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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

VA Embrace of Medicaid Expansion: A Big Win for ACA — and Democrats

It appears that Trump’s labored efforts to proclaim the death of Obamacare have proven highly premature. As Jennifer Rubin writes in her column, “What Virginia’s expansion of Medicaid means,”  in the Washington Post,

This is a victory for the Affordable Care Act, no question. Obamacare made Medicaid expansion possible and, whatever you think of the efforts by the administration and Congress to chip away at the ACA, an expansion of this size suggests President Barack Obama’s health-care legacy is on firmer footing than Democrats feared when they lost the White House, as well as their majorities in the House and Senate.

As Ed Kilgore noted at New York magazine,

For a health-care law that Donald Trump has been declaring “dead” or “dying” since 2013, Obamacare seems to have a lot of life in it yet, no thanks to his administration. Obama himself is probably sharing a bit of the good feelings among Democrats in Virginia.

For Democrats, Virginia’s Medicaid embrace is a big win, with far-reaching implications. As Rubin explains, “Achieving Medicaid coverage for 400,000 additional people is a mammoth victory for Democrats in a state that has been trending blue for years, but now seems firmly in that party’s column. The vote holds multiple lessons for both parties.”

And looking ahead to the months leading up to the midterm elections, Rubin observes,

This will be a big issue in November when multiple states (Utah, Idaho, Nebraska) will vote on Medicaid expansion, which delights Democrats. Democrats are returning to their bread-and-butter issues (e.g., wage stagnation, lack of access to health care) as they remind voters which party defended the ACA, and which party voted to eliminate it without an adequate replacement. The Medicaid issue will help the Democratic Party turn out its base, which is already pumped up to cast a symbolic vote against Trump.

…The Medicaid issue affects nearly every state and federal race. Democrats will argue that Republicans “want to take away health care” while Republicans will be forced to defend their votes and take a stance on expansion. That’s a problem given how popular Medicaid expansion has become. (“A poll conducted late last year by Public Opinion Strategies and the Virginia Hospital and Healthcare Association found 83 percent of the state’s residents supported the expansion, including a majority of self-identified Republicans. . . . Polls show that two thirds of Utah voters support the Medicaid expansion in their state. So it’s unlikely to be close,” The Post report continued.) Meanwhile, Maine’s controversial Republican Gov. Paul LePage is being sued for failure to expand Medicaid after a state referendum approving it passed with 59 percent of the vote.

In addition, Rubin writes,

Virginia will be the 33rd state (along with the District of Columbia) to approve Medicaid expansion. Medicaid expansion appears here to stay, and despite the best efforts of the GOP House and right-wing pundits, has widespread, bipartisan support in every geographic region, with the exception of the Southeast (which includes some of the poorest states) and the Great Plains (although Nebraska and Idaho could join Virginia). “In a nutshell, Medicaid is the absolute star of the Trump presidency despite every effort on their part,” said Andy Slavitt, the former head of Centers for Medicare and Medicaid Services, who served during the Obama administration. “By the end of his term, you could see five more states expand. And there is a tipping point for the hold out states at that point. The irony of course is that this is a far more Democratic idea than exchanges, a Republican idea [originating at the Heritage Foundation].”

Don’t be surprised if the political fallout provokes an infantile tantrum on the part of Trump and a doubling down on dubious, spiteful executive orders to further weaken Obamacare. There may also be some grumbling on the left about the Virginia tweaks requiring either work or volunteer service and cost-sharing. All in all, however, it’s a great victory, not only for Virginia Democrats and Obamacare, but down the road, for millions of Americans who currently lack affordable health care.

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