Virginia, after 5-year battle, passes Medicaid expansion for 400,000 poor people

Doug Stanglin | USA TODAY

After a five-year-battle, the Virginia legislature has voted to expand Medicaid coverage for some 400,000 poor people, despite opposition from the White House.

The Republican-controlled Senate voted Wednesday in favor of a state budget expanding Medicaid and the House of Delegates, which had previously backed the measure, gave its final approval shortly afterward. Several Republicans in both chambers joined with Democrats to approve the measure.

Democratic Gov. Ralph Northam, a pediatrician who made Medicaid expansion a centerpiece of his campaign in 2017, is expected to sign the legislation soon.

“Things take time. They happen in steps here,” Gov. Ralph Northam told reporters after the vote. “The makeup of the House certainly changed.”

The vote makes Virginia the 33rd state to approve Medicaid expansion under the Affordable Care Act, or Obamacare, according to figures compiled by the Kaiser Family Foundation.

The expansion of the government health insurance program was strongly opposed by the Trump administration, which has sought to repeal Obamacare outright.

The move also reflected the state's sharp shift to the left in the 2017 elections in which Democrats picked up 15 seats in the House of Delegates and almost took control of the body.

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.

Virginia GOP Speaker Kirk Cox, however, said the Trump administration's openness to conservative reforms, including work requirements, "was probably the biggest key" in getting Republican support for the Medicaid expansion.

Under the ACA, states may expand their Medicaid rolls to people with incomes up to 138% of the federal poverty level, which is $16,643 for an individual and $28,700 for a family of three. The federal government has pledged to pay at least 90% of the cost. Under this formula, Virginia will receive about $2 billion a year.

In Virginia, which has some of the strictest eligibility requirements in the country, a family of three that makes more than $6,900 a year is no longer eligible for Medicaid coverage under current law.

Senate Majority Leader Thomas Norment Jr., a Republican, said the legislature, in passing the measures, “abandons Virginia’s long-standing reputation for fiscal responsibility.”

In a floor speech, he also noted the tone of the debate, calling the "verbal abuse" he took from groups backing the measure.

“In the years I have been in the Senate, I have never been treated more disrespectfully by some of these advocacy groups,” he said. “Lying down in front of my office . . . with made-up tombstones, asking people to blow their horns when they go past my law office," he said, The Washington Post reports.

Contributing: Associated Press