Virginians Skeptical of Medicaid Expansion

A big swing in the pendulum. Image: Science Museum of Virginia.

A big swing in the pendulum. Image: Science Museum of Virginia.

by James A. Bacon

The biggest story in Virginia right now (even bigger than the U.S. 460 fiasco) is Medicaid expansion, and the latest wrinkle is that Republican skeptics are winning the debate. Frankly, I am amazed. I thought that the siren call of recouping billions of dollars in federal money that Virginians were  paying already in Obamacare taxes, along with the prospect of providing some measure of health care for thousands of the uninsured, would win the day.

The Republican argument, which I embrace — that the state should extract reforms to the way Medicaid is administered before agreeing to expand the program — always struck me as a bit esoteric. That core message, I thought, was lost amidst a welter of reasons for resisting expansion, and the media never framed the debate in the way that Republicans wanted. How many articles have we seen, for instance, illuminating what kind of Medicaid reforms Republicans propose?

Yet, as Quentin Kidd, director of the Wason Center for Public Policy, said in a statement accompanying the poll results: “Democrats are losing the debate on expanding Medicaid in Virginia. This is mostly because they are not convincing Independents that it will work. Voters seem to be moved by Republican skepticism.”

What explains the marked shift in public opinion since a February poll? Norm Leahy and Paul Goldman, Virginia’s bipartisan blogging duo, each have hit upon part of the explanation. Goldman argues that Virginia’s middle class is feeling increasingly squeezed, which I agree with. What he didn’t mention is that many are feeling squeezed by Obamacare. While the Affordable Care Act has expanded access to health care for lower-income Virginians, it has done so at the expense of many in the middle class who are losing their old insurance plans, losing their doctors, and finding that the Obamacare health-exchange alternatives are costing them a lot of money.

The other part of the story, as Leahy has argued, is that Governor Terry McAuliffe has failed to personalize the Medicaid story. There is no denying that tens of thousands of Virginians are living on the razor’s edge of financial solvency, and the lack of insurance makes their lives even more perilous. Where are the heart-rending stories about families who sold their cars, lost their homes or otherwise been forced into destitution by the lack of insurance? We haven’t seen them.

The battle is far from over. McAuliffe has threatened to continue operating the state without budget authorization (not shut to down state government, as I erroneously stated earlier), an extraordinary assertion of executive authority that may have to be resolved by the Virginia Supreme Court.

Kidd’s poll found that most Virginians hope the governor and the legislature resolve the budget stand-off by means of compromise. If the Rs play their cards right, that sentiment should play to their benefit. They need to make the case that their proposal — we’ll accept Medicaid expansion if McAuliffe and the Obama administration reform the program to make it more financially sustainable over the long run — is the compromise proposal. If they can pull that off, they can win the debate, thousands of uninsured Virginians can get Medicaid coverage, and the state can safeguard its fiscal integrity going forward.

But perhaps McAuliffe is banking on the state Supreme Court, dominated by Democratic appointees, will back him up. This will be the big show of the next two months.

Update: The Commonwealth Institute critiques the Wason Center’s survey methodology here.