CHARLESTON, SC — It depends on what the meaning of the word “expansion” is.
That might be the most appropriate way to describe the confusion and conflicting reporting stemming from a news conference given last Friday by Terry McAuliffe, the longtime consigliere to Bill Clinton and current Democratic governor of Virginia. After spending a good chunk of Monday trying to figure out just what Slick Terry meant, I don’t envy reporters in that state. But it’s possible to identify some lessons here, and some thoughts on where the coverage should go next.
Here’s what’s clear: After a months-long partisan struggle with Republicans in the state legislature over whether to accept federal funds from the Affordable Care Act to expand eligibility for the state’s Medicaid program, McAuliffe on Friday averted a government shutdown by signing a GOP-passed budget that rejects the money. But in doing so, he vetoed several Medicaid-related provisions inserted by Republicans, and promised to do, well, something about improving access to healthcare coverage.
Coverage from The Associated Press was similar (“Gov. Terry McAuliffe vowed Friday to bypass the General Assembly and expand Medicaid eligibility for about 400,000 low-income residents on his own,” went the lede) and the distribution of that story Friday afternoon spurred plenty of Twitter chatter and breaking news alerts.
But before long, there was another media narrative circulating, saying that those first stories were all wrong. By 3:30 Friday afternoon, Vox.com had a piece up under the headline, “Virginia Republicans appear to have successfully blocked Medicaid expansion.”
Huffington Post’s reported story, based on an interview with McAuliffe spokeswoman Rachel Thomas, was a little less contrary, but only a little. Here’s how their healthcare reporter Jeffrey Young tweeted the piece:
Q: Did Terry McAuliffe announce he's expanding Medicaid today? A: NO HE DIDN'T, despite what you've read elsewhere. http://t.co/VzHhw7bb7D— Jeffrey Young (@JeffYoung) June 20, 2014
And it’s true—in McAuliffe’s nearly 20-minute speech, not once did he explicitly say he was going to “expand Medicaid.” He did cite his success running on “a platform of expanding Medicaid services to 400,000 Virginians,” in the course of bashing Republicans at length for blocking expansion, and then he said this:
With respect to healthcare, let me be clear: I am moving forward. There are several options that are available to me. I have directed [health] Secretary [William] Hazel to work with our federal partners in Washington, the insurance industry, the healthcare providers, our university medical centers, nonprofit organizations, our local health department, and the hospital industry, to extend the promise of healthcare to all our people. Secretary Hazel will have a plan on my desk no later than September first of this year detailing how we move forward with healthcare in the face of demagoguery, the lies, the fear and cowardice that have gripped this debate for far too long.
Elsewhere in his comments, he said, “I am moving forward to get healthcare to our Virginia citizens,” and “There are several options out there, public, private, working in different ways with different opportunities that we can put together, working with the private sector” and, “We are going to provide healthcare for our citizens and we are going to pick the best option available to us, plain and simple.”
That’s definitely news—but there’s not really enough there to support those “expand Medicaid” headlines (which, actually, had started to appear well before last Friday).
But then, in a Q-and-A portion of the news conference, The Virginian-Pilot’s Bill Sizemore, who wrote that front-page piece, asked McAuliffe if he had any concerns “about the legality of doing that, the Medicaid expansion?” McAuliffe accepted the premise of the question, simply replying that he’d been working with the attorney general’s office to make sure anything he does will be in concert with the law.
And Virginia reporters told me that the governor’s office hasn’t objected to their published characterization of his comments as a vow to expand Medicaid—which is how The Washington Post, The News Virginian, and WDBJ in Roanoke also framed it. (Other in-state outlets, like the Richmond Times-Dispatch, the Loudoun Times-Mirror, and Watchdog.org’s Virginia bureau were more careful, largely sticking to the governor’s terms.)
So, what the heck is going on here? And does any of this matter, anyway?
