A showdown over Obamacare's Medicaid expansion pitting Republican lawmakers against Virginia's newly elected governor is almost certain following the GOP victory in a drawing to decide control of the state's House of Delegates.
The expected fight in a purple state demonstrates the law's staying power even as a Republican president and Congress work to undo it.
Gov.-elect Ralph Northam campaigned heavily on expanding the state's Medicaid program and has made it a top priority. But Democrats' inability to gain a 50-50 split in the state's lower legislative chamber on Thursday means they will need Republican defectors to back a plan, as well as figure out how to pay for its share of costs. Republicans also maintain a narrow 21-19 majority in the state Senate.
“I think there is a real possibility, because you’re talking about one or two people in each House,” University of Virginia politics expert Larry Sabato said after Democrats’ strong electoral performance in November.
It's unclear whether Democrats will challenge Republican David Yancey's win to represent Virginia’s 94th House District, which gave the GOP a 51-49 majority in the House of Delegates.
Democrats’ prior attempts to expand Medicaid — pushed every year by outgoing Gov. Terry McAuliffe — were repeatedly rebuffed by what had been strong GOP legislative majorities. The calculus changed after Democrats nearly flipped control of the lower chamber and held on to the governorship in the state's off-year election.
Virginia is one of 19 states that haven't adopted the Obamacare expansion, which allows individuals to qualify for Medicaid if they have incomes up to 138 percent of the federal poverty level, or roughly $16,600 for an individual. Nearly all of the holdout states are led by Republican governors.
Expansion of Obamacare coverage is anathema to many Republicans in the Legislature, although lawmakers in the state Senate are generally less conservative than their counterparts in the House of Delegates and are not up for reelection until 2019.
Medicaid expansion would cover roughly 400,000 low-income adults in Virginia and has the backing of the state’s hospitals and advocacy groups.
“Come hell or high water, we will do everything in our power to make sure this gets done,” House Democratic Leader David J. Toscano and Caucus Chair Charniele Herring said in a joint statement after McAuliffe included Medicaid expansion in his final budget proposal.
Northam is also likely to feel pressure. The former state senator and lieutenant governor angered liberals after a Washington Post interview in December during which he sent mixed signals about how aggressively he would push the expansion during the legislative session that starts on Jan. 10.
He later issued a statement on Twitter insisting he will advocate for the plan, adding “it is a no-brainer for Virginia families, our budget, and our economy.”
“He campaigned on it all year. If he doesn’t deliver on it, he’s going to have a problem,” said incoming Virginia House of Delegates representative Lee Carter, a supporter of single-payer health care who backs a “clean” Medicaid expansion, without features favored by some conservatives like higher costs for enrollees or work requirements as a precondition for receiving benefits.
Northam, Carter said, “appears to want to come to the table with a compromise position already. But we’ve seen what happens on the federal level when you do that, which is that the other side just demands more compromise. From my perspective, you come to the table with your wish list.”
Virginia would also be aiming to expand its program at a time when states must cover more of its costs.
The federal government paid the entire cost of covering new enrollees for three years, but states began contributing 5 percent in 2017 and will have to pay 6 percent this year. Some states have already wrestled with coming up with those funds even though the federal government continues to cover the vast majority of the costs.