Virginia's McAuliffe to get creative on Medicaid expansion

June 5, 2014, 1:29 PM UTC

By Steve Benen, Steve Benen

In Virginia, Gov. Terry McAuliffe (D) campaigned on Medicaid expansion as a key element of his 2013 platform, and after taking office, he made it clear to state lawmakers that this is one of his top priorities. Republicans responded by saying they are prepared to do practically anything to block the policy -- including a possible shutdown of the state government.

The governor, however, believes he simply cannot take "no" for an answer. Medicaid expansion would bring coverage to 400,000 low-income Virginians; it would improve the commonwealth's finances in the short term; and it would boost the state's economy in the long term.

And with this in mind, in early April, McAuliffe started consulting with lawyers about how to do the smart thing without the approval of the Republican-dominated House of Delegates. As the Washington Post reported at the time, the office of Attorney General Mark Herring (D) has also been researching the matter.

It's become increasingly clear that the governor isn't bluffing.

Gov. Terry McAuliffe is quietly planning the nuts and bolts of enrolling an additional 400,000 Virginians in Medicaid even as the House of Delegates seems as firmly opposed as ever to expanding the health-care program for the poor. The administration is considering how it would handle the flood of applications that are expected to pour in if expansion comes to pass. Privately run call centers could be an option. The planning comes on top of research McAuliffe's office has conducted into whether he has the power to expand Medicaid by executive order if he cannot get the GOP-dominated House to budge. And it comes to light as McAuliffe is claiming broad authority to keep most, if not all, of the state government running if the standoff prevents passage of a budget before July 1, the start of the fiscal year.

Without a budget, Virginia faces at least a partial government shutdown. The governor insists he won't approve a budget without Medicaid expansion; Republicans insist they won't approve a budget with Medicaid expansion. It's pushed McAuliffe to try to get creative, though the details of his plan remain elusive.

What's quite clear, however, is the merit of the underlying policy. Indeed, Dahlia Lithwick recently published a powerful piece, making the case that she’s “pissed” because “there is no excuse, not one, to block the Medicaid expansion.”

The Commonwealth of Virginia is modeling dysfunction yet again this month, as the legislature fights to the death over Gov. Terry McAuliffe’s proposed two-year, $97 billion budget. The government is imploding in large part due to the fact that state Republicans in the House of Delegates have decided to fight tooth and nail – up to and including shutting down the whole government if this is not resolved by July – to avoid expanding Medicaid benefits to cover up to 400,000 lower-income Virginians who fall into the health care coverage gap. These are the folks who can’t afford to purchase health care under the ACA, but make too much money to qualify for Medicaid. The ACA would have taken care of those people through an expansion of Medicaid – money from the federal government to the states to cover the gap. The high court, in 2012, left it to the states to decide whether to accept the expansion. Virginia is one of the states having a hard time making up its mind. As with all government shutdowns, the answer to “why is this happening?” is “Republicans hate Obamacare.” […] Last week McAuliffe proposed a two-year pilot expansion of Medicaid, which could be canceled if it proved unsuccessful. This seemed very reasonable. The House Appropriations Committee killed it. So yesterday, in Richmond, both the Senate Finance Committee and the Medicaid Innovation and Reform Commission met to argue and vote about stuff. Republicans blamed Democrats. Democrats blamed Republicans. Everyone blamed gerrymandering and gridlock and ideology.

Dahlia added that without Medicaid expansion, it’s quite likely that some struggling Virginians will, in fact, die unnecessarily. She added that “the sheer nihilism on display in Richmond shows what happens when you convince yourself that government can fix nothing.”