Gov. Terry McAuliffe has plenty of allies in his efforts to expand Medicaid
eligibility in Virginia, including the state's hospitals, insurance companies, several business organizations, liberal advocacy groups, and even some Republican state senators.
But as the 2014 legislative session nears its midway point, there's no sign that the Democratic governor has made any headway winning over one key group: leaders in the GOP-controlled House of Delegates.
Top House Republicans have not shifted in any noticeable way in their opposition to plans to expand Medicaid, plans they say are unsustainable.
"It's tough to find a compromise. You can't say we'll do half of it," said House Speaker William J. Howell.
McAuliffe has made expanding the number of lower income residents who have health insurance a top priority of his young administration and wastes few public opportunities to speak of the potential benefits of Medicaid expansion, which he said would also create jobs, protect hospitals and save the state money.
In private, he's tried to build relationships with House Republicans through numerous breakfast meetings and receptions at the Governor's Mansion.
"(McAuliffe) is optimistic that he and the General Assembly will find common ground to close the coverage gap in a way that works best for Virginia," said the governor's spokesman, Brian Coy.
But, at least so far, there's been no indication those efforts are having the desired effect.
"You can shake a lot of hands, you can slap a lot of backs, but at the end of the day our spines are strong and we're going to stand for freedom here in the commonwealth of Virginia and say no to Medicaid expansion," Del. Ben Cline, R-Rockingham, recently told a small crowd organized by the tea party group, Americans for Prosperity, gathered at the Capitol for an anti-Medicaid expansion rally.
House Republicans oppose Medicaid expansion because they say they don't trust that the federal government will make good on its promises to cover the bulk of expansion costs over the next decade. They point to the flawed rollout of other aspects of the Affordable Care Act as proof that the Virginia should be weary of expanding a publicly funded health insurance program. Instead, Republicans say they want to reform the state's current Medicaid program, which they argue is already growing too fast and is fraught with waste, before deciding whether to add more people to its rolls.
Howell said McAuliffe and his staff have made no effort to address those concerns.
"Every governor has had legislative liaisons come see me," said Howell. "I don't even know who (the McAuliffe administration's) legislative liaison is."
Katharine Webb, senior vice president of the Virginia Hospital & Healthcare Association, said while house leadership have shown no interest on ceding ground on the expansion debate, she said some rank and file Republican have "expressed they'd like to be better informed about what the consequences are of doing nothing."
But Howell said his caucus remains united.
Still, proponents of Medicaid expansion have tried to provide plenty of political cover for House Republicans to reconsider. The phrase "Medicaid expansion" has been eschewed for "closing the coverage gap," and proponents have tried to cast a Medicaid expansion as a way to fix other problems caused by the Affordable Care Act, including cuts in hospital funding.
The governor has tried to appeal to GOP lawmakers' fiscal conservatism, pointing to newly revised state estimates that show expanding Medicaid coverage along with other elements of the new federal healthcare law would save the state $1 billion through 2022.
And some Republican senators have hoped that a proposal creating something called a "Virginia Marketplace" that emphasizes the use of private insurers may induce House Republicans to soften their opposition.
But soon after Republican Sen. John Watkins of Powhatan introduced the proposal to a Senate panel last week, House leaders issued a statement calling it "Obamacare's Medicaid expansion by a different name."
"They don't want anything," said Watkins. "They want to leave a million people across the commonwealth of Virginia without healthcare."