In a speech on the floor of the House of Delegates recently I spoke of experiences I had in my first years as a member when others in the House smoked during the daily floor sessions. One member was notorious for lighting up a long cigar. A cloud of smoke hung over the House chamber. I explained that I was reminded of that cloud of smoke when in recent weeks I have listened to a series of speeches by members of the majority party explaining why they do not support expansion of Medicaid. You can listen to my speech at http://youtu.be/Vl6Bky8zjWE.

Even as reforms are being made based on recommendations of an interim study commission, others are calling for unspecified additional reforms before expansion. There is a call for an audit even though the audit reports of recent years stacked together would measure several feet in height. Doubts are being raised as to whether the federal government can afford the program while Virginians are paying nearly two billion dollars in taxes and fees specifically to support Medicaid expansion. There is a thick smokescreen of explanations and excuses as to why a quarter million Virginians should be denied health insurance.

That the budget for Medicaid has increased in recent years should hardly surprise anyone. People are living longer, many in nursing homes, and their care is costly. Health care costs are generally increasing outside of Medicaid. Our state policy has been to put the most frail and medically needy people into Medicaid. Costs are not high because of the Medicaid program--people with the greatest need have qualified for the program under the current policies.

Virginians are losing three ways: businesses and individuals are paying nearly $2 billion to support the expansion; the program is not being expanded in the Commonwealth costing the state $5 million a day in lost reimbursement; and the legislature is taking money from other programs like education to cover the critical needs for indigent care. Senate Democrats and some Republicans, House Democrats, and the Governor all have agreed to a market-based compromise, but House Republicans are refusing to go along with any plan. Without a resolution there could be a state government shutdown.

If this congressional-style impasse sounds familiar, the reasons for it became clear last week when an ad started running on Virginia radio stations sponsored by the Koch brothers' Americans for Prosperity. "There is a battle in Virginia between President Obama, Governor McAuliffe and those committed to quality healthcare. Let's face it: Medicaid expansion is Obamacare and it's threatening the quality of health care for millions of Americans." For the full ad, go to http://bit.ly/1cpHxRz. Not surprisingly Congressman Eric Cantor who led the 44 attempts in the House of Representatives to repeal the Affordable Care Act showed up in Richmond recently to address the house Republican caucus.

The issue in Virginia unfortunately is not the one million Virginians without health care. It is about the nationwide effort to defeat Obamacare at any cost--including closing down the federal or state government.