Medicaid expansion is all but a reality in Virginia after the state Senate voted Wednesday to provide health coverage to as many as 400,000 low-income residents of the Old Dominion.
The majority-GOP Senate passed the measure with the votes of all 19 Democrats along with a handful of Republican senators, bringing a six-year debate over whether Virginia should accept funding from the Affordable Care Act to expand Medicaid nearly to a close.
The state House of Delegates, also controlled by Republicans, will have to vote on the measure and is expected to adopt it; every House Democrat and 19 Republicans in the lower chamber passed a different Medicaid expansion bill earlier this year. Gov. Ralph Northam (D), who campaigned in favor of Medicaid expansion last year, has said he will sign the legislation.
Once the bill becomes law, Virginia will join 32 states and the District of Columbia in expanding Medicaid. Almost 400,000 Virginians may qualify for health coverage as a result, according to the state’s Department of Medical Assistance Services. Benefits will become available at the beginning of next year, Northam told WTOP-FM Wednesday.
The Affordable Care Act calls for the program’s benefits to be available to anyone earning up to 133 percent of the federal poverty level, or about $16,000 for a single person. Under the law, the federal government provides at least 90 percent of the funding for the expansion.
The Virginia legislation covers the state’s share of the expenses via an assessment on hospitals. The bill also reduces state spending on other programs that provide health care to uninsured people.
As written, the Affordable Care Act would have expanded Medicaid nationwide in 2014. But the Supreme Court ruled in 2012 that states could refuse to enact it. To date, 18 states ― including Virginia ― have not implemented the policy, leaving 4.5 million people uninsured, according to an analysis published by the Urban Institute this month.
Three other states may join Virginia by accepting Medicaid expansion this year. Activists in Idaho and Utah gathered enough signatures from residents to place the question on the ballot for voters to decide this November, and a campaign to do the same in Nebraska is underway. Maine voters approved a similar measure last November, but Gov. Paul LePage (R) has thus far refused to implement it.
Virginia legislators had been at an impasse over the Medicaid expansion since the Supreme Court ruling. Former Gov. Robert McDonnell (R) opposed it, while former Gov. Terry McAuliffe (D) supported it but was unable to persuade lawmakers to go along.
The political dynamics changed when Democrats made significant gains in last year’s House of Delegates elections. Although Republicans retain majorities in both chambers of the General Assembly, the election results left them with just a one-vote margin in the House, the same they had in the Senate.
Although Democrats are poised to succeed in their quest to expand health coverage through Medicaid in Virginia, there is a notable trade-off. The Medicaid expansion legislation also imposes work requirements on some enrollees, which is likely to result in fewer people gaining and keeping Medicaid benefits. President Donald Trump’s administration announced this year that it would permit work requirements for the program for the first time in history.