Because they control half the seats in the Senate, Democrats have threatened to withhold support for the state budget -- with funding for key McDonnell priorities -- unless the state agrees to avail itself of the Medicaid expansion with no (or very few) strings attached.
Democrats were emboldened in this effort after a controversial attempt by Senate Republicans to jam a mid-decade gerrymandering plan through the state legislature on the day of President Obama's second inauguration. That effort failed in the House earlier this week, but only after Democrats had coalesced around a plan to use the state budget as leverage to expedite the Medicaid expansion.
So far that plan has proved effective. On Thursday, the Virginia Senate amended its budget to include a provision green lighting the expansion, while the state simultaneously works to implement federally-approved cost control measures for the program. The budget passed overwhelmingly.
The question now is whether Democrats can stare down McDonnell and House Republicans. The House's budget bogs down, and possibly kills, the Medicaid expansion by making it contingent on the state securing approval for cost containment measures, and by requiring the General Assembly to take action before the expansion can proceed.
Per The Virginian Pilot:
The Senate-passed budget is at odds with the one passed by the House of Delegates, which agreed with Gov. Bob McDonnell that the state should not move ahead yet with Medicaid expansion.
The governor and the House Republican majority say that before the program is expanded, the state should be allowed more control and flexibility to wring savings out of the system.... What's generally agreed upon is that there's more room for compromise than there was days ago when Senate Democrats unanimously voted against the budget bill in committee."
If the House and Senate can't reconcile the differences between the two budgets it'll sink a host of McDonnell's legislative priorities, including $50 million for transportation funding. But securing the expansion will either require members of both parties to compromise, or every Democrat in the Senate to hold the line on their exact Medicaid demand.