Last winter, Virginia’s Republican legislative majority blocked Democratic Gov. Terry McAuliffe’s plan to extend Medicaid to 400,000 Virginians without medical insurance.
Afterwards, McAuliffe vowed to take executive action but discovered legal restrictions limited him to adding 25,000 people to the rolls, mostly those with mental illnesses, though he included funds to encourage 160,000 more to enroll in private insurance.
As a result, he was denounced for failing to live up to his vow by the same Virginia GOP whose legislators blocked Medicaid expansion in the first place.
To make sure he failed, the Legislature’s Republican majority last week again blocked what The Washington Post termed McAuliffe’s “top legislative priority.”
“Once again, Terry McAuliffe has far over-promised, and mightily under-delivered,” said state GOP communications director Garren Shipley, echoing the way Republican officials regularly portray actions limiting the Affordable Care Act as defeats for Democrats like McAuliffe and President Barack Obama.
In truth, preventing Medicaid expansion or other aspects of Obama-care in Virginia and other states, including Texas, is less a defeat for its political champions than a defeat for millions of Americans. After all, their participation in the landmark universal health care program is at stake when states consider the expanded Medicaid program, at mostly federal cost, or courts decide if it’s legal for them to receive a federal subsidy.
As a result, 375,000 poor (and many of them elderly) Virginians will still be denied health insurance. Over the next 10 years, the Urban Institute and the Robert Wood Johnson Foundation estimated, the state will lose $1.5 billion in additional Medicaid funds and its hospitals will lose more than $6 billion in reimbursements.
That pattern has been repeated on an even larger scale in Texas. The Urban Institute-Johnson Foundation analysis estimated more than 1.5 million people would be denied Medicaid coverage because Gov. Rick Perry rejected federal funds to underwrite 90 percent of the cost. The state will lose a potential $65.6 billion in federal funding.
By 2016, the Urban Institute says, those Texas numbers would deny 176,000 cholesterol screens, 44,100 Mammograms, 75,200 Pap smears and 3.2 million additional physician’s visits for Medicaid-eligible Texans.
That pattern has been repeated in other states where Republican governors or legislatures have sought to undermine or halt the Affordable Care Act, preventing more than 5 million Americans in 20 states from participating in Medicaid.
But things might be changing. Just last month, Republican Gov. Tom Corbett of Pennsylvania, trailing in a tough re-election bid, obtained a waiver from the Obama administration for 500,000 low-income residents to obtain coverage through private insurance.
Tennessee Gov. Bill Haslam, another Republican, indicated his state would likely go the same route shortly. GOP Gov. Matt Mead of Wyoming is negotiating to find a way to expand Medicaid after initially rejecting coverage for 17,600 low-income residents.
Republican legislators blocked the program in the only two of 20 non-participating states that have Democratic governors — Montana and Virginia. A third, Missouri, is still considering it.
Meanwhile, prospects might have dimmed for a major legal challenge threatening federal Obamacare subsidies for 4.7 million people in 27 states that refused to create state exchanges and forced residents to use the federal exchange. That refusal contributed to the program’s rocky start, when the federal exchange was overwhelmed by far more applicants than expected.
The full D.C. Circuit Court of Appeals lifted a decision by three of its judges calling the plan unconstitutional, pending a hearing by the full court, which now has a majority of Democratic appointees.
The biggest losers live in large Southern and Mountain states that have GOP governors. Texas alone lost $5.6 billion in 2016 federal subsidies, while Florida passed up $4.8 billion, according to the Urban Institute.
But the real issue remains whether the United States will continue to be a country that makes it hard to for millions lacking health insurance to get it.
Carl P. Leubsdorf is the former Washington bureau chief of the Dallas Morning News. Distributed by MCT Information Services.
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