RICHMOND — Legislators from across Virginia return to the state Capitol to resume work on the state budget Wednesday, as the standoff that for years blocked expansion of Medicaid appears to be breaking.
Momentum for extending the federal-state health-care program to an additional 400,000 low-income Virginians has been building in the Senate, with a second Republican state senator announcing last week that he would be willing to support it under certain conditions.
But even the most fervent advocates for expansion say there is a long way to go, with Wednesday merely marking the start of what could be weeks of negotiations.
“This is something that should have been done three or four years ago, but better late than never,” said Senate Minority Leader Richard L. Saslaw (D-Fairfax). “Between 350,000 and 400,000 Virginians will get the health care that’s needed.”
In a surprise flip during the regular legislative session, the Republican-led House of Delegates abandoned its years-long opposition to “Obamacare” to pass a budget that would expand Medicaid, with the federal government promising to pay at least 90 percent of the tab.
But the state Senate, which like the House is under narrow GOP control, did not agree to a budget with expansion, concerned that Washington would not make good on its funding and stick the state with the cost.
Unable to resolve the conflict, the legislature adjourned March 10 without passing a two-year budget. The state needs a spending plan in place by July 1 to avoid a government shutdown.
Gov. Ralph Northam (D), who won office last year on a promise to expand Medicaid, called the legislature back for the special session. The opening days are expected to be consumed by the dry procedural moves needed to get a budget bill through House and Senate money committees and then to each chamber for floor votes.
That is expected to take a week or more and then a conference committee would work out differences between rival House and Senate plans.
It would take two Republicans to pass expansion on a budget vote in the Senate, which Republicans control by a 21-to-19 margin. But only one is needed to pass it as 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.
Northam, who ran as a consensus builder, has signaled he would rather not have to muscle something as consequential as Medicaid expansion through the amendment process. And some Republicans have said they would rather not give Fairfax, a likely contender for governor in 2021, the resume-boosting opportunity to cast the deciding vote on Medicaid expansion, which polls well with voters.
That’s one reason expansion supporters have been hoping to flip multiple Senate Republicans. One of them — Emmett W. Hanger Jr. (Augusta) — has supported certain forms of expansion for years, though he opposes the hospital tax that the governor and House want to use to fund the state’s 10 percent share of the program.
Last week, state Sen. Frank W. Wagner (Virginia Beach) said he supports expansion under certain conditions. Those include a tax credit for middle-income people who already have insurance but are struggling to pay soaring premiums and co-pays. He also wants to beef up the work requirement that the House wants imposed on Medicaid recipients.
Wagner’s support has generated a sense of inevitability around the issue. Even those opposed to expansion say privately that it will be difficult to stop it with two Republican senators on board.
But opponents note that the criteria put forth by Wagner and Hanger conflict in some ways with each other and with what Northam and the House want.
Northam and the House project hefty savings from expanding Medicaid. The governor predicts $421 million, while the House calculates $307 million, with different start dates accounting for the gap. They want that money sprinkled throughout the budget, to fund higher education, teacher raises and other needs.
But Hanger objects to using savings on anything other than health care. And Wagner wants to use about half of the savings on raises and the like, and the other half for his proposed $250-a-year tax credit.
“Latte tax break,” is how some critics within the Senate GOP caucus dismiss Wagner’s proposed tax credit, suggesting the sum might cover the cost of fancy coffee but not soaring premiums.
A third Senate Republican appeared to waver in recent weeks, as Sen. Jill Holtzman Vogel (R-Fauquier) did not rule out voting for expansion, according to the Winchester Star.
But several Senate Republicans reiterated their opposition to expansion in interviews with The Washington Post on Tuesday, on the eve of the special session.
“I”m still a no,” said Sen. Charles W. “Bill” Carrico (R-Grayson), who had been targeted by some expansion advocates because they argued it would help his rural district. “I don’t have any faith that it will be there,” he said of federal funding.
Under the Affordable Care Act championed by President Barack Obama, Washington encouraged states to allow more people to enroll in Medicaid by offering to pick up most of the tab. Thirty-two states, including Maryland, and the District accepted the offer.
Virginia, with its legislature under GOP control, staunchly resisted “Obamacare expansion” for four years under Northam’s predecessor, Terry McAuliffe (D). Opposition in softened in the House after Democrats nearly took control of the chamber in an anti-Trump wave in November.
But the Senate, which did not face voters last year, remained firmly opposed, calling the House’s work requirement a meaningless “work suggestion” because it would operate on the honor system.
Northam carried five Senate districts currently held by Republicans: Richard H. Black (Loudoun), William R. DeSteph Jr. (Virginia Beach), Siobhan S. Dunnavant (Henrico), Glen H. Sturtevant Jr. (Richmond) and Wagner. If they are feeling political pressure from that, only Wagner has shown it. The remaining four have been opposed to Medicaid expansion, and two reached for comment Tuesday said that was still the case.
“We take a tremendous financial risk with Medicaid expansion,” Black said.
Dunnavant, an obstetrician-gynecologist, said she got into politics with the goal of improving health care and reducing its cost. But with the plans put forth by Northam, the House, Hanger and Wagner, she said, “We’re not doing either.”