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If Virginia Medicaid Expansion Passes – Hopefully This Week – Who/What Should Get Credit? [UPDATED: It Passed]

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It’s looking increasingly likely – although of course nothing’s over ’til it’s over, don’t count your chickens before they hatch, etc. – that Virginia will finally expand Medicaid, quite possibly this week after the Memorial Day weekend. Again, it’s possible it could still fall apart, but I’m cautiously optimistic that finally – at long last – Medicaid expansion’s really going to happen (note: as one Democratic elected official noted to me, it’s definitely not time to do an end-zone dance on this; perhaps right now, to continue the football metaphor, it’s first and goal?). If Medicaid expansion does pass the Senate, who/what should get credit? I’ve been observing this closely myself, and also talking to folks who have been in the middle of this debate. Based on all that, here’s my rough ranking – in descending order – of who or what should get credit (note: not who/what necessarily WILL get credit, but who/what SHOULD get credit) if/when Medicaid expansion finally becomes a reality here in Virginia.

P.S. It should go without saying that getting Medicaid expansion is more important than who gets credit. Still, I think it’s interesting to look at who was involved in getting us to where we’re at…

  1. The November 2017 elections, which resulted – thanks to a backlash against Donald Trump, including an upsurge in activism, intensity and political participation by progressives – in Democrats picking up 15 seats in the Virginia House of Delegates. This one is absolutely crucial — really can NOT be overstated — as a key factor in the fact that we’re now apparently on the cusp of Medicaid expansion in Virginia. Without those 15 pro-Medicaid-expansion Democrats replacing 15 anti-Medicaid-expansion Republicans, this simply wouldn’t be happening. Honestly, I’m not even sure it would be happening if Democrats had picked up half a dozen seats, but the number 15 certainly got Republicans’ attention and changed their calculus, at least in the House of Delegates. Also note that, other than anti-Trump energy, arguably expanding Medicaid was the top issue in the 2017 Virginia elections…
  2. U.S. Senate Democrats, plus Republican U.S. Senators John “Thumbs Down” McCain, Susan Collins and Lisa Murkowski, all of whom voted no to Republicans’ attempted repeal of “Obamacare” in July 2017. With that, one of the key excuses by Virginia Republicans to not expanding Medicaid disappeared, as it looks like the Affordable Care Act is here to stay (although of course Republicans have been working hard to sabotage it).
  3. The end of Barack Obama’s presidency removed a convenient – albeit ludicrous – target for Republicans and also might have caused Americans to reassess their views of “Obamacare,” which saw its approval ratings reach all-time highs following Trump’s election. (note: an April 2018 poll here in Virginia found “overwhelming” support – 64% to 24% – for Medicaid expansion)
  4. The end of Terry McAuliffe’s governorship and Bill Howell’s Speakership also helped, as I’m told that Republicans simply didn’t like McAuliffe or want to work with him, and also that Howell was dead sent against Medicaid expansion. So…happy retirement to both of those guys, but when it came to Medicaid expansion, it just wasn’t working out.
  5. Several General Assembly Republicans deserve credit for moving from “no” to “yes,” including State Sen. Emmett Hanger, Speaker Kirk Cox, Del. Chris Jones, Del. Terry Kilgore, Del. Will Morefield, Del. Terry Austin, Del. Riley Ingram, Del. Barry Knight, Del. Scott Garrett, Del. Robert Orrock and several others. Political calculation? Sure, at least in part. But without these folks – and hopefully a few others, such as Sen. Frank Wagner, maybe even Sen. Jill Vogel, next week – we’d still probably be stalemated on this issue.
  6. Democrats in the House of Delegates (e.g., Minority Leader David Toscano, Democratic Whip Alfonso Lopez) and State Senate (e.g., Dick Saslaw, Janet Howell, Jennifer McClellan), as well as across Virginia at all levels of government, who have pushed Medicaid expansion for years.
  7. The Virginia Hospital & Healthcare Association (VHHA) – including its President/CEO Sean Connaughton and his team – has done great work on expanding Medicaid over the past few years. That includes pushing effective and crucial arguments about why Virginia needs Medicaid expansion – jobs, the economy, the health of rural (and non-rural) hospitals, hundreds of thousands of Virginians gaining access to quality health care, etc.
  8. The Healthcare for All Virginians Coalition – “made up of more than 110 organizations across the commonwealth that believe that all Virginians should have access to affordable and quality health coverage” – which pushed relentlessly for Medicaid expansion. Just a few of those 110 organizations are are ProgressVA, the Commonwealth Institute for Fiscal Analysis, AARP Virginia, the Virginia Poverty Law Center, the Virginia AFL-CIO, SEIU Virginia 512, Planned Parenthood Advocates of Virginia, Virginia New Majority, the Virginia Coalition of Latino Organizations, Virginia Organizing…
  9. Numerous Republican former and current Virginia elected officials who have written op-eds supporting Medicaid expansion: Bill Bolling: It’s time to close the health care gap in Virginia (March 24, 2018); Frederick M. “Fred” Quayle: Health plan compromise will work for Virginia (March 5, 2018); Morgan, Rust, and May column: The House budget is a solid fiscal plan (March 21, 2018); Preston Bryant: The Fiscal Case for Medicaid Expansion (April 9, 2018); Frank Wagner: Health plan could help 2 million Virginians (April 10, 2018); Jeff McWaters: The conservative case for health coverage in Virginia (April 7, 2018); Russ Potts: Find a way – House and Senate pols need to forge a compromise to expand Medicaid (May 4, 2018); John Watkins: Both parties can champion health care reform (February 24, 2018); Ron Villanueva: Medicaid expansion will help economy; Don Merricks: The General Assembly needs to act (May 25, 2018); etc. If nothing else, these folks might have provided some political and intellectual cover for current Republican elected officials who were thinking about flipping to “yes” on Medicaid expansion.
  10. The whopping 21 Virginia Chambers of Commerce from across Virginia (including in very “red” parts of the state) that endorsed Medicaid expansion earlier this month.
  11. The U.S. Supreme Court, which repeatedly has voted to uphold the Affordable Care Act (although mixed bag here, as the SCOTUS also ruled that states could opt out of Medicaid expansion, which led to the stalemate here in Virginia in the first place).
  12. The Northam administration, including Secretary of health and Human Resources Dan Carey and Finance Secretary Aubrey Layne, which has worked hard on what is clearly their top priority.
  13. The many newspaper editorial boards that have weighed in for Medicaid expansion. These include the Washington Postthe Virginian-Pilot, the Roanoke Times, the Staunton News Leader, the Fauquier Times, the Bristol Herald Courier, the Lynchburg News and Advance, etc. I’m not sure how much clout newspaper editorials have anymore, but it is striking how most editorial boards have reached the same conclusion – expand Medicaid now.
  14. Right-wing radio host and former Virginia Trump campaign co-chair John Fredericks, who in March 2017 admitted to Terry McAuliffe that, when it came to Medicaid expansion: “you were right, I was wrong. You were absolutely correct because now what we’re finding out, is that no matter what the replacement plan for Obamacare, those states that expanded Medicaid are going to continue to get funded, perhaps in perpetuity just like you argued for 36 months.” Since then, Fredericks has been relentlessly pushing for Medicaid expansion to his right-wing audience. I’m not sure how much that has helped, but at the least it might have helped defuse some of the hostility and ignorance on the right to Virginia Medicaid expansion. (Note that Fredericks has not been the only helpful conservative voice on this topic, but he’s the only one with a daily Virginia politics radio show).