Virginia moved Wednesday to become the 33rd state to expand Medicaid coverage through the Affordable Care Act, ending a years-long impasse in the state Legislature and clearing the way for some 400,000 low-income residents to get health coverage.
The breakthrough — made possible by a coalition of Democrats and a handful of Republicans in the statehouse — continues the expansion of the government safety net made possible by the 2010 healthcare law, often called Obamacare.
Virginia’s move also serves as something of a retort to President Trump and his Republican allies in Congress, who have called for sweeping cuts in federal aid to states for Medicaid.
“The bipartisan vote is a long-overdue step towards giving hundreds of thousands of Virginians access to healthcare,” U.S. Sen. Tim Kaine (D-Va.), a former Virginia governor, said in Twitter post Wednesday. “Now let's get it done!”
Virginia is the second state to expand Medicaid since Trump was elected. Last November, voters in Maine overwhelmingly backed a state referendum to expand coverage, though the state’s GOP governor has resisted implementing the expansion.
Later this year, Medicaid expansion initiatives are expected to be on the ballot in at least three more states, including Idaho, Nebraska and Utah. The District of Columbia has also expanded Medicaid eligibility.
Medicaid, the half-century-old government health plan for the poor, is a pillar of the 2010 healthcare law’s program for guaranteeing coverage, and it has helped drive a historic drop in the nation's uninsured rate.
Surveys indicate that at least 20 million previously uninsured Americans have gained coverage since 2014, though polling suggests the coverage gains have slowed or even reversed since Trump took office.
The law makes hundreds of billions of federal dollars available to states to extend Medicaid coverage to poor adults, a population that had been largely excluded from the safety net program.
Medicaid eligibility historically was limited to vulnerable populations, such as low-income children, pregnant women, the elderly and people with disabilities.
Most states moved to expand eligibility as soon as the healthcare law made additional federal aid available.
But GOP opposition — concentrated in the Deep South and the Great Plains — had left nearly 3 million low-income Americans without insurance in the states that hadn’t expanded Medicaid, according to an analysis by the nonprofit Kaiser Family Foundation.
Many Republicans have argued that the program is ineffective, though a growing body of research contradicts that claim, showing Medicaid significantly improves poor Americans' access to vital medical care.
Virginia, where the Legislature was firmly Republican until last year, was among the states resisting expansion.
But sweeping gains by Democrats in last year’s elections nearly swung control of the Legislature. And though Republicans retain narrow majorities, the election changed the political debate around Medicaid.
At the same time, the state’s new Democratic governor, Ralph Northam, warned the Legislature he would not sign a state budget that didn’t include Medicaid expansion.
Earlier this year, the Virginia House of Delegates, the state’s lower chamber, approved a budget that included Medicaid expansion, with several GOP lawmakers joining Democrats to back the plan.
Wednesday, the Senate finally agreed.
Key to the deal was a compromise that forced Democrats to support a new mandate in Medicaid that will require at least some new Medicaid enrollees to work or show they are looking for work.
This has been a conservative priority that the Trump administration has encouraged in other states, including Kentucky, Indiana, Arkansas and New Hampshire.