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McAuliffe can only go so far on Medicaid expansion

Virginia Republicans have "won" the fight -- 375,000 low-income Virginians will not have access to affordable care, for reasons that defy moral comprehension.
Virginia Governor Terry McAuliffe during a news conference at the Patrick Henry Building in Richmond, Va.,  Monday, March 24, 2014.
Virginia Governor Terry McAuliffe during a news conference at the Patrick Henry Building in Richmond, Va., Monday, March 24, 2014.
In the early summer, Virginia Gov. Terry McAuliffe (D) dropped not-so-subtle hints about his intentions: he was fully prepared to embrace Medicaid expansion by somehow circumventing Republican state lawmakers.
The governor said in June his Department of Health and Human Resources "will have a plan on my desk by no later than September, first detailing how we can move Virginia health care forward even in the face of the demagoguery, lies, fear and cowardice that have gripped this debate for too long."
McAuliffe, who ran on a platform of Medicaid expansion during his successful campaign last year, followed through, but it turns out there's a pretty severe limit on what a governor can do in the face of unyielding legislative opposition.

Gov. Terry McAuliffe (D), who vowed in June to defy the Republican-controlled legislature and expand healthcare to 400,000 uninsured Virginians, unveiled a much more modest plan Monday after being thwarted by federal rules and a last-minute change to state budget language. McAuliffe outlined measures to provide health insurance to as many as 25,000 Virginians, just a fraction of those he had hoped to cover by expanding Medicaid under the Affordable Care Act.

No one can doubt the governor's efforts -- he tried everything he could think of. But in order for Virginia to do the smart and responsible thing, the GOP-led legislature would have to do what policymakers in most states have done: embrace the basic arithmetic of Medicaid expansion.
And Virginia Republicans simply would not budge. To this extent, far-right GOP lawmakers "won" the fight -- roughly 375,000 low-income Virginians will not have access to affordable medical care, for reasons that defy moral comprehension.
The governor has vowed to keep fighting, but no one sees a scenario in which Virginia Republicans suddenly do the sensible thing, at least not anytime soon.
Sam P.K. Collins summarized how McAuliffe's new policy would work: "The plan uses $40 million in leftover state funds to expand coverage to those without insurance -- particularly children of state employees and those struggling with mental health issues. A report detailing McAuliffe's plan also highlights an increase in educational outreach and assistance to residents during the fall open enrollment period for the federal insurance marketplace. "
I’m reminded once more of Dahlia Lithwick’s  powerful piece on this, 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.”
For more on how we got to this point, take a look at our coverage from June.
As for the larger context, I should note that the broader trend on Medicaid expansion is generally quite positive, at least so far as helping families is concerned. 
But the dead-enders and remaining holdouts are causing suffering for no reason. In addition to Virginia, policymakers in North Carolina are hurting the state on purpose, too: "North Carolina taxpayers could spend more than $10 billion by 2022 to provide medical care for low-income residents of other states while getting nothing in return, a McClatchy Newspapers analysis shows."
Senate Minority Leader Mitch McConnell (R-Ky.), whose hatred for the Affordable Care Act is limitless and untied to reality, recently conceded that Medicaid expansion is almost certain to remain in place indefinitely. There are apparently some state lawmakers who've missed the memo.