Virginia Republicans have blocked any attempt to accept the Medicaid expansion: A wealthy state is choosing to keep 400,000 poor Virginians uninsured.

Why Virginia’s Republican Party Is Proud of Keeping Its Poor Uninsured

Why Virginia’s Republican Party Is Proud of Keeping Its Poor Uninsured

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Feb. 18 2015 5:11 PM

Virginia’s False Pride

The state’s Republican Party is proud of keeping its poor uninsured.

Virginia’s Democratic Gov. Terry McAuliffe
Virginia’s Democratic Gov. Terry McAuliffe has, for now, all but given up on pushing for the expansion of Medicaid under the Affordable Care Act in his state.

Photo by Sarah L. Voisin/The Washington Post

Virginia state legislators, especially the Republicans who control both chambers, are feeling very good about themselves these days. The legislative sessions of the past couple years were marked by partisan acrimony, but this year, things are calmer and more harmonious—a restoration of the “Virginia way,” the state’s proud tradition of gentility that suffered such a shock amid last year’s tawdry scandal involving former Gov. Bob McDonnell, his acquisitive wife, and a chatty cook.

“I think people just want to get the work done and show all our constituents that we can get out of here actually on time for once,” Del. Peter F. Farrell, a Republican from the Richmond suburbs, told the Washington Post’s Laura Vozzella. Del. Greg Habeeb, a Republican from Roanoke County, told her this year’s session had been so quiet “because the House Republican caucus is so focused on kitchen-table issues that don’t drive salacious headlines. … It’s been a very productive session, but it’s been an out-of-the-headlines session.” Even the spokesman for the Democratic Gov. Terry McAuliffe got in on the self-congratulation, saying the session is “maybe not interesting if you’re hosting Crossfire, but it’s what Virginians want from their leaders.”

What’s making this year’s session so much more civil than last year’s, when a partisan impasse brought the state to the brink of a government shutdown? It’s not some collective mood swing toward comity. It’s that McAuliffe has, for now, all but given up on pushing for the goal that was at the heart of last year’s standoff: the expansion of Medicaid under the Affordable Care Act. Republicans in Richmond, led by House Speaker William Howell, have dug in against the expansion, despite the fact that virtually the entire cost would be covered by the federal government, that Virginia, as one of the wealthier states in the country, could easily afford its small share of the cost, and that other more conservative states, such as Arkansas and Indiana, are proceeding with the expansion.

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That obstruction is bad enough from the standpoint of the 400,000 low-income Virginians who are left uncovered in the struggling coal counties of southwest Virginia, the inner city of Richmond and Newport News, or the immigrant enclaves of the Washington suburbs. What’s even more remarkable, though, is how Virginia Republicans have managed to cast the mere mention of the expansion as some kind of incendiary hot-button issue intended only to inflame partisan strife, taking the widespread yearning for our more bipartisan politics of yore and using it to smother debate over a very real and consequential policy fight. When McAuliffe dared to mention the expansion in his State of the State speech last month, Republican legislators chided him for bringing up the “divisive issues … that led to last year’s impasse.” How uncouth of him!

Last year, McAuliffe had pushed the expansion to the point of winning a slender majority of support for a market-based version of it in the then– evenly divided Senate, only to see it run aground in the House. Accepting reality, he has decided to hold off on another showdown in this session, calculating that he’ll have better odds of bringing the issue back up next year, once legislators are past this fall’s election—and more importantly, past the Republican primaries preceding the election where they might face a challenge if they dared to go along with expansion. “There’s a recognition that right now the votes aren’t here for this session,” Sen. Adam Ebbin, a Northern Virginia Democrat, told me. “The threat of primaries is looming over any Republican seeking re-election. They’re aware that their votes are being watched back home.”

Not that there haven’t still been some attempts at persuasion. In the House of Delegates, Democrats sent their GOP counterparts letters laying out how many people in each of their districts would be covered by the expansion, a relevant fact considering how many rural districts with large numbers of uninsured are represented by Republicans. “We’ve got [legislators] where 6,000, 7,000 people would get health insurance at no cost … and they’re voting no,” said Del. Scott Surovell, chairman of the Democratic caucus. “We wanted to make sure everyone understood how many people stood to benefit. And it didn’t matter.”

What explains an intransigence that exceeds even that in some more conservative states? One theory is that Virginia’s proximity to Washington has resulted in the toxicity of the Obamacare debate there overflowing into Richmond politics. Others note the heavy investment of the Koch brothers’ Americans for Prosperity in grass-roots organizing against the expansion, which is targeting Republican lawmakers who might go soft. Regardless, opposition to expansion has assumed a profound, almost doctrinal significance among many Virginia Republicans. When I recently asked Morgan Griffith, a Republican who served as majority leader of the House of Delegates before his 2010 election to Congress representing southwestern Virginia, about Virginia’s holding out on the expansion even as some red states accept it, he compared it to the state being the first one to include religious freedom in its Constitution. “Sometimes being an outlier is not a bad thing,” he said. “It’s all right to be an outlier. I’m not worried about being an outlier.”  

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The latest official act of obstruction came last week, when the Senate stripped out the expansion from McAuliffe’s proposed budget and added language prohibiting him from moving forward with the expansion on his own. Now down by two seats in the Senate, and with two of their members out sick, Democrats were unable to even keep the majority leader, Sen. Tommy Norment, from cutting off debate on the issue before the vote. But three senators managed to get in a few words on the floor at the end of the day.

One of them, Northern Virginia’s Barbara Favola, noted that the state’s taxpayers are sending hundreds of millions of dollars to Washington to cover the cost of Medicaid expansion in other states, even as Virginians get none of that benefit. “We’re not going to move forward to insure these 400,000 individuals who don’t have the money to go to the doctor when they’re sick. They won’t receive Pap smears, they won’t receive screenings for high blood pressure, they won’t receive screenings for prostate problems.” Then she cut to the political heart of the matter: “The fear that lawmakers might have [of primary challenges] is nothing compared to the fear that these 400,000 individuals have every day because they now can’t go the doctor when they need one.”

It was, by the standards of the “Virginia way,” an impolitic speech. But Favola told me she doesn’t care if she’s given offense. “When lawmakers aren’t tackling the real important issues, it’s easy to go along and get along,” she said. “It’s a travesty for the state.”

Alec MacGillis, a reporter for ProPublica, worked at the Baltimore Sun from 2000–2005.