RICHMOND, Va. — The federal government is again open for business, and Republicans in Washington are licking their wounds from the failed Tea Party attempt to derail President Obama's health care overhaul. But here in Virginia's capital, conservative activists are pursuing a hardball campaign as they chart an alternative path to undoing "Obamacare" — through the states.
One leading target is Emmett W. Hanger Jr., a Republican state senator from the deeply conservative Shenandoah Valley, who prides himself on "going against the grain." As chairman of a commission weighing one of the thorniest issues in Virginia politics, whether to expand Medicaid under Mr. Obama's Affordable Care Act, he is feeling heat from the Republican right.
His openness to expansion has aroused the ire of Americans for Prosperity, the conservative advocacy group backed by the billionaire industrialist brothers Charles and David Koch. Dressed in emerald green T-shirts bearing the slogan "Economic Freedom in Action!" its members are waging what the senator calls "an attempt to intimidate me" in Richmond and at home.
They have phoned his constituents, distributed leaflets and knocked on 2,000 doors in his rural district. When the Republican town committee met Monday night in Mr. Hanger's home county, Augusta, Americans for Prosperity was there.
In Richmond on Tuesday, hundreds of volunteers in green shirts turned out for a commission hearing, bused in by the advocacy group's field organizers, who provided Subway sandwiches for lunch.
"This has been one of those trench warfare kind of efforts for a year now, and I think it is one of those hidden stories of the whole fight against Obamacare," said Tim Phillips, president of Americans for Prosperity. "It's not flashy; it's just in a whole bunch of state capitals and in the districts of a whole lot of state legislators, but it's such a crucial aspect of the overall long-term effort to roll back Obamacare."
The state-by-state strategy represents a split from the course pursued by Heritage Action for America and its sister organization, Heritage Foundation, which drove the "defunding Obamacare" movement that led to the recent government shutdown. In an opinion article published Friday by The Wall Street Journal, Jim DeMint, the foundation president, made no apologies. "Obamacare will now be the issue for the next few years," he wrote.
Expanding Medicaid, a joint federal-state program for the poor, is critical to the law's goal of covering the nation's 48 million uninsured. Hospitals and insurers were also counting on more Medicaid patients to make the economics of the law work. For states, the terms seemed attractive: The federal government would pay 100 percent of the cost of new enrollees for the first three years, 90 percent after that.
But in June 2012, the Supreme Court ruled that states could opt out of Medicaid expansion. The ruling opened the door for conservative opponents of the law. Americans for Prosperity, with paid staff members in 34 states, walked through it. So did another group, Tea Party Patriots, which recently gave $20,000 to organizers of a referendum drive to put the question of Medicaid expansion on the Arizona ballot.
Americans for Prosperity has spent millions in states around the country, including Arkansas, Florida, Ohio, Louisiana, Michigan and Pennsylvania, to run the kind of aggressive campaign that it is now waging here in Virginia, where much will depend on the governor's race. The Democratic candidate, Terry McAuliffe, who leads in the polls, favors expansion. The Republican candidate, Kenneth T. Cuccinelli II, is opposed.
So far roughly half the states are moving forward with Medicaid expansion, and an increasing number of Republican governors are expressing interest. Michigan, where Gov. Rick Snyder recently signed Medicaid expansion legislation into law, was "a tough loss," Mr. Phillips conceded. In Ohio, Gov. John R. Kasich wants to expand. So does Gov. Tom Corbett in Pennsylvania, even though the legislature has already rejected it.
"This is going to be an issue all through 2014 for us," said Jennifer Stefano, a former television reporter who runs Americans for Prosperity's Pennsylvania chapter. "I don't believe this fight is in Washington or ever was. I think this is a street fight. It's a man to man, so to speak, fight of going door to door."
That, at least, is the way the battle is being waged here in Virginia, where Mr. Hanger, a 30-year veteran of state politics, is navigating politically treacherous waters.
His panel, formed after the State House and Senate could not agree, must evaluate whether the state Medicaid program has put in place certain changes to improve care and cut costs. It has five members from each chamber; the program can be expanded only if three from each chamber agree. So far, four House members are opposed.
Mr. Hanger said he had not made up his mind, but added, "It makes absolutely no sense to not utilize those federal dollars when we have this unmet need."
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