RICHMOND — Leaders of Virginia’s House of Delegates are trying to sell wary fellow Republicans on Medicaid expansion by tying it to President Trump and Vice President Pence.
House Speaker M. Kirkland Cox (R-Colonial Heights) contends that expanding the federal-state health-care program during the Trump administration offers the “best chance for conservative reforms.” He also compares the House’s expansion plan with the “Indiana-style model” adopted by that state in 2015, when Pence was its governor.
Cox’s effort to associate the plan with Trump and Pence comes as it faces a critical vote Thursday, when the House of Delegates takes up the matter as part of its proposed two-year budget.
There is little doubt that the House, which the GOP controls by a 51-to-49 majority, will keep Medicaid expansion in the spending plan, given that Democrats and at least a few Republicans are on board.
But expansion advocates hope it does not merely squeak out of the chamber. Firm support for expansion from House Republicans could strengthen that chamber’s hand in budget negotiations with the Senate, which is expected to pass a rival budget plan Thursday without expansion.
Republican voters strongly supported the idea of Medicaid expansion when it was tied to Trump, according to an internal poll conducted by the House Republican Caucus and obtained by The Washington Post.
“The House health care plan allows Virginia to work with the Trump Administration to expand Medicaid while guaranteeing common sense reforms to control costs and protect taxpayers. Do you support or oppose this plan?” voters were asked.
When expansion is presented as a way to “work with Trump,” Republicans were nearly twice as likely to support it than Democrats. The poll used a computerized voice to pose the questions to 1,000 likely voters, a method generally considered less accurate than surveys conducted by live callers. House leaders have presented the findings to GOP holdouts.
Cox, who endorsed Sen. Marco Rubio (R-Fla.) over Trump in the 2016 presidential primary, opposed Medicaid expansion for years but changed course after an anti-Trump wave in state elections last year nearly erased the GOP’s 66-to-34 majority in the House.
Expansion is a top priority for Gov. Ralph Northam (D), as it was for his Democratic predecessor, Terry McAuliffe. They contend it would provide health care to as many as 400,000 uninsured Virginians and create 30,000 jobs.
A poll released this month by the Wason Center for Public Policy found 56 percent of voters support expanding Medicaid while 53 percent said they would back a compromise of partial Medicaid expansion if “across-the-board expansion” does not pass the General Assembly.
Republicans have warned over the years that Washington could not afford to make good on its promise to pick up most of the $2 billion annual cost. Some fiscal hawks in the House say that concern has hardly gone away given the soaring federal deficits projected to result from Trump’s budget plan. Other Republicans have expressed philosophical objections to providing an entitlement to able-bodied Virginians, no matter how poor.
Cox still describes his support grudgingly, noting that the Republican-led Congress has been unable to repeal the Affordable Care Act, the Obama-era health-care law that laid the groundwork for expansion. But as he seeks to woo House and Senate Republicans, Cox contends having Trump in the White House softens the blow.
“My long-standing concerns about the cost of expansion aren’t going away, but unfortunately the ACA is here to stay and the Trump administration is the best chance to secure conservative reforms,” Cox said. “The governor agreed to an Indiana-style model with a strong work requirement instead of straightforward Medicaid expansion.”
Pence’s plan, dubbed Healthy Indiana Plan 2.0, required co-pays from low-income recipients and charged smokers higher rates. Hospital fees and cigarette taxes covered the state’s share of the costs.
The plan Cox supports also would impose work requirements for able-bodied adults and co-pays. It would allow the state to pull out of expansion if the federal government reneged on its promise to pick up 90 percent of the $2 billion-a-year cost. And hospitals would foot the state’s 10 percent share through a “provider assessment.”
John Fredericks, a conservative radio host who was chairman of Trump’s Virginia campaign, echoed Cox’s appeal to Trump supporters in The Bull Elephant, a conservative blog.
“In my mind, if it’s good enough for a conservative like Mike Pence and Indiana, then it’s good enough for Virginia,” Fredericks wrote.
But some expansion foes are not buying the Trump-Pence appeal.
On its Facebook page, the Virginia chapter of Americans for Prosperity posted a photo of Pence by a remark he made at a National Governors Association meeting in July 2017.
“Obamacare has put far too many able-bodied adults on the Medicaid rolls, leaving many disabled and vulnerable Americans at the back of the line,” Pence said.
U.S. Senate hopeful Corey R. Stewart, who co-chaired Trump’s Virginia campaign with Fredericks but was later ousted, blasted House Republicans as ‘flimsier than toilet paper” and announced plans to hold a news conference on the steps of the state Capitol on Thursday.