Virginia's governor is set to sign legislation in coming days expanding Medicaid after the state's Republican-controlled General Assembly ignored warnings from the White House against expanding the health care program for the poor.
The state Senate voted Wednesday in favor of a state budget that expands Medicaid. The House, which had had previously endorsed expansion, gave its final approval shortly thereafter. Several Republicans in both chambers joined with Democrats to approve the measure.
Ironically, Republican lawmakers said it was the Trump administration's embrace of work requirements for low-income people on Medicaid that help get the measure passed after years of partisan battles.
Expanding Medicaid was a key provision of then-President Barack Obama's health care overhaul, which President Donald Trump has vigorously sought to negate. White House officials, including budget director Mick Mulvaney, urged Virginia lawmakers this year not to expand Medicaid. Trump's recent budget proposal calls for repealing Medicaid expansion, and Mulvaney said the administration is "committed to addressing the unsustainable growth'' of the program.
But Virginia GOP Speaker Kirk Cox said the Trump administration's openness to conservative reforms, including work requirements, "was probably the biggest key'' in getting Republican support for Medicaid expansion this year.
And a failure by the GOP-led Congress to repeal and replace the health law helped spur several Republican state legislators to flip positions.
"There's always talk of repealing Obamacare; that did not happen,'' Cox said.
Democratic Gov. Ralph Northam's expected signature should enable roughly 400,000 newly eligible low-income Virginias to begin enrolling in Medicaid at the start of next year. A tally from the Kaiser Family Foundation shows Virginia will become the 33rd state to approve Medicaid expansion
The Senate passed it 23-17, with four Republicans joining the Democrats. The House endorsed it about an hour later with a lopsided 67-31 vote.
It took more than four years of battles over whether Virginia should expand the publicly funded health care program for the poor. In 2014 and again this year, the fight led to standoffs over the state budget.
But Republicans took notice when Democrats campaigned heavily on expanding Medicaid last year and made unexpectedly large gains, reshaping the state legislature in an anti-Trump wave. Some were eager to take the issue off the table before next year's election, when both House and Senate seats are up.
Virginia Democrats have argued the state should not pass up the roughly $2 billion in extra federal funding the program would bring to the state. Republicans had previously been near unified in blocking past expansion efforts, saying the long-term costs were unsustainable.
In the final hours, Sen. Ben Chafin, a Republican lawmaker from Virginia's economically depressed southwest coal country, announced his support for expansion on the Senate floor. He said his rural area needs expansion to bolster its hospitals and provide care for constituents.
"I came to the conclusion that no just wasn't the answer anymore,'' Chafin said.
Several Republican senators remained strongly opposed, saying Medicaid costs would eventually overwhelm the rest of the state's budget needs for schools and public safety.
"It is a ticking time bomb,'' said GOP Sen. Bill Stanley.