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Peter’s Take: Prospects Improve for Virginia Medicaid Expansion

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

Full Virginia Medicaid expansion is the top 2018 legislative priority.

I strongly support this priority to ensure that our most vulnerable citizens gain health coverage.

7,700 currently uninsured Arlington residents will have much healthier lives with full Medicaid expansion.

However, since Democrats lack a majority in both legislative branches, they must make a deal with Virginia Republicans to expand Medicaid.

Virginia House of Delegates

In the House of Delegates (HOD), the dam broke earlier this year during the regular legislative session when Del. Terry Kilgore (R-Scott), the Chairman of the HOD Commerce and Labor Committee, announced he would back expansion because, according to The Washington Post, “his struggling coal-country district would get the ‘hand up’ it desperately needs if more uninsured Virginians were made eligible for the federal-state health-care program.”

Kilgore’s announcement was key to gaining the support of a substantial number of additional HOD Republican legislators who have supported an HOD budget plan. From the Richmond-Times Dispatch:

“That would accept $3.2 billion in federal money to pay for 90 percent of the cost of expanding the program on Jan. 1, 2019 [to 300,000 Virginians], while relying on a new ‘provider assessment’ on hospital revenues to cover the state’s share of the cost of health coverage for currently uninsured Virginians whose care is uncompensated.”

However, these HOD Republicans joined Kilgore in tying their support to certain conditions and limitations:

“Kilgore said work requirements like those the Trump administration has allowed Kentucky to impose, coupled with a mandate that recipients contribute a ‘small co-pay,’ would make for “a conservative approach” to expansion.”

Virginia Senate

At least two Republican Senators now have conditionally endorsed expansion. From The Washington Post:

“One of them — Emmett W. Hanger Jr. (Augusta) — has supported certain forms of expansion for years, though he opposes the hospital tax [‘provider assessment’].”

Frank W. Wagner (R-Virginia Beach) last week authored a guest column in which he supported expansion under certain conditions. From the Post:

“Those include a tax credit for middle-income people who already have insurance but are struggling to pay soaring premiums and co-pays. He also wants to beef up the work requirement that the House wants imposed on Medicaid recipients.”

Expansion scenarios now

There are at least 5 possible Medicaid expansion scenarios:

  1. Expansion with a perk for lower-middle class. Wagner’s proposal.
  2. Expansion but no hospital tax. Hanger’s proposal.
  3. Expansion with work requirements.The HOD proposal.
  4. Full expansion, no work requirements. Northam’s proposal; unlikely to happen.
  5. No expansion at all. That’s what 19 Senate Republicans currently say they want; unlikely to happen.


As Governor Northam has advocated, Democrats’ long-term goal must continue to be full Medicaid expansion. But, overriding even that goal, Democrats must help people who are dying, or who are much sicker than they need to be because of untreated illnesses. For this reason, Democrats should make the best possible deal with Republicans.

Support for Medicaid expansion has been provided by leading business groups like the Northern Virginia Chamber of Commerce. This has led to major Republican support expressed by the chairs of the General Assembly’s Commerce and Labor committees. New Republican HOD Speaker Cox’s support also is noteworthy.

A final decision on Medicaid expansion probably is weeks away because:

  • hundreds of millions of spending on other budget needs are tied to Medicaid expansion
  • Senate Republican leaders want to see new revenue projections first

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