Medicaid expansion supporters in Virginia have new hope

YORKTOWN, Va. (AP) — Milton Batalona's recent breathing problems were so bad he could barely walk 10 feet without getting winded. His coworkers at the grocery store where he works urged him to get treatment right away, but the 34-year-old from Yorktown, Virginia, said he was too scared he'd get stuck with a bill he can't afford.

"They kept saying, 'Go to the emergency room, go to the emergency room' and I was like, 'I can't afford the emergency room," he said.

Batalona said he makes $16,000 a year working part-time and can barely cover rent, food and other expenses. So instead of visiting an emergency room or an urgent care center, he said he waited until he could get an appointment at a free clinic for what turned out to be a flu-related illness. Having health insurance, he said, would have made a big difference in his peace of mind.

"It would definitely be something great to take off the table," he said.

Batalona is one thousands of working poor in Virginia who are at the center of a tense debate at the General Assembly that threatens a possible state government shutdown. Lawmakers are split on whether to expand Medicaid in Virginia, and the disagreement is preventing them from passing a state budget. If they don't pass one by July 1, the state government will shut down.

Long a political nonstarter in the Old Dominion, Medicaid expansion's prospects are much brighter this year. And the momentum shift is due largely to President Donald Trump.

A federal-state collaboration originally meant for poor families and severely disabled people, Medicaid has grown to become the largest government health insurance program, now covering 1 in 5 people. Under former President Barack Obama's health law, states got the option of expanding Medicaid to cover more low-income adults.

Virginia is one of 18 states that refused. But an anti-Trump backlash last year helped Democrats gain seats at the General Assembly and give the issue new life.

Some House GOP leaders, including Speaker Kirk Cox, are now supporting Medicaid expansion after years of opposition.

Pro-expansion Republicans said the Trump administration's embrace of work requirements for low-income people on Medicaid has helped them change their mind. They also reason that Republicans' failure last year to repeal Obama's health care law, one of Trump's key campaign promises, means that Medicaid expansion is here to stay.

Del. Terry Kilgore, one of the first Republican lawmakers to back Medicaid expansion this year, said the work requirements have been key in winning over his support. The powerful lawmaker's district in Virginia's struggling southwest coal country has about 4,800 adults who would qualify for Medicaid expansion.

"We can't be the party of 'no,'" Kilgore said after announcing his change of position.

LaDonna Sexton is a former nurse who lives in Kilgore's district and works part time at a health clinic making about $800 a month. Sexton said she's constantly fearful she or her adult son, who is a diabetic and uninsured, will need costly emergency or other medical care. Being on Medicaid, she said, would be life-changing.

"I can't even describe in words what kind of relief that would be," she said.

Opponents of expansion said the program is unaffordable and the federal government's pledge to cover no less than 90 percent of the costs is unreliable.

"There are so many uncertainties about Medicaid and Medicaid expansion right now that a more fiscally constrained approach is to not expand it at this point," said Republican Senate Majority Leader Tommy Norment.

Overall, the state estimates that 400,000 people would be eligible for Medicaid expansion and about three-quarters of them would sign up.

Batalona is one of about 4,200 people in Norment's district who would qualify for Medicaid expansion, according to the nonprofit Commonwealth Institute. Batalona said he has many coworkers and friends who have serious health needs.

"It would not be fair to them to say, 'Oh we couldn't afford to keep you alive, sorry,'" he said.