Let’s tackle the second question first. Despite the pushback from other outlets, The Virginian-Pilot’s Sizemore told me he’s comfortable with the way his reporting framed the story—and that he doesn’t think the word choice is all that significant. Sizemore said he doesn’t see how McAuliffe could do anything to expand coverage to hundreds of thousands of uninsured Virginians without tapping into federal Medicaid money through the Affordable Care Act.
“You need to follow the old journalistic adage: follow the money,” he said. And if that’s how any program would be supported, “as to whether it’s [called] ‘Medicaid expansion’ or something else, I think it’s largely a semantical difference,” he said. “I don’t think it’s a difference of substance.”
That’s a fair point, if Sizemore’s read of the situation is correct. But some of the other reporting specifically questions whether McAuliffe’s “options” would be funded by federal Medicaid funds through the ACA. From Young’s HuffPost piece, paraphrasing Thomas, McAuliffe’s spokeswoman: “But that doesn’t necessarily mean he will expand Medicaid eligibility using the authority and federal funding granted by the Affordable Care Act.” And as Laura Vozzella of the Post reported in a good piece back in May, it’s not at all clear that McAuliffe could legally act to accept those funds—which means that if that’s what he meant, the “vow” may have been empty. (More on this below.)
On the other hand, if McAuliffe was promising to do everything else in his power, his authority would be clear, but the effect would likely be smaller. Thanks to the ACA, Medicaid enrollment is growing even in states like South Carolina that have rejected federal funds to expand eligibility. A governor who wanted to could probably accelerate that “welcome mat” effect, and find some other ways to move the coverage needle too. Is that “expanding Medicaid”? Maybe. But it seems unlikely to reach as many people as a full-fledged “expansion,” whatever the governor is saying now.
So why are we still speculating about this, days after McAuliffe spoke to the media? In large part because the governor’s office seems content to have it both ways in the press. I spoke to Thomas, McAuliffe’s spokeswoman, on Monday, to try to clarify what the governor’s plan was, and also to ask what she thought of the “vow to expand Medicaid” coverage. She wouldn’t bite. The message: All options are on the table, we’re not ruling anything out, we’re looking to expand coverage one way or another.
“Whatever that includes, whatever people may call that, I think it’s too early to say until we have a plan,” she told me. Too early to call it a “Medicaid expansion” plan? She declined to answer on the record.
To speculate a little further: McAuliffe has deliberately avoided saying he would “expand Medicaid,” because he knows he’s in a tricky situation, and he’s trying to preserve maximum possible wiggle room. But he probably wasn’t too upset about that front page in The Virginian-Pilot, either. Beyond the very real substance of the issue, he’s got a lot invested in this fight, and the high-stakes, take-charge approach isn’t a bad look, especially for someone who wasn’t especially beloved by many Democrats before he took office. The press can get too invested in political kabuki, but this is a case where trying to decode some of the shadowboxing might actually help readers better understand what’s going on. In addition to the basic virtue of precision, a more cautious approach when describing McAuliffe’s position—one that doesn’t go further than the governor did—seems most likely to steer the coverage in that direction (though the Post’s Friday story did some of this decoding, even as it went with the “expand Medicaid” frame).
And the broader issue, going forward, is just how much uncertainty there is here—about what that report in September might say, about what the limits of McAuliffe’s authority is, and about what will happen if he tests those limits. I pinged a couple smart healthcare experts, Chris Lee at the Kaiser Family Foundation and Washington & Lee law professor Tim Jost, to ask if there was any way McAuliffe could accept federal funds without the legislature’s support—pretty much the question Vozzella explored in May. Neither had much of an idea, as it’s really more a question about the state constitution than the ACA. A couple other experts who are connected to health policy in the state couldn’t offer much clarity either.
So maybe the story is: The governor won’t be pinned down, and no one really knows what’s going to happen. I’ve been scanning for follow-ups, and I haven’t seen that story yet. On the other hand, I could have missed it—I’ve been busy trying to figure out what the meaning of the word “expansion” is.