In his first months on the job, Virginia Gov. Terry McAullife is trying to capitalize on Democrats' takeover of top state offices and the state Senate by pushing a key element of President Obama's health care law through a Republican-dominated House of Delegates.
The General Assembly's regular session ended a week ago without an agreement on expanding Medicaid, leaving the matter to be resolved with the rest of the state budget at a special session at the end of March. Now McAuliffe is drawing on his past as a rock-star fundraiser by barnstorming cash-strapped hospitals to pressure the House to accept billions in federal money to insure the poor.
If the two sides can't agree on a two-year budget by the end of June, state government would shut down. McAuliffe has rejected Republican calls to pass the $96 billion budget without expanding Medicaid and revisit the subject in another special session.
Earlier this month McAuliffe visited a hospital and health clinic in southwest Virginia in an effort to highlight how struggling hospitals in poorer, less populated areas desperately need the federal cash. The former head of the Democratic National Committee and Clinton confidante — who once wrestled an alligator for campaign cash — appeared at ease while meeting with patients and hospital officials in a county that McAuliffe lost to his Republican opponent by nearly 45 points in last year's election.
"We see everyday patients that are actually dying," said Paula Hill Meade, clinical director at the Health Wagon free clinic. "It's either eat or buy their medicines."
Meade says the clinic has seen a 70 percent increase in the number of clients in the last year as the area economy has suffered from problems in the coal industry.
After meeting with two patients, the governor raised his voice and slammed his hand on a table for emphasis.
"I wish your delegate and senator would come here and look you in the eye, and explain to me why we're not giving them health coverage," McAuliffe said.
The Republicans who control the state's House of Delegates oppose expanding Medicaid and argue that states would have to foot the bill if the federal government doesn't keep its funding promise. The Obama administration has pledged to pay for the first three years of expansion and no less than 90 percent after that.
About half the states have decided to expand Medicaid, and several others are still considering an expansion. While a handful of states with Republican governors are expanding, most southern states have declined to do so.
The election of McAuliffe and a Democratic lieutenant governor armed with a deciding Senate vote gave supporters of Medicaid expansion hope that it could happen this year. But McAuliffe had little luck finding a deal before the end of the regular session.
If McAuliffe were able to swing one of the largest states in the South, it not only be a symbolic victory for the Obama administration but would also show there are ways for states with divided governments to "get to 'yes,'" said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, which advocates for low-income people.
Virginia, which has a long history of resisting public assistance, ranked 48th in per capita Medicaid spending last year, according to state figures.
But McAuliffe is confident that the state, which also elected a Democratic attorney general last year, is ready to break from its conservative legacy.
"This is too much money," said McAuliffe, adding that a state budget estimate projects the Affordable Care Act with expanded Medicaid for 400,000 residents would save Virginia $1 billion by 2022.
The current plan being pushed by Virginia Senate Democrats and three Senate Republicans would expand Virginia's current use of private insurers to Medicaid clients. Similar approaches have been used elsewhere, such as Arkansas, to make expansion palatable to Republicans.
But House Republicans have rejected that plan. They have also said that increased Medicaid spending wouldn't cure all of rural hospitals' many budget woes, and note that their proposed budget would increase payments to free health clinics.
Republican Del. Terry Kilgore, whose district includes the Health Wagon clinic, said most messages from his constituents following McAuliffe's visit were against a Medicaid expansion.
"Other than from the hospitals, I'm not getting a cry and hue from my constituents to expand Medicaid," said Kilgore.
Larry J. Sabato, director of the University of Virginia Center for Politics, said he doubts Republicans, wary of facing primary challengers from their right flank, will hand McAuliffe a win.
The new governor is a millionaire former Democratic National Committee chairman who was co-chairman of Bill Clinton's presidential campaign and Hillary Rodham Clinton's 2008 campaign.
During the legislative session, the former D.C. power player tried to woo lawmakers with frequent receptions at the Executive Mansion, but has said Republicans simply aren't interested in negotiating.
Republicans, in turn, have said that McAuliffe isn't interested in having a serious debate. They have also pointed out that some of the hospitals McAuliffe has visited enjoy comfortable profit margins and have generous pay for top executives.
"The whole world is upside down, they're attacking CEO pay," said McAuliffe in an interview with The Associated Press aboard a state-owned plane flying back from Wise County.
McAuliffe had said he has more trips planned and expects Republican lawmakers to feel pressure from their constituents.
Before leaving the clinic in Wise County, McAuliffe made a promise to Pat Beverly, a grocery store cashier who said she can't afford health insurance.
"I'm going to get this done for you," McAuliffe said. "If it's the last thing I do."
Afterwards, Beverly told a reporter that she and her husband make about $2,000 a month, which could put them slightly above the cut-off line for Medicaid expansion.
Regardless, Beverly, who said she's good at reading people, said she had her doubts about McAuliffe's pledge.
"Right now I'm reading that it's just a big show," she said.