On April 11, 2018, Virginia legislators will return to Richmond for a special session in which they will aim to finish work on the Commonwealth’s budget.  At center stage, yet again, is the issue of Medicaid expansion, still unresolved eight years after Obamacare became law.

Medicaid is a deeply flawed program that was meant to cover the truly needy.  Expansion would bust Virginia’s budget, requiring future tax increases or cuts to other government services.  And it would shove hundreds of thousands of Virginians onto government-run healthcare, the real goal of those pushing expansion.  Doctors increasingly do not accept Medicaid patients, and jobs and businesses are not going to feel confident about investing in a state that has a budget consumed by social programs. 

From June 2012, when the Supreme Court upheld Obamacare but made the Medicaid expansion component optional for states, until January 2014, Virginia had a Republican governor and a two-thirds Republican majority in the House of Delegates.  Medicaid expansion had no chance of passing.  In January 2014, Terry McAuliffe (D) took over as Governor.  For the entirety of his nonrenewable four-year term, he pushed Medicaid expansion at every opportunity, without any success.  For much of his time in office, McAuliffe and Missouri’s Jay Nixon were the only Democratic governors in America whose states had not expanded the program.  In McAuliffe’s case, this was thanks to the fortress of opposition in the Republican-dominated House of Delegates.

The Virginia State Senate, by contrast, has been closely divided for more than a decade, with narrow Democratic control from January 2008 to January 2012 and then a 20-20 tie that was broken by a moderate Republican Lieutenant Governor from January 2012 until January 2014 and then by a Democratic Lieutenant Governor from January 2014 until June 2014, when a Democratic Senator resigned, causing Republicans to take a 20-19 majority that was extended to 21-19 when a Republican won the seat in an August 2014 special election.  That 21-19 Republican edge survived the 2015 elections and has held to this day; the next State Senate election is not until November 2019.

In the November 2017 elections, however, the Republican edge in the House of Delegates evaporated from 66-34 to 51-49.  McAuliffe’s Democratic successor, Governor Ralph Northam, has been dealt a much better hand.  Sure enough, twenty Republican Delegates flipped to supporting expansion, including their new Speaker, Kirk Cox.  The House-passed version of expansion includes a work requirement. 

The one obstacle to Virginia expanding Medicaid is the 21-19 State Senate.  The Senate passed a budget that did not include an expansion of Medicaid; this is the source of the stalemate that legislators and the governor will attempt to resolve next month.  By all accounts, opposition to expansion is hanging by a thread; if one Republican State Senator switches, that’s it.  Senator Emmett Hanger has supported Medicaid expansion in the past; he is viewed by Democrats as a gettable vote.  However, he opposed the 2018 House-passed expansion because it included a tax on hospitals, which would harm his rural district. 

Senator Hanger needs to hear from his constituents and all Virginians.  He needs to hear that Medicaid expansion is crowding out those for whom the program was originally created.  He needs to hear about the waiting lists that have been created for the needy.  He needs to hear how and why Medicaid is crowding out state budgets, how it accounted for less than 10% of state budgets in 1985 and more than 29% of total state spending in 2016.

Speaker Cox and the nineteen other Republican Delegates who voted for Medicaid expansion need to hear from Virginians as well.  The people who have voted for them for years, enough of whom turned out to provide their bare majority after the last election, do not want the Commonwealth to take on this massive budget buster and throw more Virginians onto government healthcare.

And President Trump, Health and Human Services Secretary Alex Azar, and Republicans in Washington need to hear us, too.  If they had kept their promise and repealed Obamacare, the states that had not expanded Medicaid would be sitting pretty while liberal states would be forced to reckon with their fiscal irresponsibility.   

Instead, progressives are sitting back and laughing while Republicans abandon what they used to believe.