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Peter’s Take: Virginia Medicaid Expansion – Let’s Make a Deal

Peter’s Take is a weekly opinion column. The views and opinions expressed in this column are those of the author and do not necessarily reflect the views of

Given the 2017 election results, Virginia’s Democratic legislators are in a much better position than ever before to expand Medicaid under the Affordable Care Act. This is their top 2018 joint legislative priority.

Virginia Democratic legislators can’t do this alone. They lack a majority in both legislative branches.

Virginia Republican legislative leaders still seem cool to the idea. But Senate Majority Leader Tommy Norment (R) has acknowledged: “I do think we’ll see something this year for health care for lower-income Virginians. I’m not saying full Medicaid.”


Gov. Ralph Northam (D) and Democratic legislative leaders must negotiate aggressively with Republicans to reach the best possible deal.

Virginia is losing out on $6.6 million a day in federal money by not expanding Medicaid eligibility to roughly 400,000 low-income Virginia adults.

Under the ACA, states can choose whether to expand Medicaid to cover people making up to 138 percent of the federal poverty level, or about $16,640 for an individual. The federal government currently picks up almost all the cost, although that percentage is scheduled to decline to a 90 percent federal share by 2020.

About half of the 31 states that have chosen the Medicaid expansion have Republican governors.

One of those Republican governors is Ohio’s John Kasich. Kasich has forcefully criticized Donald Trump’s failed efforts in 2017 to gut the Medicaid expansion program:

“That is a very, very bad idea, because we cannot turn our back on the most vulnerable,” Kasich said. “We can give them the coverage, reform the program, save some money, and make sure that we live in a country where people are going to say, ‘at least somebody’s looking out for me,'” he said. “It’s not a giveaway program — it’s one that addresses the basic needs of people in our country.”

Michigan’s Republican Governor Rick Snyder agreed, touting “Michigan’s embrace of the Medicaid expansion, which has covered 642,000 people in the state.”

Virginia Republican legislative leaders can pick and choose from among a whole host of Medicaid expansion options pioneered by Republican leaders in other states. Besides Ohio and Michigan, Virginia Republican leaders can look to states like Arkansas or Pennsylvania. From Vox:

Prior to 2018, Virginia Republican leaders offered a variety of excuses for not following the example set by Republican leaders in any of these other states. They argued that Virginia could not afford the 10 percent share of the costs that the federal government ultimately will not cover. But, that particular Republican argument was taken off the table when Virginia’s hospitals offered to cover the state’s share.

Virginia Republicans also argued during most of 2017 that the ACA was going to be repealed. That never happened. And, Republicans like Kasich and Snyder have had the courage to fight successfully for their covered residents. Virginia Republican leaders should emulate them.

Finally, Virginia Republicans have argued that there is fraud and abuse in Virginia’s Medicaid program. While it is true that some fraud and abuse has been identified, there is a detailed roadmap for fixing those problems. There is no reason not to simultaneously implement the identified fraud and abuse safeguards and expand Medicaid.


Virginia Democratic and Republican legislative leaders must work together to reach a bipartisan solution to expand Medicaid. It’s the right thing to do. The benefits substantially outweigh the costs.

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