
Most Virginia Republicans staunchly opposed expansion for the past four years, concerned that the federal government would not keep its promise to pick up most of the $2 billion-a-year tab. But opposition in the House softened after Democrats nearly took control of the chamber in November in an anti-Trump wave. The 19 Republicans who flipped seemed to have concluded that they have more to fear from energized Democrats and independents than from potential primary challengers on the right.
The Senate, which did not face voters last year, remained opposed during the session. Sen. Emmett W. Hanger Jr. (R-Augusta), who has supported expansion for years, was the only Republican in that chamber to favor it — and even he wanted substantial changes to the House plan.
But in the past two weeks, Sen. Frank W. Wagner (R-Virginia Beach) conceded at a GOP gathering that he thinks expansion will happen, and Sen. Jill Holtzman Vogel (R-Fauquier) did not rule out voting for it in an exchange with the Winchester Star.
“Don’t go wobbly — Mrs. Vogel, stand firm on Medicaid,” an editorial in that paper implored Thursday.
Two Senate Republicans would have to join Democrats for expansion to pass on a budget vote, the most conventional route for passage. But it would take only a single defection to pass it through a budget amendment. That’s because the Senate’s presiding officer, Lt. Gov. Justin Fairfax (D), is allowed to break ties on budget amendments but not on the budget itself.
Hanger has said he would supply that lone GOP vote if the House plan is changed to overcome his objections, which include a tax imposed on hospitals. In recent weeks, he has been working with the Northam administration, health insurers and hospital groups, and sounded optimistic.
Given Hanger’s stance, Wagner told a Republican group last week that he believes Medicaid expansion will happen, so he wants to get engaged to make the plan as “conservative as possible.”
“Would you rather have me get involved in the process and try to drive it as conservative as possible?” Wagner later asked rhetorically, as he confirmed his remarks to The Washington Post.
Vogel declined to say if she would continue to oppose expansion or whether there is a form of expansion she would support, the Winchester Star reported Wednesday.
“There are a number of ways to get . . . this right, including good reform measures to adopt,” Vogel told the paper.
She did not respond to a request for comment from The Post.
Even before they left Richmond, House Republicans faced attention-grabbing criticism. Corey Stewart, a Trump supporter vying for the chance to take on U.S. Sen. Tim Kaine (D-Va.) in the fall, brandished a roll of toilet paper as he called expanders “flaccid.” Senate Majority Leader Thomas K. Norment Jr. (R-James City) said he would resign from leadership if he ever found himself out on a limb like House Speaker M. Kirkland Cox (R-Colonial Heights), who voted for expansion.
But the response to those and subsequent attacks has been underwhelming, some legislators and other observers say.
“I don’t think there has been a large outcry,” said Bob Holsworth, a former Virginia Commonwealth University political scientist. “It’s now become more of a policy choice rather than an emotional argument about Obamacare.”
If the reaction seems mild, that could be a triumph of messaging. House Republicans have billed expansion as conservative “Medicaid reform” since their plan would impose work requirements on recipients — something the Trump administration has supported elsewhere. (Critics on the right say the requirements amount to a nonbinding “work suggestion.”)
“I think it’s a combination of the failure to repeal and replace Obamacare [in Washington], and a post-2017 election hangover,” said Jennifer Duffy, a senior editor for the nonpartisan Cook Political Report. “Republicans, particularly those in the establishment, seem to be very depressed by last year’s results and thus helpless about their ability to impact anything going on in Richmond.”
Some see a hopeful sign that voters, sick of the Washington-style polarization, are in the mood for bipartisanship. Others see a worrisome signal that Republican activists feel so burned — by Richmond and Washington — that they’ve thrown up their hands.
Del. Christopher K. Peace (R-Hanover) is in the hopeful camp, calling reaction to his Medicaid vote “largely positive.” Same goes for Del. Bob Thomas (R-Stafford), who said he has heard grumbling from “less than 10” constituents. But one person unhappy with his vote, former Stafford supervisor Paul Milde, announced Thursday that he would challenge Thomas for the nomination next year.
Del. James W. “Will” Morefield (R-Tazewell) said the welcome mat is out for expansion in his coal-country district, where a local board of supervisors and chamber of commerce passed resolutions in support. He said he was unfazed by AFP, which has targeted him with Facebook ads, phone banks and a “Stop Obamacare” meeting planned in his back yard April 7. Even with a free lunch tossed in as an enticement, only four people have signed up so far.
Anita Moody, a conservative activist who lives in Morefield’s district, called his office, leaving a voice mail to register her disappointment.
That’s as far as she has taken it, though, explaining that it’s hard for people in rural areas to attend rallies because that often requires traveling great distances.