Medicaid expansion divides legislature

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By Landmark News Service

UPDATE: 3/9/14:

Mental health reform? Check.

Ethics reform? Check.

State budget to fund core government services? Nope.

Hopelessly divided over Medicaid expansion, General Assembly partisans departed the Capitol on Saturday afternoon at the close of this winter's 60-day session without agreement on the next two-year budget.

The homebound lawmakers are free to raise campaign cash in the interim, but they won't be away long: Gov. Terry McAuliffe is calling them back for another try March 24. McAuliffe anticipates a special session lasting three weeks.


In some of his most forceful comments yet on Medicaid expansion, Gov. Terry McAuliffe condemned Republicans in the House of Delegates last Thursday for refusing to provide health care for the poor even though it is a “life and death” proposition.
Speaking at a morning news event heralding a new state pilot program to better treat patients jointly eligible for Medicare and Medicaid, the Democrat denounced his GOP rivals for their unwillingness to even consider the matter.
“’No, no, no, no’ is not a way to negotiate,” McAuliffe said to a state Capitol audience in reference to House Republicans’ reluctance to discuss including Medicaid expansion in Virginia’s proposed two-year, $96 billion budget.
He and fellow Democrats are just as adamant about extending government-backed health care to thousands of uninsured low-income Virginians as most Republicans are in opposing it.
With hope dim for bridging that partisan chasm before the legislative session’s scheduled end Saturday, overtime work appeared imminent and the end of the week.
House Majority Leader Kirk Cox (R-Colonial Heights) proposed a 30-day extension of the legislative session to enhance the GOP bargaining position. It was adopted by the House but rejected by the Democrat-controlled Senate.
McAuliffe called that approach “gimmickry.”
“We’re not going to get anywhere by doing this,” added Senate Majority Leader Richard Saslaw (D-Fairfax County).
That brought this written response from GOP Sen. Ryan McDougle of Hanover County: “Virginians should prepare themselves now for a lengthy battle and the very real prospect of a Democrat-engineered government shutdown.”
The day’s sound and fury yielded only finger-pointing — McAuliffe said House Republicans have roadblocked compromise, ignoring “cost-saving facts and the lifesaving facts.”
House Republican leaders said they will stand firm.
“This is nothing more than political posturing on his part,” said Del. Chris Jones (R-Suffolk), chairman of the budget-writing House Appropriations Committee.
“We represent our constituents,” Jones said. “The people that I talk with in my pharmacy, that I see each and every day, think that Obamacare has been a disaster. They do not think that we should proceed until we reform Medicaid as we know it.”
McAuliffe’s administration estimates that as many as 78,000 so-called dual-eligible patients can opt into a streamlined managed-care system to coordinate Medicare and Medicaid benefits that the governor said will yield millions in savings.
Virginia initially sought federal approval for the pilot program in 2011, years before McAuliffe was governor.
Now that it’s in place, McAuliffe estimated it will save the state $126 million over two years.
“This is a testament to the effectiveness and efficiency of the Virginia health care delivery system,” the governor said. “And it shows that we are now ready to take the next step by accepting the federal funds and bringing those funds back to Virginia and closing the coverage gap.”
McAuliffe and his allies want lawmakers to approve a “Marketplace Virginia” private option plan to recover $1.7 billion annually in federal tax dollars to subsidize insurance for people now ineligible for Medicaid or other health care programs.
They say as many as 400,000 Virginians could benefit from that.
To drive home the high stakes, McAuliffe recounted the tale of a Southwest Virginia patient he recently met. The governor said the woman works but doesn’t have insurance and gets her diabetes medicine from a health clinic that could be imperiled if Medicaid expansion does not go forward.
Republicans are skeptical of the plan and relying on Washington to fund it.
Jones said it will take 18 to 24 months before any savings from the new pilot program announced by McAuliffe will be apparent.
Beyond that, House Republicans insist that further money-saving reforms are needed before the Medicaid program can be expanded.
Cox, like many of his Republican colleagues, says the federal government might renege on its promise to fund the expanded program in perpetuity at no less than 90 percent.
“The 90 percent will never hold,” he said. “I can guarantee you, when we get to 2020, we’ll be down to probably 50 percent.”

