RICHMOND — Gov. Ralph Northam on Friday gently warned state budget negotiators to send him a spending plan that includes Medicaid expansion or he will add expansion as an amendment, a procedure that gives him a stronger hand in the Senate.
If forced to go that route, Northam (D) said, he would have more power to shape an expansion deal already passed by House Republicans that calls for work requirements, co-pays and other conservative measures.
“We’ve obviously compromised, and if I send an amendment down — which I will if I need to — some of those compromises won’t be in there,” Northam later told reporters, noting that he would have more say over how to spend the $420 million in projected savings from expansion.
Northam won office last year on a promise to expand the federal-state health-care program to as many as 400,000 uninsured Virginians. Republicans in the House and Senate steadfastly blocked expansion for four years under Northam’s predecessor, Terry McAuliffe (D), saying the federal government could not afford to make good on its promise to pick up most of the $2 billion-a-year tab.
Opposition in the House softened this year after Republicans nearly lost control of the chamber in November elections. But there has been no visible shift in the state Senate. The GOP controls both chambers by two seats.
One longtime Republican moderate, Sen. Emmett W. Hanger Jr. (R-Augusta), supports expansion in some form, although he has objections to the plan passed by the House. Even if the plan could be modified to suit Hanger, the budget would still die on a 20-to-20 vote.
Lt. Gov. Justin Fairfax (D) presides over the Senate and can break most ties, but he is prohibited from voting on the budget. So Northam needs to win over two Republicans to pass a budget with expansion.
But Fairfax is allowed to vote on budget amendments. So if the legislature sends Northam a budget without expansion, Northam could add it as an amendment — one that could clear the Senate as long as a single Republican votes for it and Fairfax breaks the tie.
Northam made his intentions clear Friday morning over breakfast with a bipartisan group of state senators and delegates appointed as budget conferees. Their task is to reconcile the House and Senate budgets before the legislature adjourns March 10.
Using a budget amendment to muscle through something as consequential as Medicaid expansion would be something of a hardball tactic for Northam, a soft-spoken former state senator and pediatrician with close friendships in both parties. But he did not overtly present the scenario as a threat. He shared it in response to a question posed by Senate Majority Leader Thomas K. Norment (R-James City), co-chairman of the Senate Finance Committee and a budget conferee.
“I answered his question that I did plan to send an amendment down,” Northam told reporters hours later at an afternoon gathering.
Asked how his response was received, Northam said: “I was asked a question, and I responded to it. . . . I didn’t have to do the Heimlich on anyone, so it was all good.”
Sen. Stephen D. Newman (R-Bedford), one of the budget negotiators, described the breakfast as “a very good, affable meeting.”
“I appreciate the governor’s candor,” Newman said. “He’s always an honest and honorable man to work with, and he has been straightforward on this, as he has been on other things.”
But he took Northam’s statement as a concession that the legislature will send him a budget without expansion.
“I’m pleased to hear the governor stating publicly that he kind of anticipates the likelihood that the Senate will stay very strong throughout the entire budget process,” Newman said.
Newman also questioned whether the governor could count on Hanger’s support for such an amendment, given the senator’s concerns about the House-approved expansion plan.
“I don’t see a pathway today toward the McAuliffe-Northam plan,” Newman said. “I don’t know anyone . . . that anticipates that plan could actually make it in a reconvene session or in a regular session. I think Mr. Hanger and others who want to find a way in the Senate have said very clearly that that approach won’t work.”
Laura Vozzella covers Virginia politics for The Washington Post.
WISE, Va. — The sick and the disabled pour out of these mountains every summer for their one shot at free health care, but this year was supposed to hold hope for a better solution.
Donald Trump won the White House in part on a promise to fix the nation’s costly and inefficient health-care system. Instead, Republicans in Congress are paralyzed and threatening to dismantle the imperfect framework of Obamacare.
No relief is in sight for someone like Larry McKnight, who sat in a horse stall at the Wise County Fairgrounds having his shoulder examined. He was among more than a thousand people attending the area’s 18th annual Remote Area Medical clinic, where physicians and dentists dispense free care to those who otherwise have none.
“I really think that they don’t have any clue what’s going on,” McKnight said of political leaders in Washington. “You watch the news and it’s two sides pitted against each other, which in turn just makes them pitted against us, the normal person.”
About 1,100 such people descended on the fairgrounds Friday, with more expected Saturday and Sunday. Medical personnel from across the state were there with makeshift examination rooms in tents and sheds. Sheets hung from clothespins for privacy; giant fans pulled hot air through buildings intended for livestock shows.
These events are staged nationwide, but the Wise clinic is among the biggest, drawing people from throughout Appalachia and casting Washington’s sterile political debates into the starkest human terms.
A third of the patients who registered Friday were unemployed. Those who couldn’t afford a room slept in their cars or camped in the fields around the fairgrounds. They lined up in the dead of night to get a spot inside the event.
Tabitha Lindley and her mother, Tammy Lindley, check for messages before dawn after sleeping in their car. In the foreground is Dalton Barton, Tabitha’s fiancee. They hoped to get dental work done. (Michael S. Williamson/The Washington Post)
Josh Phillips waited all night, with hundreds of others, for a chance at dental work. He rested in a wheelchair as he waited to be sent to a check-in area. (Michael S. Williamson/The Washington Post)
It is the place of last resort for people who can’t afford insurance even under Obamacare or who don’t qualify for Medicaid in a state where the legislature has resisted expansion.
