VIRGINIA’S new governor, Ralph Northam, did in five months what his predecessor, Terry McAuliffe, couldn't manage in four years. He convinced a usually obdurate Republican legislature to bring this blue-trending state fully under the Affordable Care Act—even as the Trump administration continues efforts to kill it.
On June 7th Mr Northam signed into law a new state budget. Its defining feature is more than $2.5bn in federal funds to bring more than 300,000 uninsured Virginians under Medicaid, a national health-care programme for the poor and disabled. Medicaid expansion is an option through the ACA, also known as Obamacare, for providing health care for those without.
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Virginia became the 33rd state to expand Medicaid, not just because Mr Northam and fellow Democrats were united on a health-care fix but because Republicans, who now only barely control the state legislature, were divided. The Republican Party refused four times to consent to Medicaid expansion during Mr McAuliffe’s governorship, if only to bring Mr McAuliffe, an old ally of the Clintons, who is now considered a presidential prospect, to heel. They began rethinking their stance after the election last November in which an anti-Trump tsunami carried Mr Northam to an easy victory and nearly erased Republicans’ majority in the House of Delegates. Fifteen Republicans were defeated, reducing the party’s advantage to a mere two seats.
In January, gambling that a less hard-hearted approach on Medicaid would improve chances Republicans would survive the next House election in 2019, the new Speaker, Kirkland Cox, said he would support expansion if it included a work-for-benefits requirement for Virginians able to hold a job or train for one. This is a feature of expanded Medicaid programmes in such Republican states as Kentucky and Arkansas. Mr. Cox’s reversal brought along 19 Republican votes, ensuring its passage in the House.
The Virginia senate was a less easy sell. The resistance of Senate Republicans pushed the General Assembly into an extended overtime; it was not until two members defected in the early spring that passage seemed likely. For the final vote, two more Republicans joined the Democrats’ push, not only guaranteeing Mr Northam’s victory but affixing to it the veneer of bipartisanship.
All this stands in marked contrast to politics across the Potomac River, in Washington, DC. And it highlights a defining characteristic of the new governor: a concerned attentiveness. As a pediatric neurologist, the soft-spoken Mr Northam spends a lot of time listening and asking questions before proposing a cure. The breakthrough in Virginia also contrasts with the McAuliffe years, during which the state government became something of a free-fire zone, with Mr Northam’s voluble predecessor and the General Assembly’s Republican bosses reflexively trading cheap shots.
The state’s relatively robust economy also helped decide the long-argued Medicaid issue. A torrent of fresh state tax dollars, much of it a consequence of President Donald Trump’s federal tax overhaul, meant there were pricey inducements for some Republicans to drop their opposition to expansion. They included supplementing emergency cash accounts, something credit agencies said was essential for the state to preserve its highest-possible, triple-A debt rating, a badge of honour for Virginia since the rating system was implemented some 80 years ago.
There were also dollars for long-vacant judgeships. Filling them is almost entirely the privilege of the legislature’s majority party. Republicans have jealously guarded this often-overlooked form of patronage, much as the former Democratic majority did. Another goodie, one that apparently brought along Republicans from the economically distressed coalfields, where jobs are as scarce as health care: continued tax relief for the few mining companies still operating in Virginia.
Mr Northam must now start planning his next move. There is talk he will focus on strengthening pre-kindergarten programmes, advancing the oft-repeated Democratic line that investing in ways to keep children in classrooms will keep them out of prison as adults. To help keep moving an economy in which more than one in four dollars flows from the federal government, Mr Northam is also planning additional initiatives in job training. Taxes, too, could be on the agenda. Virginia has to decide whether its tax code should conform to the new federal tax scheme; that could determine whether some taxes go up or down, or stay the same.
But Mr Northam’s first triumph—Medicaid expansion—could be a tough act to follow.