States Continue to Embrace Obamacare Despite Trump’s Opposition

Virginia’s passage of Medicaid expansion in late May 2018 is further proof that states will continue to embrace key tenets of Obamacare despite the best efforts of President Trump’s administration to undermine it.

The battle for an expanded Medicaid program in Virginia was a long one, with eight years of partisan sniping before the bill passed in the General Assembly on May 30. Four state Senate Republicans crossed the aisle to join with Democrats to include the measure in its budget. The House quickly approved it, which isn’t surprising, given this chamber had shown greater support of Medicaid expansion in recent months.

Despite the Trump administration’s strategy of dismantling the Affordable Care Act in piecemeal fashion, other states, including Idaho, Nebraska, and Utah, could soon follow in Virginia’s footsteps and expand their Medicaid programs.

Virginia’s action was a long time coming and is a blow for Trump, who lost a personal battle last fall when the candidate he backed for Virginia governor, Republican Ed Gillespie, was bested by Democrat Ralph Northam, who supported Medicaid expansion. The election also served as a wake-up call to state Republicans, who saw their majority in the House of Delegates fall from 66-34 to 51-49. Voters said healthcare was one of their top agenda items during exit polls.

It’s clear the Virginia GOP got the message: Their constituents wanted increased access to healthcare services and coverage, and Medicaid expansion is a key component of that.

The Affordable Care Act, aka Obamacare, made expansion of state Medicaid programs possible after becoming law in 2010. Several states jumped at the opportunity immediately. While Virginia took a bit longer, it was the 33rd state, along with the District of Columbia, to adopt Medicaid expansion, under which states can enrol residents with incomes up to 138 percent of the federal poverty level, which equates to $16,643 for an individual. Under current Medicaid rules in Virginia, which has some of the most stringent eligibility requirements in the country, the threshold is $9,700.

The new Medicaid rule is expected to take effect Jan. 1, 2019. It’s estimated that an additional 400,000 Virginia residents will be able to enrol for Medicaid coverage then.

Ironically, the Trump administration’s decision to allow states to mandate work requirements helped set the stage for increased Republican acceptance of Medicaid expansion. Expect state lawmakers to continue finding loopholes as they increasingly seek to appease their constituents during this election year.

Chris Silva is a senior analyst at DRG and specializes in information technology, telehealth, and big data, among other topics. Follow him on Twitter at @ChrisSilvaDRG.