At 37, with a long graying ponytail, McKnight had never been sick until about eight months ago. So he hadn’t worried too much about not being able to afford insurance on his roughly $18,000 a year in pay as an auto mechanic. But now he was getting a referral to the University of Virginia hospital to check for the source of his pain, which he had vowed to withstand without resorting to opioid medication.
“The normal person doesn’t care about a lot of the things that they care about [in Washington]. Most people want to work, they want insurance and they want to be able to take care of their family without assistance,” he said.
The only way to do that, he said, is to have everybody — the healthy and the sick — paying into a centralized health insurance plan. “I really think the only thing that would truly help this country is if it were single-payer,” McKnight said.
Around here, that’s not politics, it’s just life. Many of these people voted for Trump — not only for his vow to fix health care, but also for his promise to bring back the coal industry. They’re still waiting for results, with varying degrees of patience.
Patricia McConnell was having trouble speaking around the bloody gauze in her mouth. She had just had four teeth pulled. The unemployed former manager of a McDonald’s had driven eight hours from her home in Glen Burnie, Md., to attend the clinic.
Virginia Gov. Terry McAuliffe hugs Patricia McConnell, who saved money for six months for gas and a hotel room to attend the Remote Area Medical event and have dental work done. (Michael S. Williamson/The Washington Post)
“My teeth were hurting,” she said. McConnell, 63 and disabled, said she had health insurance through Medicaid but no dental coverage.
So this was her dental plan: She’d save for six months to afford a motel room and gas, then wait in line in the morning heat to see a volunteer dentist.
McConnell has been watching the health-care debate in Washington and wondering if it will ever amount to anything that actually helps people like her. “I don’t know what they’re trying to do,” she said, struggling to get the words out around the gauze.
She voted for Trump, she said, and still feels that he’s working hard to help. But his anger and his tweets seem to aggravate Congress, and no one is working together, she said.
They need to set all that aside and work to pass health care for everyone, she said. “Let’s get this done.”
Others had a hard time mustering the faith that anyone cared.
“They’re trying to kill us poor people, is what they’re trying to do,” said Robert Horne, 55, a disabled former construction worker seeking dental care. Horne said he voted for Hillary Clinton last fall because of her pledge to maintain the Affordable Care Act.
That didn’t work out, either.
Virginia Gov. Terry McAuliffe (D), who flew out to the clinic Friday morning, had invited Senate Majority Leader Mitch McConnell to join him but said that the Republican leader “politely” declined. McAuliffe, who visits the clinic every year, spent nearly two hours touring it — twice as long as scheduled — and took every opportunity to proclaim that he’s been trying for three years to get the state legislature to agree to expand Medicaid under Obamacare.
The Republican-controlled General Assembly has resisted, unlike the legislatures in nearby states, which McAuliffe kept reminding the patients and doctors who crowded around him on the hot fairgrounds.
Virginia Gov. Terry McAuliffe chats with Joey Johnson of Clintwood, Va., who is confined to a wheelchair. (Michael S. Williamson/The Washington Post)
Kaitlen Hagy, 3, tries to keep cool with a hand fan at the Wise County Fairgrounds. She was in line for eyeglasses. (Michael S. Williamson/The Washington Post)
“All of our neighbors in Kentucky and West Virginia and Maryland — they did it!” he said to a Christian counseling group that had set up shop under an awning. But in Virginia, he said, legislators turned down millions in federal dollars that would be available under Medicaid expansion.
“We need it,” called out Tonya Hall, operations director for a hospice-care facility. “Let them come and visit some in southwest Virginia. Let them see the poverty. Let them see how we live. Let them come.”
“This isn’t about politics,” McAuliffe said.
“Right!” Hall agreed. “It’s about people.”
“It’s about people’s lives,” McAuliffe said to a round of “Amens” from the group.
Hall, 42, said she had voted for Trump but that she was disappointed he hadn’t been able to do anything to improve the health-care system. If Obamacare can’t be fixed, she said, “then I say we scrap it and start over. You can see the need,” she added, gesturing at the masses of people waiting for their turn with a medical professional.
Beyond her, a long line stretched into the triage tent, where people were sorted and their vital signs measured. Allen Sexton, 37, was there to have all his teeth removed, years after a car accident had left them a scrambled mess.
In a metal shed nearby, vision specialists sat in darkness, performing eye exams in pools of light. One man said that his glasses had broken a year ago and that he couldn’t see at a distance or up close, but he’d been driving anyway.
There was another tent for orthopedic care. Another for basic checkups. Each one was full, with more people waiting outside on metal folding chairs or standing in lines.
Politicians prowled the fairgrounds. Several area legislators attended while Attorney General Mark Herring (D), running for reelection, walked with McAuliffe and Sen. Tim Kaine (D) helped register patients.
Stan Brock, the English philanthropist who founded the RAM clinic program more than 30 years ago, said there was one more visitor he’d like to see at the clinic.
“It’s absolutely imperative that the president of the United States come and visit one of these events,” he said. “I believe if he did, he would take some immediate action.”
Greg Schneider covers Virginia from the Richmond bureau. He was The Washington Post's business editor for more than seven years, and before that served stints as deputy business editor, national security editor and technology editor. He has also been a reporter for The Post covering aviation security, the auto industry and the defense industry.
It’s unclear exactly what if any political dispute, however, led to the chaplain’s dismissal.
