Virginia Lawmaker: Medicaid Expansion Is the Compromise

Democrats in Virginia and around the country rebuked Virginia Gov.-elect Ralph Northam for softening on a campaign promise to push for Medicaid expansion in a recent interview with the Washington Post. Newly elected state Delegate Lee Carter, a Democratic Socialist, says enough is enough, warning that Northam may be alienating the Democrats who put him in office.

Northam told the Washington Post last weekend that he will not try to force a vote on expanding Medicaid — an issue that was central to his campaign — in the legislature. Responding to criticisms, the governor-elect’s spokesperson told the Washington Post that Northam still wants to expand the program. Northam also renewed his commitment to Medicaid expansion on social media following the outcry.

I have and will continue to advocate for Medicaid expansion because it is a no-brainer for Virginia families, our budget, and our economy. We can also come together on smart policy choices that will allow us to deliver better care at lower cost.

— . (@RalphNortham) December 17, 2017

Still, it remains unclear whether Northam will ask the legislature for a straight up or down vote on the measure or instead try to work out a compromise that may include reforms that could actually reduce Medicaid eligibility for some people.

Northam will enter office in January with a slate of newly elected Democrats, including Carter — a 30-year-old marine veteran who toppled the Republican House whip in the November election.

“It’s important to recognize that there are 750,000 Virginians with no health insurance whatsoever. So when we’re talking about the Medicaid expansion — there’s 370,000 people who are eligible under the federal rules,” Carter said in an interview with The Intercept. “So a clean Medicaid expansion only covers half of those people. A clean Medicaid expansion is the compromise. That’s where I’m coming from, that’s what I hope he’d be advocating for. I don’t think his comments were indicative of that.”

Carter himself has not had health insurance for nearly a year, as purchasing coverage through the health care marketplace can be cost-prohibitive. He thought about how that might change on the night he won his election, reportedly telling his wife, “You know what I won? Health insurance.”

Virginia is one of a handful of states that has yet to utilize the Affordable Care Act’s provision to expand Medicaid access. Republicans in the state legislature have been blocking the move, but the Democratic wave in November makes the body nearly evenly split. Northam would only have to swing a handful of Republicans in order to fully expand the program.

As a candidate, Northam made expanding Medicaid a cornerstone of his bid for governor. He highlighted that promise in campaign commercials aired throughout the state, a fact that was not lost on his supporters:

Here's @RalphNortham calling anyone who thinks Virginia shouldn't expand Medicaid "needs their head examined" – today he walked back this promise. pic.twitter.com/oTAHKF6kuw

— People for Bernie (@People4Bernie) December 17, 2017

But he wavered on that promise in his recent interview with the Washington Post. Summarizing his view, the paper wrote, “Northam said he has no plans to try to force Republicans to accept a broad expansion of Medicaid. Instead, he has begun talks with lawmakers in both parties about overhauling the state’s Medicaid system to expand access to health care while better defining eligibility to control costs.” Later in the interview, Northam said he consulted with both Democratic and Republican lawmakers and that he plans to instead push for a bipartisan solution that could involve, among other things, encouraging those who do not currently work to work. “I want people to have skin in the game. I want to incentivize people to really have good health,” he said.

Carter believes voters will punish Democrats if the party does not make progress on expanding health care coverage.

“There was a clear mandate from the voters on health care. I mean it was completely unambiguous,” he said. “750,000 Virginians with no health insurance whatsoever. There’s a million or two million more who have health insurance but can’t afford their deductible. Something has got to change on health care. It’s got to change in a dramatic matter. And if we don’t deliver on that, in two years there’s gonna be hell to pay.”

Former Virginia Democratic Rep. Tom Perriello, who unsuccessfully challenged Northam for the Democratic nomination earlier this year, pointed out on Twitter that the Medicaid promise was a big part of the Democrats’ success last month:

Blocking Medicaid expansion was a major reason so many Republicans lost their House seats in VA this year. Full expansion should be bi-partisan, and every legislator in Richmond should have to cast a public vote before 2019 on a policy that is morally right & good for VA economy.

— Tom Perriello (@tomperriello) December 17, 2017

Indeed, an NBC exit poll found that 37 percent of Virginia voters said health care was the most important issue to them. University of Maryland polling released earlier this year found that 69 percent of Virginians supported Medicaid expansion.

Northam has also made getting a full Medicaid expansion more difficult by so-far not appointing Republicans from the legislature into his administration. Doing so would trigger special elections that could throw control of the legislature to the Democrats instead.

Carter expressed some disappointment in the governor-elect’s move.

“It certainly would’ve made it easier to achieve our legislative priorities if he had done that,” Carter said of appointing a Republican to a cabinet position. “It’s not necessarily the decision I would have made, but it wasn’t the decision for me to make.”

Top photo: Lee Carter, a socialist who won a seat during this year’s elections in the Virginia House of Delegates for the 50th District, poses on November 9, 2017 in Manassas, Virginia.