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Farnsworth, Hanna & Harris: Medicaid recipients in House of Delegates districts

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You wouldn’t know it from partisan rhetoric or from last week’s vote in the Virginia House of Delegates, but the commonwealth’s rural Republican heartland relies on Medicaid about as much as inner-city urban communities.

Even though GOP delegates rejected overwhelmingly a plan for expansion of that federal health care program for the poor, Republicans represent 32 of the state’s top 50 delegate districts ranked by percentage of the population on Medicaid. Democrats represent the other 18. These high Medicaid districts represented by both parties would benefit disproportionately from a Virginia Senate-approved plan to add hundreds of thousands of Virginians to the Medicaid program.

Using Medicaid data compiled by the Virginia Department of Medical Assistance Services, we created a map that identified Top 50 and Bottom 50 districts in terms of Medicaid population. (Given majority rule in the House of Delegates, we figured that a 50-50 division was as good as any.)

Dark red districts in the accompanying map are those with relatively high Medicaid populations and Republican representation, while dark blue districts have larger Medicaid populations and Democratic representation. Lighter shades of red and blue mark the bottom 50 districts, as measured by Medicaid population, and their partisan representation.

With a Republican victory in a Tuesday special election, the GOP now holds 68 of 100 delegate seats. Many of those Republican districts are sparsely populated, and therefore the map is mostly red. Democratic-held districts generally are concentrated in more populous urban areas and appear much smaller on the map.

As the map shows, a huge swath of the state, including nearly the entire area south of Interstate 64 and west of Interstate 85, is both Republican in its politics and more reliant than average on Medicaid. Another stretch of high Medicaid reliance and Republican representation can be found along the Interstate 81 corridor, also one of the state’s more conservative regions.

Del. Mamye E. BaCote, a Democrat who represents parts of the cities of Hampton and Newport News, has the district with the highest Medicaid population: 33 percent. Del. Daniel W. “Danny” Marshall III represents the Republican-held district with the highest Medicaid population, at 30 percent. The 14th District, which includes the city of Danville and parts of Henry and Pittsylvania counties, ranks fourth overall in Medicaid population, behind BaCote’s district and two others held by Democrats.

The map also identifies the three districts held by Republicans with the greatest percentage of Medicaid recipients. They include Marshall’s district, as well as Terry G. Kilgore’s 1st District, located in the state’s southwest corner, and the 61st, which is represented by Thomas C. Wright Jr. and is located along the North Carolina border and near Interstate 85. Both the 1st and the 61st have 28 percent of their population on Medicaid.

These three Republican-held districts rank in the Top 10 in the percentage of the population on Medicaid. Democrats represent the other seven. These 10 districts are separated by only a few percentage points in terms of Medicaid population, ranging between 28 and 33 percent.

The lack of competitive districts in nearly all corners of the state encourages most delegates to focus on primary voters, not the district as whole, as a party nomination is tantamount to election in most districts. For Republican incumbents, conservative objections to anything relating to the Affordable Care Act are likely to trump the preferences of poorer voters who might benefit from a Medicaid expansion but are less likely to participate in primaries.

Republicans represent 36 of the 50 districts least reliant on Medicaid, with Democrats holding the other 14. Most of these low-reliant districts are located in the Northern Virginia suburbs and along I-64 and I-95 north of Richmond.

Indeed, the map demonstrates that when it comes to Medicaid, urban districts represented by Democrats and many rural districts represented by Republicans are more alike than they otherwise would appear.

Stephen J. Farnsworth is professor of political science and international affairs and director of the Center for Leadership and Media Studies at the University of Mary Washington; contact him at Stephen P. Hanna is professor and chair of geography at UMW; contact him at Benjamin Harris is a senior political science major at UMW and a research associate at UMW’s Center for Leadership and Media Studies; contact him at


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