Two weeks ago, Virginia Governor Ralph Northam approved a state budget that included allocations for Medicaid expansion. The expansion will go into effect on January 1 and will cover over 400,000 currently uninsured adults.

Democratic Leader David J. Toscano (D-Charlottesville) and Democratic Caucus Chair Charniele Herring (D-Alexandria) are celebrating the passage and declared, “This is a great day for the Commonwealth, especially those nearly 400,000 Virginians who will now have access to affordable healthcare.”

The state House of Delegates approved Medicaid expansion through their budget bill in March, but for months the state Senate refused to include an expansion in their bill. GOP State Senators Frank Wagner and Emmett W. Hanger Jr. changed their positions once a work requirement was added to the bill. With the exception of adults with disabilities, most recipients of Medicaid in Virginia will be required to work or volunteer. Individuals who are above the federal poverty line will also be required to pay premiums of up to 2 percent of their income, another addition that appealed to Republicans.

Republicans have felt increased pressure to pass Medicaid expansion since they nearly lost control of the House of Delegates to Democrats in the November 2017 elections. Three races were closely contested, and GOP incumbent David Yancey was not declared the winner of the final disputed district until January, preserving a Republican majority with a 51-49 split. Still, the Democrats picked up 15 seats, meaning that they came very close to ending the Republicans’ 17-year control of the state House. Governor Northam, also a Democrat elected in 2017, has been instrumental in increasing the pressure on Republicans since he ran on the promise of expanding Medicaid.

Virginia is the 33rd state to expand Medicaid since the Affordable Care Act (ACA) was passed, and other states still have the opportunity to follow suit. When state governments have refused to pass legislation, activists have often tried to get initiatives on the ballot. In Idaho and Nebraska, advocates are gathering signatures, and Utah already has sufficient names to qualify for a ballot initiative. In Maine, voters already approved a Medicaid expansion through a referendum, but Gov. Paul LePage is trying to block it, leaving expansion up to a court decision.

Medicaid expansion helps cover adults with incomes that are too high to qualify for traditional Medicaid but still too low to buy insurance through the private healthcare market, a group that falls into what is known as the “coverage gap.” There are still about 2 million Americans who fall into this coverage gap, indicating the importance of activists’ efforts to expand Medicaid in their states.

The Affordable Care Act is what originally made Medicaid expansion possible. When it went into effect in 2014, states began having the option of expansion. In accordance with the law, the federal government has to pay no less than 90 percent of expansion costs in each state. Despite the Republicans’ multiple attempts to repeal the ACA last summer, the law remains in place, and the federal government continues to finance its part of Medicaid expansions. In states that have expanded Medicaid, coverage is available to low-income adults up to 138% of the poverty line.

 

Media Resources: AlexandriaNews 5/31/18; New York Times 5/30/18; Washington Post 3/10/18; healthinsurance.org 5/31/18; Politico 5/30/18; Feminist Majority Foundation 12/20/17; NPR 1/4/18; Henry J. Kaiser Family Foundation 11/1/17; Feminist Majority Foundation 9/20/17

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