RICHMOND, Va. — Virginia Republicans are softening their opposition to expanding the state’s Medicaid program, opening the door to a potential bargain with new Gov. Ralph Northam on a long-stalled Democratic priority.
House Speaker Kirk Cox sent letter to the new Democratic governor on Monday saying his caucus “is willing to begin a dialogue on healthcare” as long as certain conditions are met. Virginia Republicans have previously been steadfast in opposing Medicaid expansion, a key part of former President Barack Obama’s health care law.
Cox says his caucus still opposes a “straightforward” expansion of the publicly funded healthcare program for the poor and disabled, and that any discussion must include work requirements and other reforms favored by the GOP.
The shift in tone by Republicans comes after a wave of Democratic victories in November severely reduced the number of GOP delegates in the state House to a 51-49 majority. Republicans have a one-vote majority in the state Senate, but there are enough pro-Medicaid expansion votes to get through the upper chamber.
Cox’s letter comes as conservative state lawmakers around the country are rethinking their opposition to expanding Medicaid under the Affordable Care Act, now that the Trump administration is allowing work requirements for low-income recipients.
But whether Virginia will ultimately expand Medicaid and in and what form is still unknown.
Cox warned Northam not to block Republican requests for federal waiver to mandate work requirements for the state’s existing Medicaid population, a potentially fatal sticking point with the governor.
“If your position is to pass straightforward Medicaid expansion without work requirements or other reforms, then you will be responsible for the failure to provide healthcare coverage to more Virginians,” Cox said.
The state’s current program is highly restrictive. Able-bodied adults with no children are not able to receive benefits regardless of how poor they are. Northam has previously said he opposes strict work requirements.
His spokeswoman, Ofirah Yheskel, said Northam was “encouraged” that Republicans are willing to begin discussions.
“Though he believes the dialog should begin with connecting more Virginians with quality health care, not less,” she said.
Advocates for Medicaid expansion are making a renewed push this year after years of making little progress. Republicans held firm under strong pressure from former Gov. Terry McAuliffe, the business community and state hospitals in 2014, the last time Medicaid expansion was seriously debated.
Legislation pushing for Medicaid expansion was defeated last week by a Senate panel, and most observers expect the debate to revolve around the state budget. McAuliffe proposed a state budget in December that projects a savings of $421.7 million over two years, due to expanding Medicaid.
Republican Senate Majority Leader Tommy Norment said lawmakers are still wrestling with whether to include all of that money, part of it, or none of it when they release their own version of the budget next month.
“The focus has been on Medicaid and I would say it’s almost paralyzing budget discussions,” Norment said.