A raging political battle over Obamacare came to an abrupt end Wednesday when the Virginia legislature—controlled by Republicans—voted to expand Medicaid under the health law. Newly elected Democratic Governor Ralph Northam is expected to sign the legislation, which is projected to extend health coverage to some 400,000 low-income Virginia residents.
The four-year-long path to Medicaid expansion has been a bumpy one in Virginia, which has elected a string of Obamacare-supporting politicians to statewide and federal office but still been largely controlled by Republicans who slam all things Obamacare in the state legislature. Gridlock has consistently marred the process, with a number of seemingly winning compromises between the parties ultimately going down in flames—especially as the Affordable Care Act’s ultimate fate was in limbo while Congress and the Trump administration debated the best way to repeal it.
Subscribe to Brainstorm Health Daily, our newsletter about the most exciting health innovations.
A number of political realities appear to have reshaped that calculus: Northam’s nearly nine-point win in the 2017 gubernatorial election; a wave of Medicaid expansion-touting Virginia lawmakers’ victories in the General Assembly; and Congress’ failure to repeal Obamacare (and its Medicaid expansion) despite multiple tries. While Congress did nix Obamacare’s individual mandate to carry health insurance as part of the tax law signed by President Trump late last year, most of its major provisions—including the popular Medicaid expansion aimed at households earning just 138% of the Federal Poverty Level (or about $35,000 for a family of four)—remain in effect.
Virginia’s Medicaid expansion decision could have broader implications; 33 states plus DC have embraced the expansion to date, according to the Kaiser Family Foundation. It’s an open question whether more states will jump on the bandwagon given the failure of Obamacare repeal and Medicaid’s popularity. There has been a deep imbalance in the uninsured rate in states that expand Medicaid versus those that don’t.