Vir­gini­ans want Med­i­caid ex­pan­sion, but thanks to ger­ry­man­der­ing, they’re not go­ing to get it.

The Washington Post Sunday - - METRO - BY STEPHEN J. FARNSWORTH

De­spite years of Repub­li­can ef­forts in Wash­ing­ton to re­peal the Af­ford­able Care Act, sup­port in Vir­ginia for Med­i­caid ex­pan­sion re­mains as strong as ever.

A new Univer­sity of Mary Wash­ing­ton sur­vey of 1,000 adult Vir­gini­ans found that 70 per­cent fa­vor in­creas­ing ac­cess to Med­i­caid, an im­por­tant but op­tional part of the Af­ford­able Care Act, with only 25 per­cent op­posed. A year ago, 68 per­cent said they wanted Vir­ginia to ex­pand this pub­lic health-in­sur­ance pro­gram for low-in­come, unin­sured state res­i­dents.

Gov. Terry McAuliffe (D) fa­vors Med­i­caid ex­pan­sion, but Repub­li­can ma­jori­ties in the leg­is­la­ture do not. De­spite a fed­eral re­im­burse­ment pro­gram for states that ex­pand Med­i­caid that will cover nearly all the added ex­penses, GOP law­mak­ers pre­dict Vir­ginia tax­pay­ers even­tu­ally will be stuck with much higher costs.

Med­i­caid en­roll­ment is great­est in the com­mon­wealth’s most ur­ban and the most ru­ral ar­eas. Nearly ev­ery House of Del­e­gates dis­trict south of In­ter­state 64 and west of In­ter­state 95 has Med­i­caid en­roll­ment lev­els above the state av­er­age, as do dis­tricts in Rich­mond and Hamp­ton Roads. These ar­eas are most likely to ben­e­fit from Med­i­caid ex­pan­sion.

In the Septem­ber UMW sur­vey, 50 per­cent of Repub­li­cans fa­vor the idea, with 44 per­cent op­posed. In con­trast, 92 per­cent of the state’s Democrats and 66 per­cent of in­de­pen­dents fa­vor cov­er­ing more peo­ple un­der Med­i­caid.

Few pol­icy is­sues gen­er­ate such strong pub­lic sup­port, but the mea­sure lan­guishes in Rich­mond be­cause of ger­ry­man­der­ing, not cit­i­zen pref­er­ences.

When lines are drawn to cre­ate leg­isla­tive dis­tricts fa­vor­ing one party to an over­whelm­ing de­gree, politi­cians of that party are far more at risk of los­ing in a party pri­mary than in a gen­eral elec­tion. In 2015, only 29 of the state’s 100 del­e­gate elec­tions fea­tured Demo­cratic and Repub­li­can can­di­dates. Only six were close con­tests, de­cided by fewer than 10 points.

In such a po­lit­i­cal en­vi­ron­ment, Repub­li­can law­mak­ers rightly fear an­gry con­ser­va­tives far more than any other vot­ing group. Any safe-seat Repub­li­can who sides with McAuliffe on Med­i­caid ex­pan­sion — even if he or she rep­re­sents a dis­trict that would ben­e­fit — would likely be de­feated in a low-turnout pri­mary by a more con­ser­va­tive op­po­nent.

Given hy­per-par­ti­san line-draw­ing, the 70 per­cent pub­lic sup­port shown for this pol­icy change does not mean much. Med­i­caid ex­pan­sion re­mains a long way from be­ing en­acted in Vir­ginia.

The writer is a pro­fes­sor of po­lit­i­cal sci­ence at the Univer­sity of Mary Wash­ing­ton and di­rec­tor of the univer­sity’s Cen­ter for Lead­er­ship and Me­dia Stud­ies.

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