Last Wednesday the 2014 session of the General Assembly adjourned sine die at the end of the Reconvened Session that is called at the conclusion of each regular session to consider amendments to legislation proposed by the Governor and vetoes he made of any bills. Much of the work during the Reconvened Session dealt with technical issues related to the drafting of bills during a fast-paced session. Although the regular session has concluded, the General Assembly is already in special session to consider the biennium budget and closing the gap in health care coverage.

As I wrote in a column a few weeks ago, I give the regular session an "I for Incomplete" grade because it has failed to date to pass the most important work of every session in an even-numbered year--passing a budget for the state for the next two years beginning July 1. Otherwise, as I wrote in the same column, the session would be considered a reasonably productive one.

Republicans in the House of Delegates have refused to consider closing the gap in health care coverage even though federal dollars are available to cover 100 percent of the cost. While I have tried to understand their logic for wanting to separate the expansion of Medicaid from consideration of the budget, I can only conclude that separation of the two issues is simply an attempt to defeat any effort to expand Medicaid. How or why would a legislature consider or pass a budget that ignores five million dollars a day in federal revenue available to it? Why would a legislature choose to ignore the nearly two hundred million dollars in state general funds that Medicaid expansion would free up to meet critical needs in education and public safety? How can one argue that separating Medicaid expansion from the budget would make for a "clean" budget when 20 percent of the current budget is the current Medicaid program? Why would we watch billions of dollars be paid by Virginia businesses to the federal government without adopting the program these dollars were intended to support? Why should residents of the poorest area of our state--the southwest--go without health care when their neighbors in Kentucky and Tennessee are receiving care through Medicaid? Why should we ignore the pleas of our hospitals who suffer serious financial challenges from providing uncompensated care to indigent people when Medicaid expansion would cover these costs? Why are we ignoring the fact that our free clinics have more patients than they can serve?

There are many more questions that could be asked of Republicans in the House of Delegates, but the answer to all is the same: politics. Political considerations are keeping the Republicans from being willing to consider what they term "Obamacare." The Koch brothers funded Americans for Prosperity along with Grover Norquist and the Tea Party are actively working against Medicaid expansion, and Republican incumbents fear a primary challenge from the right if they vote for anything related to expanding Medicaid.