Months before Virginia Gov.-elect Ralph Northam rode a massive Democratic wave of progressive support into victory in November, he ran on a platform that specifically championed expanding Medicaid, which offers health insurance to low-income people. Northam, whose campaign website currently shows him providing medical care to a child and whose logo features heart monitor imagery, campaigned on the issue by pointing to a June 2016 speech in which he argued for Medicaid expansion on moral and economic grounds.

“Together, we will move forward to expand Medicaid, so 400,000 hardworking Virginians—including 15,000 veterans who have served our country—can get the health care they deserve,” Northam says in a campaign ad that uses the speech. “Every day we don’t expand Medicaid, we’re losing $5 million dollars to surrounding states that we’re competing with.“

Medicaid expansion is a major aspect of the Affordable Care Act, but was rendered optional by a 2012 Supreme Court ruling, leading many states with Republican legislatures or governors to refuse to expand the program. Former Virginia Gov. Terry McAuliffe (D), who tried unsuccessfully several times to expand Medicaid, championed Virginia as the next state to expand the program at Northam’s victory party. He noted the main obstacle to the policy—a slate of anti-expansion Republican lawmakers—was being routed by progressive upsets across the state.

Just over a month since Northam’s election, however, the Gov.-elect appears to be sending mixed signals regarding his intentions on Medicaid. In his first interview since the vote, Northam told the Washington Post that he did not intend to force the state GOP’s hand:

…Northam said he has no plans to try to force Republicans to accept a broad expansion of Medicaid. Instead, he has begun talks with lawmakers in both parties about overhauling the state’s Medicaid system to expand access to health care while better defining eligibility to control costs.

Approximately 68 million people are on Medicaid, including children, pregnant people, the disabled, the elderly, and low-income people. One of the main talking points against expanding the program is that many “able-bodied” people who can just get a job are on Medicaid. Republican lawmakers have long been trying to instill a work requirement for beneficiaries — something the Trump administration has said it is willing to consider on a state-by-state basis. But as the Kaiser Family Foundation has noted, a majority of adults on Medicaid are already working, and 8 in 10 live in working families.


In addition to saying that the state would need to better define eligibility,Northam also highlighted that many people on Medicaid can work. “I want to help them get back on the workforce [through] training,” he said.

The news outraged several progressive commentators, such as Crooked Media founder, popular podcaster, and former speechwriter for President Barack Obama Jon Favreau.

“I would urge Ralph Northam and his staff to clarify his Medicaid position as fast as possible or he’ll deserve the wrath he gets from Democrats everywhere,” Favreau tweeted.

Several hours later, Northam appeared to do just that, tweeting that he “will continue to advocate for Medicaid expansion because it is a no-brainer for Virginia families, our budget, and our economy.”

I have and will continue to advocate for Medicaid expansion because it is a no-brainer for Virginia families, our budget, and our economy. We can also come together on smart policy choices that will allow us to deliver better care at lower cost. — Ralph Northam (@RalphNortham) December 17, 2017

But the tweet also included a second sentence whose meaning wasn’t immediately clear: “We can also come together on smart policy choices that will allow us to deliver better care at lower cost.”


Some progressive commentators wondered whether Northam was referring to work requirements for Medicaid access. Any uncertainty regarding Northam’s position is unlikely to play well in Virginia, where expanding Medicaid is a deeply popular. A September University of Mary Washington poll found that 70 percent of Virginia adults favor increasing access to the program.