AUDIE CORNISH, HOST:
Despite longtime Republican opposition to the Affordable Care Act, Virginia's state Senate voted today to expand Medicaid under the ACA. That means coverage for almost 400,000 low-income residents. Four Republicans crossed the aisle to support the move. Mallory Noe-Payne is a reporter for Radio IQ and Virginia Public Radio in Richmond. I spoke to her earlier and started by asking her what brought some Republicans on board.
MALLORY NOE-PAYNE, BYLINE: Well, their reasoning is largely financial. If Virginia expanded Medicaid, essentially the state would shift hundreds of millions of dollars from our state budget to the federal budget. There's a lot of things that the state provides that if we expanded Medicaid the federal government would be responsible for paying for. So that frees up state money for education spending, public safety. That has always been the case.
This year, there is one big thing that's changed that they both cite in their reasoning, and that's the Trump administration. Unlike the Obama administration, the Trump administration is supporting conservative reforms to Medicaid expansion, things like work requirements. And so that's able to be part of the compromise package here in Virginia.
CORNISH: So talk a little bit more about that. It sounds like Virginia Republicans aren't worried about the Medicaid expansion going away under the Trump administration. They're willing to work with these new restrictions.
NOE-PAYNE: So part of bringing Republicans to the table when this conversation started at the beginning of the year was implementing conservative reforms, things like work requirements - so making sure that people who are eligible for Medicaid are looking for work or maybe volunteering or seeking education, things that we see in other welfare benefits but haven't traditionally seen in Medicaid.
CORNISH: Is that a dramatic shift for Virginia?
NOE-PAYNE: Yeah, it's a big shift for Virginia. Republicans hadn't supported Medicaid expansion at all before. And the Republicans in the House of Delegates changed their tune this year for the first time.
CORNISH: Now, I understand former Senator Rick Santorum was there today telling Republicans to vote no on the expansion. What did he have to say, and do you think he'll have any sway with local Republicans in Virginia?
NOE-PAYNE: What he had to say was that it's possible the Affordable Care Act could still be repealed. That would be bad for Medicaid expansion. It means that those federal dollars would go away. So he was trying to convince Republicans that they weren't secure dollars.
CORNISH: And that would leave Virginia on the hook for 2 billion, correct?
NOE-PAYNE: For - yes, a lot of money. And that's been the concern in the past. That's been one of the reasons that Virginia hasn't expanded Medicaid before. But something that's different this year is that a repeal and replace effort failed in Congress. And so Republicans feel a little bit more certain that because that effort failed, it's not going to come up again.
CORNISH: With this, Virginia becomes I think the 33rd state, you know, that would approve Medicaid expansion. Do Virginians see themselves as part of a broader movement?
NOE-PAYNE: I think so. I mean, this vote comes after November's elections, where we saw a lot of Democrats come out. They changed the makeup of our state legislature. And so, I mean, we had this blue-wave election, and now there's been real policy consequences. And so heading into these midterm elections, I think that people will turn to Virginia as an example of what happens when people come out and vote.
CORNISH: Mallory Noe-Payne is a reporter for Radio IQ and Virginia Public Radio in Richmond. Thank you for sharing your reporting with us.
NOE-PAYNE: You're welcome. Transcript provided by NPR, Copyright NPR.
