Governor offers 2-year Medicaid pilot program

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Virginia’s $96 billion budget hangs in the balance as legislators continue to debate Medicaid expansion.

By Landmark News Service

RICHMOND — How dysfunctional is the Virginia General Assembly right now?
So much that members back in town for the opening day of a special session on an unfinished state budget clashed over routine procedural resolutions.
Those measures, which set rules for legislative sessions, are normally agreed to as a matter of course.
On Monday, the House of Delegates and the state Senate split on them — an inauspicious start to a critical policy-making session when Virginia’s $96 billion, two-year budget hangs in the balance.
To blame is a bitterly partisan Medicaid expansion conundrum: Should it be part of the budget debate or not?
Gov. Terry McAuliffe, a Democrat, and his allies insist it should because the government-subsidized health insurance program is a key piece of the state budget.
Republicans disagree. They say action on the fiscal plan to fund state and local operations should be distinct from extending Medicaid to thousands of low-income, uninsured Virginians through the federal Affordable Care Act.
McAuliffe, in a Monday morning speech, pitched lawmakers a full-on Medicaid expansion pilot program for two years starting in October, telling legislators the state can back out if it becomes untenable.
Senate Republican Leader Tommy Norment of James City County offered faint praise for McAuliffe’s creativity in proposing a pilot program, but he suggested the governor’s “confrontational” tone was a freshman political misstep.
McAuliffe presented to lawmakers a budget amendment package, including 104 items, that would accept billions in federal dollars to extend coverage to as many as 400,000 Virginians.
Forced inclusion of Medicaid as a condition for passing a budget, critics say, threatens a state government shutdown that could harm localities, public colleges and other core services.
House Majority Leader Kirk Cox accused Democrats of using that as debate leverage despite pleas from state-dependent localities that, the Republican said, want a “clean budget now.”
(For example, school systems in the Twin Counties are waiting to turn in their final budgets until they know how much the state will provide for education.)
McAuliffe responded by saying, “There is nothing clean about sweeping under the rug 400,000 Virginians who are counting on us to provide them health care.”
What’s further troubling, said Republican Del. John O’Bannon, a physician, is that expansion is “built on the false promise of free money from Washington” to pay the bulk of new enrollment costs.
Traditional Medicaid is a 50-50 split between Washington and Virginia, which has about 1 million on its Medicaid rolls. The feds have pledged to pay no less than 90 percent of expansion costs.
McAuliffe tried to dispel critics’ arguments Monday, saying Virginia can save $225 million over the next two years by drawing down federal funds to support expansion.
To counter claims that the state wouldn’t be able to back out once it expands, he waved a letter from the federal Centers for Medicare & Medicaid Services stating Virginia could withdraw after two years with “no financial penalty.”
And he promised to shoulder the blame: “If expansion doesn’t help our people, then I, and I alone, will take the responsibility,” he told assembled lawmakers, lobbyists and state officials Monday morning at the state Capitol.
By day’s end, however, the Republican House had already rejected that idea — it tabled the governor’s budget in committee and sent its own version, sans Medicaid, to the floor for debate.
In an afternoon statement, McAuliffe said, “House Republicans voted today to continue Washington-style gridlock instead of accepting a budget that includes a responsible proposal to bring billions of federal dollars back to Virginia to close the health care coverage gap and invest in core priorities like education and mental health.”
Del. Chris Jones, a Republican whose Appropriations Committee voted down McAuliffe’s proposal, maintains the state needs further reforms to its Medicaid program before possible expansion.
He’s skeptical Virginia can back out of expansion: “Once you start it, there’s no unwinding it.”
The Senate, where a private-option “Marketplace Virginia” model had been proposed as a Medicaid expansion alternative, took no action on its budget or McAuliffe’s proposed adjustments Monday.
Senators set a hearing on budget legislation for April 1, with plans to return April 7 for “a couple days, or longer,” Senate Majority Leader Richard Saslaw advised colleagues.
Contrasting budget plans will be sent into small group negotiations once both legislative chambers vote on them.
The next budget cycle begins July 1.
Lawmakers managed to achieve one small compromise Monday: approving changes to the so-called “caboose budget” that runs through June 30.
As they approach the remaining work on the biennial budget, Del. Algie Howell urged colleagues to consider the human face of the uninsured.
Recounting an anecdote about his uninsured mother’s need for heart surgery, Howell said he was able to provide financial assistance in a way others can’t.
The Democrat asked lawmakers to try to understand the plight of those less fortunate.
“We need to find a way to help them,” he said.