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“There are no excuses left”: Virginia Gov. Terry McAuliffe explains his new Medicaid expansion push

Virginia Gov. McAuliffe And Nevada Gov. Sandoval National Governors Association Leadership Event Photo by Drew Angerer/Getty Images

Virginia Gov. Terry McAuliffe announced Monday that he would make a renewed push to expand his state’s Medicaid program under the Affordable Care Act. If successful, the public health program that covers low-income Americans would grow to include 400,000 Virginia residents. That's a big “if” — and McAuliffe knows it. But he's decided to try anyway, hoping against very long odds that Democrats’ newfound momentum on health care might deliver him a long-sought victory on the issue.

“Year after year, they [Virginia Republicans] have put out false excuses for not expanding,” McAuliffe said in an interview Tuesday. “The latest one that I always heard was that the law would be repealed. Now we have heard from the president of the United States himself that it’s not going to be repealed.”

McAuliffe is among a growing number of governors and state legislators who watched congressional Republicans fail to repeal Obamacare — and, with the law seemingly here to stay, think this is the exact right moment to push for Medicaid expansion.

The odds are not in McAuliffe’s favor. He has pushed for Medicaid expansion in 2013, 2014, 2015, 2016 … basically ever since he was elected governor. He worked out a deal with the Obama administration where his state wouldn’t have to kick in the 10 percent funding share that every other state does. Instead, Virginia hospitals agreed to cover that portion.

But the Republican-controlled Virginia House of Delegates remains steadfastly opposed to Medicaid expansion. Republican leadership quickly released a statement after McAuliffe’s Monday press conference noting that they remain opposed to Medicaid expansion.

Why does McAuliffe keep fighting what seems to be a losing battle? We spoke Tuesday about his new Medicaid expansion push and what he expects to happen next. What follows is a transcript of our interview, lightly edited for clarity and length.

Sarah Kliff

You’ve pushed for Medicaid expansion basically every year you’ve served as governor. And every year, Republicans in your state basically say, no, we don’t want to do this. Why do this again, right now? What makes 2017 different?

Terry McAuliffe

Year after year, they [Virginia Republicans] have put out false excuses for not expanding. The latest one that I always heard was that the law would be repealed. Now we have heard from the president of the United States himself that it’s not going to be repealed.

We can sit here in Virginia and forfeit $4.6 million a day or $2.6 billion per year. We’ve already forfeited $10.4 billion to fund our health care providers. I could probably create upward of 75,000 jobs with that money.

There are no excuses left at this point. Every time they put up a false excuse, I come up with an answer. You can’t say that the law is going to be repealed. Both the president and Speaker [of the House Paul Ryan] say it’s here to say. We have a committee in the House of Delegates that is supposed to come up with some proposals. They need to get to work, and come back to me with recommendations.

I’m concerned because you’re seeing other states work on this. Kansas, Georgia, North Carolina are all making noise. I’m going to be surrounded soon by Maryland, West Virginia, and North Carolina — three states who I compete with for business, who will have a healthier workforce because more people are getting covered. It will bring down their costs, and Virginia will be at a strategic disadvantage.

Enough is enough. I worked with [former Health and Human Services Secretary Sylvia Mathews Burwell] to get a waiver to run this with no financial obligation to the state. If there is no obligation to the state, not a penny, why won’t you do that? It’s just unfortunate. Many of the Republicans here are terrified of the Tea Party, that if they do the right thing and vote to get health care for citizens, they’ll get run out of a job.

Sarah Kliff

Do you expect Medicaid expansion to pass this year in Virginia? Like you’ve said, Republicans in your state seem pretty committed to making sure it doesn’t.

Terry McAuliffe

I have no illusions. When I was governor-elect, the speaker [of the Virginia House of Delegates] said it was never going to pass. We have a speaker who has told many reporters that not allowing Medicaid expansion to come to Virginia will be his greatest accomplishment.

