For Virginia politicians, the decision to expand Medicaid ultimately came down to looking at what Virginia was already paying for the program, Democratic Gov. Ralph Northam told insurers on Thursday.
Later that day in Richmond, Northam announced that the CMS has approved the state plan amendments for Medicaid expansion.
"Every day we weren't expanding Medicaid, we were giving money to the surrounding states," Northam said, speaking at the America's Health Insurance Plans conference in Washington.
Enrollment for Medicaid expansion in the state starts Nov. 1, with coverage starting Jan. 1 for the newly eligible population of adults earning up to 138% of the federal poverty line.
Virginia is still waiting for agency approval of its Section 1115 Medicaid waiver to set work or community service requirements for expansion adults who aren't enrolled in post-secondary education. The state also wants to set sliding scale premiums.
Northam's comments on the tipping point that drove Medicaid expansion in a state—where the issue had roiled politics for years—reflect shifting attitudes across the country. Idaho, Nebraska and Utah voters will decide next month whether they want their states to expand the program.
In the early years of the Affordable Care Act, conservative critics were able to galvanize opposition to expansion by framing their argument in terms of rejecting greater government funding. Proponents have changed the rhetoric about funding.
"From a business perspective, it was about the amount of money we were forfeiting to other states," Northam said, noting that another factor was the realization after the congressional GOP's failed attempts to overhaul Obamacare that the ACA was here to stay.