Virginia is inching closer to providing health care to 400,000 low-income residents after a key state Republican signaled this week that he was willing to split with his party and support Obamacare’s Medicaid expansion.

Virginia is among 18 states that have not expanded Medicaid under the Affordable Care Act (ACA), leaving roughly 400,000 in a “coverage gap” — meaning, they’re uninsured because they make too much to qualify for Medicaid but too little for subsidized private insurance. But this year, the state legislature could change that, thus fulfilling a goal Democrats have been trying to accomplish for years.

Democrats need two Republicans in the state Senate to pass Medicaid expansion as part of the main budget — Republicans control 21 seats and Democrats 19 — and on Friday, state Sen. Frank Wagner (R) joined state Sen. Emmett W. Hanger Jr. (R) in saying that he was willing to support expansion on certain conditions.

In an op-ed @vafrankwagner signals willingness to expand Medicaid in exchange for a tax credit for those with insurance struggling with their premiums, co-pays and deductibles. He estimates it would cost $150 million dollars. #vagov @wcve pic.twitter.com/f3bAAYuAbn — Craig Carper (@Craig_Carper) April 6, 2018

Wagner wants, for example, to condition Medicaid eligibility on work and provide a more generous tax credit for those who buy insurance on Healthcare.gov. Hanger, on the other hand, wants to eliminate a hospital “bed tax,” which would be used to pay for the expansion.


Gov. Ralph Northam called for a special legislative session, which begins April 11, after the House and Senate couldn’t reconcile differences on a two-year spending bill, largely due to ongoing negotiations over Medicaid expansion. Both chambers need to agree on a budget by July 1 to avoid a shutdown.

There’s a sense of optimism now that the state Senate may join the House and add Medicaid expansion to the main budget — but nothing is certain. Senate Majority Whip William Stanley (R), an ardent opponent of Medicaid expansion, said in a conference call Thursday, organized by the conservative group Americans for Prosperity, that his party was “21 strong” and that he did not believe Republicans would get their concessions. According to the Washington Post, other than Hanger, Stanley did not refer to any other potential Republican defectors by name. State Senate Republican leadership also rebuked Wagner’s concessions, saying they’re “as distant from the respective plans being advocated by the Governor and the House as the Senate’s budget plan.”

This is the closest Virginia has come to passing Medicaid expansion, largely due to the fact that Democrats made big gains in the House of Delegates last November. The Virginia’s gubernatorial race saw historic voter turnout, and many were driven to the polls because of health care. Going into the election, Republicans held a 66-34 majority, but now barely maintain control at 51-49. All 40 state Senate seats are up for election in 2019.

“I think the House heard that message, loud and clear. I think the Senate still needs to listen a little bit,” Gov. Northam told NPR.

There’s a catch-22 for progressives, as Virginia will likely expand Medicaid with work requirements. The Virginia House approved a budget with Medicaid expansion in February that included work requirements for some beneficiaries. Northam was noncommittal when asked by Vox whether he could support Medicaid expansion with work rules.


“It’s not a perfect plan,” a communications official for Planned Parenthood Virginia tweeted following the House vote. “We remain concerned about the proposed work requirements. Access to healthcare is a right and shouldn’t be restricted to those who are able to work.”

By rejecting Medicaid expansion, Virginia gives up $142 million of federal funding every month, according to one estimate.

This post has been updated to include statement from state Senate Republican leadership.