Last week we wrote about Medicaid expansion—what it is, why you should care, and where it stands in terms of passage in the General Assembly. But this week, we’re going to talk about sneaky ways some conservatives are trying to sabotage the idea of giving health coverage to 400,000 uninsured Virginians too poor or too sick to afford health insurance.

What’s all this I’m hearing about “clean” expansion? What does that mean?

There are two ways that Virginia could go about expanding Medicaid. The simplest and fastest way to get people healthcare would be through what’s called a “state plan amendment.” In this option, Virginia simply notifies the federal government that we will accept federal dollars to expand Medicaid to cover more people. The feds don’t get to say yes, no, or maybe. We ask for the money and they give it to us. We at Progress Virginia strongly support this option (called a “clean” expansion) because it’s the fastest and most common sense way to get Virginians access to healthcare without delays or political games.

Some Republicans would prefer to expand Medicaid through a waiver. In this scenario, Virginia would ask the federal government to let us change the rules for our Medicaid program. These rules aren’t as simple as they sound—they can be punitive measures to discourage people from applying for Medicaid or to make it harder for them to qualify. Beyond the obvious, we also oppose this route because it gives Donald Trump’s bureaucrats the ability to reject Virginia’s request for expansion. Trump has been very vocal in his opposition to the Affordable Care Act—making healthcare coverage for Virginia families contingent on his sign-off could leave families waiting for approval that never comes. When you are sick, or poor, you don’t have the luxury of time.

I’ve seen headlines about work requirements for Medicaid. What does that mean?

Republicans in the House of Delegates want to extract concessions in exchange for potentially dropping their roadblocks to Medicaid expansion. They’ve zeroed in on demanding Medicaid enrollees jump through more hoops in order to qualify for health coverage. House Bill 338 is their proposal. This mean-spirited and punitive bill isn’t even about Medicaid expansion! Instead, it would require Virginia to submit a waiver to the Trump Administration, not to expand coverage, but to get permission to require current Medicaid enrollees to comply with specific work requirements to continue to getting Medicaid.

Work requirements don’t create jobs or raise wages—they put onerous and punitive requirements between our friends and neighbors and the healthcare they need.

Here’s why work requirements for Medicaid are a really, really bad idea:

• It’s expensive: HB338 would cost Virginia about $10M to implement all of the paperwork and verification programs necessary for work requirements (for scale, that’s about $25/person for 200,000 enrollees.)
• It’s not a great use of money: Studies show 8 in 10 Medicaid recipients already live in a household where someone is working. And exemptions for folks like pregnant women, individuals with disabilities, and full-time caregivers mean fewer people would be affected.
• It’s a violation of our values: People have to be healthy in order to work, but that isn’t possible when they don’t have health insurance and can’t see a doctor when they need to. Work requirements don’t create jobs or raise wages—they put onerous and punitive requirements between our friends and neighbors and the healthcare they need.

Take action: Contact your Delegate and Senator to close the coverage gap

The bottom line is there’s still a long way to go with this legislative session and the road to Medicaid expansion. The best thing you can do? Take action right now to contact your Delegate and Senator and tell them to support a clean Medicaid expansion to close the coverage gap for 400,000 Virginians.