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Virginia Senate Democrats and rogue Republicans approve Medicaid expansion

Advocates have been trying to get the Virginia Legislature to expand Medicaid for at least five years, and on Wednesday, Senate lawmakers handed them a big win. Four Republicans joined all 19 Democrats, by a vote of 23-17, to pass a two-year $115 billion budget that includes Medicaid expansion. When state Senators initially voted to add Medicaid […]

Advocates have been trying to get the Virginia Legislature to expand Medicaid for at least five years, and on Wednesday, Senate lawmakers handed them a big win.

Four Republicans joined all 19 Democrats, by a vote of 23-17, to pass a two-year $115 billion budget that includes Medicaid expansion. When state Senators initially voted to add Medicaid expansion, only three Republicans joined. The Senate is expected to also pass its $115 billion two-year budget on Wednesday and both are expected to pass the House. Lawmakers could either give final approval or reconcile differences in a conference committee. The General Assembly and Gov. Ralph Northam (D) have until June 30 to pass a budget to avoid a shutdown.

Northam said he predicts the budget bill will land on his desk this week. He is expected to sign it into law.

Virginia will likely join 32 states, as well as the District of Columbia, that have expanded Medicaid eligibility under the Affordable Care Act (ACA), providing health coverage to about 300,000 to 400,000 low-income residents.

The House passed a budget with Medicaid expansion in April — a reality many advocates likely couldn’t have predicted years ago. Republicans in Virginia’s General Assembly have resisted Medicaid expansion for years, despite the fact that 61 percent of residents supported it as early as September 2014.

Medicaid expansion was only possible after a record number of voters, largely mobilized by heath care, elected more Democrats to the House last November. Going into the election, Republicans held a 66-34 majority, but now barely maintain control at 51-49. The turn of events was notable as poor heath is associated with lower levels of voter turnout — but Medicaid has proven to be a galvanizing political force. (States that expanded Medicaid see higher voter turnout.)

While the budget bill is a big deal for progressive advocates, there’s a catch. In addition to providing health care to thousands of low-income residents, some beneficiaries will likely have to jump through extra hoops to stay covered. The budget includes a provision which asks the federal government to approve work requirements for newly covered starting in January 2019. It would condition eligibility on 80 hours of reported work a month after 12 months of enrollment. If beneficiaries fail to meet the requirement, they’ll be locked out of coverage until the end of such 12-month period.

In an interview with WTOP on Wednesday, Northam said work requirements were part of the “give and take on both sides,” adding that Virginia will “try to approach it with a carrot rather than a stick.” But it’s unclear how the state will do that.

Wednesday’s Medicaid expansion vote means many could be insured for the first time. Some 138,000 residents fell in the coverage gap, as they earn too much money to qualify for Medicaid, but too little to qualify for subsidized private insurance available on the Obamacare marketplace.

The Senate GOP leadership has been resistant, citing potential costs. The federal government pays for the bulk of costs associated with Medicaid expansion. By resisting Medicaid expansion, Virginia has given up approximately $142 million in federal funding every month.

In a strange turn of events, former Pennsylvania Sen. Rick Santorum (R), who has a home in Virginia, paid a visit to the Virginia Legislature Wednesday, according to Daily Press reporter Dave Ress. He reportedly tried to dissuade Senate Republicans from voting for Medicaid expansion, claiming federal lawmakers are trying to repeal Obamacare. (Congress still doesn’t have the votes needed to pass Trumpcare.) But his efforts were apparently unsuccessful. And should Republicans successfully repeal the ACA, Virginia’s Medicaid expansion will end, under the bill’s language.

Virginia’s landmark vote comes on the heels of other recent Medicaid wins. On Tuesday, the Utah ballot measure aiming to expand insurance to 150,000 people officially earned enough signatures to be included on the November ballot, according to POLITICO reporter Rachana Pradhan.

This story has been updated to include the first of two budget votes, that includes Medicaid expansion. The Senate is expected to also pass its $115 billion two-year budget on Wednesday and both are expected to pass the House.


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