WASHINGTON -- Terry McAuliffe's election as Virginia governor Tuesday renewed hopes that the state might expand Medicaid for 400,000 low-income residents under the Affordable Care Act.
McAuliffe campaigned on the Medicaid expansion and went so far as to say that he would not sign a budget unless it included it. His opponent, Attorney General Ken Cuccinelli, said that a vote for him was a vote against the Medicaid expansion.
Based on the results of the election, it seems like Medicaid expansion for Virginia is in the near offing. McAuliffe reiterated Wednesday that he would push to expand the federal program. "Medicaid expansion was, I think, the central issue in this campaign," he said at a press conference. But a hurdle remains in the way: the state's heavily Republican House of Delegates.
When he assumes the governor's chair, McAuliffe will have two possible paths to pursue Medicaid expansion's passage.
A panel tasked with charting out Medicaid reform could approve expanding the program, after which the issue would be brought to both houses of the legislature for a vote. But that panel has a 7-3 composition of Republicans to Democrats -- Republicans have three members from the state Senate and four from the House of Delegates, and Democrats have two members from the Senate and one from the House of Delegates. Any changes must be approved by three members of the House and three members of the Senate.
Alternatively, McAuliffe could try to bypass the commission and include Medicaid funding in a state budget, and then bring it up for votes in both the state Senate and House of Delegates.
The state Senate is split between Republicans and Democrats, and it did not face elections last night. However, state Sen. Ralph Northam (D-Norfolk) won the lieutenant governor's race, and so Democrats are down a seat until a special election can be held for what would potentially be a tie-breaking vote.
In contrast, the state House of Delegates is heavily dominated by Republicans -- something that largely did not change after elections Tuesday night. And in an interview with The Huffington Post on Wednesday, House Speaker Bill Howell (R-Stafford) shot down the idea of inserting an expansion into the budget.
"He can't do it. The law is very clear. He has a little problem understanding that in some of the comments he made during the campaign," Howell said of McAuliffe. "But the law is clear in Virginia that the only way we can expand Medicaid is a majority of both House and Senate members call for expanding Medicaid."
"He can try the way he wants to in the budget, but it's not going to work," Howell said. He added that he would allow a vote on Medicaid reforms if the committee voted to recommend expanding Medicaid.
The vice chairman of the Medicaid committee, Del. Steven Landes (R-Weyers Cave) told HuffPost that the election changed nothing in terms of the Medicaid expansion, noting that McAuliffe did not win 50 percent of the vote. "Mr. McAuliffe obviously doesn't have a clear mandate," he told HuffPost, adding that he thought House candidates who were running on Tuesday in total got "about 25,000 more votes than he [McAuliffe] did."
In addition to covering an estimated 400,000 people without insurance, expanding Medicaid would have economic benefits for the state. The Virginia Hospital & Healthcare Association estimated that it would provide a $3.9 billion boost to the economy annually, and federal funds could support over 30,000 jobs.
There are some reasons for optimism for Medicaid expansion proponents in Virginia. Some Republican members of the Medicaid reform commission do favor expanding the program, provided that some changes are made to it.
State Sen. John Watkins (R-Richmond), who is on the committee, told HuffPost that he is a proponent of expanding Medicaid. However, he added, he would only favor moving forward after the problems with the health care exchanges are settled and the federal government shows that the Affordable Care Act can work.
The chair of the group, State Sen. Emmett W. Hanger Jr. (R-Augusta), meanwhile, has faced heavy pressure from the Koch-backed Americans For Prosperity to oppose Medicaid expansion, The New York Times reported. But Hanger has said that he still favors the expansion -- with reforms.
"We can control our destiny with Medicaid. We can accept expansion with the understanding that we have the option to reverse course if the federal government does not honor its commitment," he wrote in the Roanoke Times in June. "Yes, Medicaid needs reform, and the impetus for reform is one of the main reasons that I am a proponent for strategic expansion."
CORRECTION: An earlier version of this article misidentified House Speaker Bill Howell. He represents Stafford, Va.