To me, I find this almost unfathomable and unbelievable that someone’s legacy will be to look back and scores will have died because they don’t have health care. So I continue to fight for it, to do what is in the best interest of my state. The big difference this time is I can say, I called your bluff. The law isn’t going to be repealed.

Sarah Kliff

I report on other state Medicaid expansion efforts, and one of the things I’ve seen elsewhere, like in Kansas, is moderate Republicans peeling off from leadership to support Medicaid expansion and work with Democrats. Is there a chance of that happening in Virginia?

Terry McAuliffe

A reporter recently asked me, why do you keep doing this? We have 66 Republicans in a House of Delegates with 100 members. The speaker determines what they do, and he told me in November 2013 that this will never pass. I’m under no grand illusion that through my personality or inviting him for drinks I’ll convince him otherwise.

As you know, in Virginia the party controls the committee. He can walk down one day and take you off your committee. I have had legislators come sit in my office and say, I’d vote for it tomorrow, but if I do, I won’t be here next year.

Sarah Kliff

What’s the role of Virginia hospitals in this new push? I know they generally tend to be pretty big Medicaid expansion proponents in most states.

Terry McAuliffe

I do know the business community, hospitals, and others are getting together. The speaker has said he is 100 percent against this, that there is nothing from me that will convince him to change his mind.

My hope is that some of the arguments from business leaders will resonate in his district, that they’ll go and talk to those legislators. I keep coming back to the fact that we have a bill where no state dollars can be used. I knew this was going to be hard, but there are no excuses.

Sarah Kliff

Can you talk a bit more about that particular proposal Virginia has? Usually one of the arguments that Republicans launch against Medicaid expansion is that even though the government pays 90 percent of the cost, the state still needs to pay 10 percent, and that can be hard to find.

Terry McAuliffe

I told the hospitals that in Virginia, they are going to have to come up with the difference. The hospitals — I’ll read you the quote right here, in the newspaper — they have decided to pay the state share of the expansion. Here is the quote: A spokesman for the Virginia Hospital & Healthcare Association confirmed Monday, “Almost two years ago, we developed a proposal to fund the state’s portion of Medicaid expansion. If Republicans and Democrats are interested in that proposal, we’re willing to have that conversation.”

Sarah Kliff

And you needed a waiver from the federal government for that particular proposal, right? I understand you worked one out with Secretary Burwell during the Obama administration, but do you think the Trump administration would provide you with the same flexibility?

Terry McAuliffe

I’m very confident. I’m still talking to the folks up there, but I can’t even have a conversation with Health and Human Services without everyone here immediately saying we’re not doing it. The federal government doesn’t care, as long as we pay for it. We could craft some unique things.

Sarah Kliff

Let me push back on that a bit. The Trump administration is trying to dismantle Obamacare right now. Why would they help you work to expand to nearly a half-million more people?

Terry McAuliffe

Good question. It’s hard to believe that they’ve done it with 31 states [that have expanded Medicaid], that we might get to 34 states soon and now they’re going to stop with Virginia. I met with [Health and Human Services Secretary Tom] Price because I serve as the chairman of the National Governors Association. We met him three times when we were up in Washington, DC, for the Governors Association meeting. We got full indication that they want to work with us. This is one of those places where they talk about flexibility.

Sarah Kliff

One last question: You mentioned earlier that you thought Republicans in your state won’t support Medicaid expansion because of politics, that they expect to get primaried by the Tea Party. Do you foresee a future where Medicaid expansion is no longer political? Does that start happening now that Obama is out of office, or will it take a lot longer?

Terry McAuliffe

I think for us non-expansion states, the reality will start to sink in. And the reality is we’re forfeiting money to other states. Those states we compete with are getting healthier, getting more people covered, and bringing down costs.

This is like signing up for Medicaid originally — I think Virginia was the 47th to sign up, [Editor’s note: I looked into this, and McAuliffe is close but not exactly right — Virginia was the 41st state to participate in Medicaid.] But ultimately, every state will do this. You’re going to do this at some point whether you like it or not.