How Virginia's Governor Plans to Insure More without Expanding Medicaid
By Bill Sizemore
Gov. Terry McAuliffe unveiled a stopgap package of health care initiatives Monday that he said will improve the lives of more than 200,000 Virginians in the absence of an expanded Medicaid program.
McAuliffe, a Democrat, has lobbied hard for Medicaid expansion, a key element of the federal Affordable Care Act, but has been stymied by opposition in the Republican-controlled General Assembly.
He said Monday he will continue to push for expansion of the federal/state health insurance program -- calling it a "moral challenge" for Virginia -- but in the meantime will move forward with initiatives he can undertake on his own to help the neediest of the nearly 1 million Virginians with no insurance.
The measures, authorized by four emergency regulations and an executive order, use about $40 million in carried-over state money between now and mid-2015 to leverage about $50 million in new federal funds.
That's a drop in the bucket compared to the $2 billion per year that would be available from Washington if Medicaid were expanded.
The new initiatives include extension of coverage to an estimated 20,000 uninsured Virginians with severe mental illness, dental coverage for 45,000 pregnant women enrolled in the existing Medicaid program and enrollment of 5,000 children of low-income state employees in the state health insurance program for children.
Also planned are an outreach program targeting 160,000 Virginians who are eligible for subsidized coverage under the new federal insurance marketplace but have not applied, heightened collaboration with the U.S. Department of Veterans Affairs to increase access to health care for veterans, and creation of a new task force to combat prescription drug and heroin overdoses.
McAuliffe and his aides characterized the initiatives as bold and innovative, but implicit in Monday's rollout was an acknowledgment that the Republican-led legislature has thwarted the governor's No. 1 policy goal.
Dr. Bill Hazel, McAuliffe's secretary of health and human resources,developed the plan unveiled Monday, and he called it "an exercise in triage" and "a bridge to true reform."
Republican Assembly leaders were noncommittal in their reaction to the actions McAuliffe took Monday. Senate Majority Leader Tommy Norment, R-James City County, and House Speaker Bill Howell, R-Stafford County, said the initiatives will require approval by the 2015 Assembly in order to become permanent.
Norment said the governor had "averted an unwarranted constitutional crisis" by not trying to expand Medicaid unilaterally without legislative approval.
McAuliffe made it clear he will continue pushing for Medicaid expansion, noting that neighboring states including Kentucky and West Virginia have opted to expand the program.
"They have now put Virginia at a competitive disadvantage," McAuliffe said. "If you're a new business looking to put a new manufacturing facility, will you not go to a state that has closed the coverage gap because their health care premiums are now lower and their workforce is now healthier?"
"These steps that I'm taking today are just the beginning. We must continue to press forward together to achieve better health care for all of our citizens. The stakes could not be any higher."
McAuliffe noted that Mary Washington Healthcare, which operates two hospitals in the Fredericksburg area, announced last week it is laying off 66 employees and cutting the pay of dozens more.
"These jobs would have been saved and these payroll cuts would not have happened if the General Assembly had come together to close the coverage gap," he said.
The legislature plans to reconvene Sept. 18 to debate Medicaid expansion.
McAuliffe said Hazel has been in near-constant contact with federal Medicaid officials, and they have expressed an openness to innovative ways of unlocking the federal funds that would be available to expand the program.
The federal government has pledged to fund the entire expansion through 2016, with the federal share gradually declining to 90 percent by 2020.
Republican Assembly leaders have said they don't trust the federal government to keep that promise and fear the state would be left to pick up the cost of the whole program at some point.
McAuliffe said federal officials have indicated support for a public-private partnership that would rely totally on private-sector funding for the state's share so no state money would ever be at risk.
"As I have always said, my door is always open," McAuliffe said. "I will host the leadership of the General Assembly at any time or any place" to work out a plan.
"How we care for the most vulnerable is not only a sign of good government. It's a reflection of our priorities as a commonwealth."
Many Democrats are skeptical that next week's special legislative session will move Virginia any closer to McAuliffe's goal.
State Sen. Louise Lucas, D-Portsmouth, who attended Monday's announcement, is one of those: "I have no hope that the Republicans are going to come with an agenda that's going to advance Medicaid expansion. I have no hope at all."
(c)2014 The Virginian-Pilot (Norfolk, Va.)