As a gubernatorial candidate, Bob McDonnell recognized that health care becomes more expensive when uninsured people go to emergency rooms for routine ailments.

So he made this promise in a September 2009 policy paper: "The McDonnell administration will increase the funding provided to Virginia"s community health centers and free clinics."

Since coming to office, however, McDonnell has repeatedly tried to cut funding to community health centers, free clinics and other "safety net" organizations that serve the uninsured and medically underserved.

Let's start this follow-up on his campaign pledge with a little background.

There are 183 safety net health providers in the state and they served about 230,000 people last year, according to Deborah Oswalt, executive director of the Virginia Health Care Foundation.

That's a small portion of the 1 million Virginians Oswalt estimates lack health insurance. Of them, about 703,000 are non-elderly adults who live at twice the federal poverty rate or below. The children of these low-income people are eligible for the state's health care program Family Access to Medical Insurance Security.

Adults are eligible for Medicaid if they have children and live in a household with income at 30 percent or below the poverty line -- giving Virginia one of the strictest thresholds for Medicaid eligibility in the nation.

Obamacare, which was signed in March 2010, could change that by expanding Medicaid. It initially required states in 2014 to cover all non-elderly people from households with incomes up to 133 percent of the poverty line, with the federal government paying the entire cost for the newly-eligible recipients for the first three years.

In essence, the law required states in 2014 to move a large swath of their uninsured residents to Medicaid.

Now, let's return to McDonnell. He became governor in January 2010. The nation was crawling out of recession and McDonnell inherited a $4 billion shortfall in revenues needed to support existing state programs.

McDonnell's predecessor -- Democrat Tim Kaine -- left behind a budget-balancing plan that included a 10 percent funding cut to safety-net health organizations over the next two fiscal years, saving $1.9 million. McDonnell, while critical of Kaine's overall budget proposal, incorporated the 10 percent safety-net cut in budget amendments he submitted to General Assembly that February. Legislators, however, rejected the reduction.

In December 2011, McDonnell again sought to cut the state's annual appropriation of $9.6 million for safety-net facilities. He recommended a 2 percent reduction for the fiscal year beginning July 1, 2012, and a 50 percent cut for the following budget year. Legislators, again, rejected the idea.

When McDonnell urged the cuts, he expected many of those served by free clinics and community health centers would be swept into the Medicaid expansion required by Obamacare, according to Jeff Caldwell, a spokesman for the administration until recently.

But the future of Obamacare was uncertain at the time. The U.S. Supreme Court had agreed to hear a challenge to the law. McDonnell was among many Republicans who said the law was unconstitutional.

In June 2012, the high court upheld Obamacare but struck down the provision requiring states to expand Medicaid. Enlarging the program became optional. McDonnell and the General Assembly earlier this year put Virginia's decision in the hands of a new commission charged with determining whether expansion would save the state money and improve the delivery of healthcare. The governor and some GOP leaders portrayed the panel as a "firewall" that will prevent Medicaid growth unless major changes to the program are made in Washington and Richmond.

Even if there is expansion, Oswalt says there will be a need for the safety net providers and added state support.

"There still will be more uninsured people that are eligible for services than the safety net currently serves," she said.

The bottom line is that McDonnell has taken no action to keep his campaign pledge to increase funding for free clinics and community health care centers, which has remained at a static $9.6 million a year since he came to office. Contrary to his vow, McDonnell has tried twice to cut that appropriation, only to be stopped by the General Assembly.

We rate this a Promise Broken.