While the Virginia legislature voted Wednesday to expand Medicaid and provide health coverage to an additional 400,000 low-income residents, ending a years-long battle among state lawmakers, the Democrats' victory was tainted by a work requirements provision made possible by a Trump administration policy unveiled earlier this year, which permits such rules for the first time in the program's history.
With Democratic Gov. Ralph Northam, a pediatrician and Army doctor by trade, planning to sign the measure into law, Virginians and advocates for Medicaid expansion welcomed the development but emphasized the dangers of the caveat, which, as research from the Center on Budget and Policy Priorities has shown, "will almost certainly cause many low-income adults to lose health coverage."
i'm glad Virginia is expanding Medicaid, but work requirements and premiums build inescapable Kafakesque mechanisms that do very little to cut costs and do very much to stigmatize and punish people — especially poor people and people with disabilities
— kill tim faust (@crulge) May 30, 2018
Great news for 400,000 Virginians, but it's shameful work requirements had to be added to get it done. The struggle continues! https://t.co/zHqQZ3PmVF
— People For Bernie (@People4Bernie) May 30, 2018
Once Northam signs the bill, Virginia will join the 32 other states plus D.C. that have expanded Medicaid under the Affordable Care Act (ACA), according to the Kaiser Family Foundation (KFF), which tracks state actions on the program. Northam told a local radio station he expects the expansion to take effect in January.
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Idaho, Nebraska, and Utah are also working to expand Medicaid, but through ballot measures rather than state legislatures, following a precedent set by Maine voters last November. Although Maine's voter-approved expansion has been blocked by outgoing Republican Gov. Paul LePage, healthcare advocates have filed suit to force implementation.
The group Reclaim Idaho has traveled throughout the state to collect the more than 56,000 signatures needed to get the measure—which could provide coverage to up to 62,000 residents—on the ballot, and Governing reports that Nebraska's Insure the Good Life is "on track to reach the required 85,000 signatures by July 5."
Earlier this week, Utah announced that campaigners collected enough signatures secure a ballot measure, which would expand the program to some 150,000 residents. However, like Virginia, Utah would also impose work requirements with its expansion.
Even though, as Governing notes, "the Trump administration made expansion more enticing for some Republicans by letting states add new eligibility rules, such as work requirements and time limits," the remaining 14 states aren't currently considering any expansion of their Medicaid programs, according to KFF.