In Virginia, there are 400,000 low-income people who can’t afford health coverage but don’t qualify for federal insurance subsidies. If they lived across the state line in Maryland, West Virginia or Kentucky, which have expanded their Medicaid programs, they could get the coverage they need. Terry McAuliffe, the Virginia governor, campaigned on bringing an expanded Medicaid program to Virginia, too.
But it hasn’t happened, and the reason is a group of recalcitrant Republicans in the House of Delegates who have blocked Medicaid expansion at every opportunity. They are so determined to keep poor people from getting health care that they are preventing passage of a two-year budget for the state for the fiscal year beginning July 1. If an agreement isn’t reached by then, they seem fully prepared to let the state government shut down, furloughing employees and shuttering services just as their counterparts in Washington did last fall.
Virginia is at least debating the issue. Nineteen Republican-dominated states, mostly in the South and Midwest, have flatly said no. To accept expanded Medicaid in their view is to accept the Affordable Care Act and let the public witness its benefits. They cannot allow that to happen. One Virginia Republican said his colleagues were openly hoping to limit the number of people covered by the law.
“They are trying to exhibit their disdain for the Affordable Care Act,” State Senator John Watkins, a supporter of expansion, told The Washington Post. “They feel if enough people refuse to use it, somehow it’s going to go away, that it will fail.”
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There are obvious benefits to expanded Medicaid, which the Republicans have chosen to ignore. For three years, the federal government would pay 100 percent of Virginia’s expansion — a multibillion-dollar infusion — as opposed to the current 50-50 split in Virginia and most states. After that, the federal share would be reduced gradually to 90 percent by 2020. Though states will incur some additional costs after 2016, they will pay far less to hospitals for uninsured coverage, and will benefit economically from the improved health of their citizens.
These arguments are so compelling that Republicans have been reduced to a familiar dead-end explanation for their refusal: namely, that the federal government can’t be trusted to pay the 90 percent share promised by the health care law. This same tactic has been adopted by anti-expansion Republicans in other states, as well as by politicians who won’t agree to immigration reform. If the facts aren’t on your side, then your best bet is to exploit the party’s widespread mistrust of government.
Hoping to avoid a government shutdown, Governor McAuliffe is now exploring whether he can expand Medicaid without the legislature’s approval. That raises complicated legal and constitutional questions, but his impulse — in the face of coldhearted political opposition — is perfectly understandable.