As Medicaid Legislation Goes Down in Senate, Northam Recommits to Expanding Coverage

Jan 25, 2018


A key committee in Virginia’s Senate took up debate of Medicaid expansion Thursday. Even though the bills failed, Governor Ralph Northam says it’s just the beginning of the process.

In an interview just after the Senate Education and Health Committee voted to kill several Medicaid expansion efforts, Northam says it’s still early in the session and he’s committed to negotiations.  

“And so I’m a good listener. We will put all this together and hopefully toward the end of the session we will come up with a plan that’s good for Virginia, that everybody can walk away from the table and say I’ve really done something good here, we’ve expanded healthcare, and they can take that back to their districts,” Northam said.

Republican Senator Emmett Hanger supports Medicaid expansion. During the Senate committee hearing he floated reform ideas like requiring able-bodied recipients to work, or pay monthly premiums.


Republican Senator Siobhan Dunnavant, a doctor, also proposed expanding access to healthcare, but not through Medicaid expansion. Her proposal would have expanded the existing GAP program, which provides limited benefits to poor Virginians who have a serious mental illness.

Northam wouldn’t comment on many of those specific policy proposals, saying he’s talked with lawmakers in the House and Senate and that his administration is in the preliminary stages of coming up with a way to expand Medicaid.

“Rather than comment on one specific part of a plan, I want to put everything together and come out what what’s in the best interest of Virginia,” Northam said.

The Trump administration has recently allowed states to require Medicaid recipients work before receiving access to healthcare. Northam says he’s not in support of a work requirement, and that it could add unnecessary red tape.

“I think it puts people in awkward positions. We’ll look at a work search program where we at least assist people that want to get into the workforce,” he said.

Although legislation failed in the Senate committee Thursday, Medicaid expansion is baked into the Governor’s budget proposal -- so the conversation isn’t over yet.


Noe-Payne: Now former Governor McAuliffe was not successful in expanding Medicaid. How is your approach going to be different?

Northam: Again it goes back to what Virginians care about. And the fact that they came out in record numbers on November the 7th. This was a mandate on healthcare and expanding healthcare. So I have, I think, the advantage of having been here for ten years. I was in the Senate for six years and served as Lieutenant Governor for four. So I have relationships with individuals on both sides of the aisle and I think that both Republicans and Democrats saw what happened on November the 7th, they know what Virginians are interested in. So we have a unique opportunity right now to bring people from both sides of the aisle and talk about this. And really what I have advocated for is a straight Medicaid expansion, one that we don’t have to use waivers, one that Washington can’t hold us up on and so that’s the way I’ll plan to move forward.

Noe-Payne: But there are proposals in the legislature to do some innovative things, like work requirements. Would you support work requirements for Medicaid as part of a potential compromise?

Northam: I think we have to design and develop a simple Medicaid expansion, without creating bureaucracy. And so work requirement is doing just that, getting into more bureaucracy. What I’ve always advocated for is to look at areas where we can help people -- what I would call a work search program. So if there’s an individual that’s capable of working that wants to enter the workforce then we’ll do everything in Virginia to help them with that.

Noe-Payne: So you’re not against incentivizing work in some way. What would that look like?

Northam: We always encourage if people can work we can help them do that. But again sometimes it’s easier said than done. So we want to look at each individual and see how we can help them. But to just make a blanket statement that we’re going to require folks to work I think is a little bit short sighted and unrealistic.

Noe-Payne: Are there any other reforms to Medicaid that could help control the cost of spending?

Northam: Well it’s two different issues. One is Medicaid expansion and then looking at ways how we can reform, look at ways that we can better incentive, reimburse hospitals and providers to make sure that they’re willing to take care of Medicaid recipients. There are a lot of discussions that we’re having in that area. But it’s a separate issue from Medicaid expansion.

Noe-Payne: Is there another way, or any other way, in addition to or instead of Medicaid expansion, that would help provide more coverage for more Virginians?

Northam: Well there are other mechanisms out there. For example free clinics. There are clinics like the RAM clinic - remote area medical clinic - which I have participated in every year. But I always look at those individuals that come out once a year, line up after midnight the night before in whether it be the heat or cold - to get one day of access to an eye doctor, to a dentist and to medical doctors. And I would just say here in Virginia in 2018 there has to be a better way.

I remind people in Virginia every day that no individual, no family, should be one medical illness away from financial demise. That’s just not acceptable to me. So we can remedy that, and that’s by bringing people from both sides of the aisle to the table and finding out how we can bring those resources back to Virginia.

This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.