Dems: Medicaid expansion means money for schools
Extortion. Immorality. Hypocrisy. Fiscal irresponsibility. Hostage-taking.
Such words were flying last week as the rhetoric got hotter than ever in the General Assembly’s pitched battle over Medicaid expansion.
The fight seems almost certain to delay passage of a state budget by the legislature’s scheduled Saturday adjournment, setting up the possibility of a government shutdown when the new fiscal year kicks in July 1.
Amid the name-calling and blame-mongering, a group of liberal Democratic lawmakers unveiled an analysis breaking down how much additional money could be freed up for local school divisions if Virginia takes the available federal money to expand the Medicaid program.
According to the Virginia Progressive Caucus, expansion would result in $285 million in savings over the next two years that could be used for other state services.
Opponents of Medicaid expansion “are voting against a lot of money and a lot of jobs for their people in their districts,” Del. Scott Surovell (D-Fairfax County) said at a news conference.
That’s money that Virginians are entitled to, said Del. Charniele Herring (D-Alexandria): “This is Virginia’s money. It’s our taxpayer money, and it is immoral for us to let it go outside of this state.”
Meanwhile, another left-leaning group suggested Virginia set up a new trust fund to capture anticipated Medicaid expansion savings to spend on future state costs for subsidizing care to people now uninsured.
According to Commonwealth Institute for Fiscal Analysis projections, that proposal would cover state expenses for the thousands covered under the system through 2050 if the fund yielded a 4 percent rate of return, or through 2068 at 7 percent.
Institute President Michael Cassidy pitched the trust fund in response to anti-expansion factions who cite future state costs among their reasons for reluctance.
“There has been a lot of angst expressed by opponents of closing the coverage gap that Virginia won’t have the resources to meet the small state share that would come with covering more Virginians,” Cassidy said. “We could actually cover the costs of covering over 400,000 Virginians until the year 2050 at no additional cost to the state.”
For states that expand Medicaid to more low-income uninsured people, Washington has promised to fund 100 percent of costs for new enrollees through 2016, then gradually phase the funding down to a permanent 90 percent rate by 2020.
Those in the so-called coverage gap are uninsured needy people who don’t now qualify for Medicaid in Virginia, and aren’t eligible for subsidies to purchase coverage through a health care exchange.
House Speaker Bill Howell (R-Stafford County), in a letter to Gov. Terry McAuliffe, warned of harm to public colleges, localities and other state agencies from budget inaction.
Howell said those who favor the Senate plan “are extorting the taxpayers of Virginia, using hundreds of millions of dollars in funding for our teachers, schools, local governments and hospitals as leverage in order to expand ObamaCare in Virginia.”
Medicaid aside, “the House and Senate budget bottom lines are 99.9 percent in agreement,” wrote Howell, who asked: “Why would anyone insist on holding up the entire state budget over one issue?”
The conflict is a key impediment to compromise on the two-year, $96 billion state budget.
Taking $1.7 billion annually in recovered federal tax dollars under the Marketplace plan, said pro-expansion Sen. John Watkins (R-Powhatan County), would continue Virginia’s years-long pattern of accepting money under the federal health care law.
Post-2010, “we have already received and embedded in our budget every year since then funds that came about as a result of the Affordable Care Act,” he said in a floor speech last Wednesday.
Speaking after Watkins, Sen. Jeff McWaters (R-Virginia Beach) lobbied against expansion. The Affordable Care Act is “in chaos and potentially complete meltdown,” said the retired health care executive, advising colleagues not to proceed with expansion without further inspection.
A joint budget conference committee containing six delegates and seven senators had until Saturday to come up with a compromise before the session is extended.
If an agreement isn’t finalized by July 1, the state government will shut down until terms can be negotiated.

Additional reporting by Capital News Service