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What a difference an election can make. Democrats electoral success in Virginia last year now has it on the verge of becoming the next state—the 34th, counting D.C.—to accept Medicaid expansion under the Affordable Care Act. Democratic Gov. Ralph Northam called a special session beginning on April 11th to resolve the expansion dispute and finalize the budget and they are very close to having done that. The final fight is over work requirements, which the votes of two Senate Republicans hinge upon.
The deal is all but done except for some of the details, said Sen. George Barker (D), whose Northern Virginia district covers parts of Fairfax and Prince WIlliam counties and part of Alexandria. [...]
The work requirement provides Republicans with political cover for changing their position on Medicaid expansion, said John McGlennon, a government professor at the College of William and Mary in Williamsburg.
This newfound support for Medicaid expansion among some Republicans is the result of a mix of other factors, including the party’s poor showing during the House elections last year and specific regional issues, McGlennon said. [...]
As for the minority party in the House, McGlennon said, “The Democrats were willing to pass what the Republican Speaker was willing to swallow.”
It's a foot in the door for expanded coverage as far as Democrats are concerned, and even with the work requirements could bring 400,000 people into coverage. "My preference would be not to have a work requirement," said state Sen. Janet Howell (D) who represents a district in northern Virginia, "but I don’t see any way to get expansion passed unless we have one." Northam has left the door open for the work requirements, but hasn't endorsed the proposal. He has refused to sign a budget that did not include the expansion.
The current version of the work requirement would require enrollees to work a minimum of 20 hours per month for the first three months, with that requirement gradually increasing to 80 hours per month after a year. If someone doesn't meet those standards for more than three months out of the year, they lose coverage and have to wait until the next year to reapply. It exempts children, people with serious mental illness, people over 55, those who are disabled or medically frail, are taking care of children or family members, and pregnant women and or women who have just given birth. Being enrolled in school, volunteering, or being in a job-training program for the specified hours would qualify as meeting the requirements.
It's still a ridiculous burden to put both on the uninsured and on the state that has to come up with the system to track and enforce the work hours, but it's not as punitive, say, as what the Republicans in the U.S. House want to do with food stamps.