Virginia's Medicaid Expansion Debate Is Not Over

by | July 11, 2014

By Travis Fain

The Virginia General Assembly will go back into session this September to debate Medicaid expansion, legislative leaders said Wednesday.

The reconvened session would fulfill a longstanding promise from House Republican leaders, who said repeatedly during Virginia's months-long budget standoff that they'd discuss expansion only after a budget passed.

They've promised to discuss now, not to pass. Several key Republican leaders have said they're against using taxpayer money from the Affordable Care Act to expand the health insurance program for the poor, and Gov. Terry McAuliffe won't drop his plans to go it alone on expansion, his office said Wednesday.

In a news release announcing the session, Speaker of the House William Howell, R-Stafford County, noted his own "deep concerns" about expansion. He called the state's current Medicaid program unsustainable, said the federal government can't be trusted to fund expansion long term and noted that expansion would shift Virginia's approach on Medicaid.

The $2 billion a year infusion would take Medicaid from a program that primarily covers disabled people and children in Virginia and turn it into a "a welfare-entitlement program that covers able-bodied, working adults," Howell said in the release.

Expansion is meant to cover anyone without insurance who makes up to 138 percent of the federal poverty measurement. Above that, the Affordable Care Act includes subsidies for people to purchase insurance through state and federal exchanges.

Senate Republican Leader Thomas K. "Tommy" Norment, R-James City, noted his own opposition to expansion Wednesday, in a joint House and Senate news release on the session. He said the reconvened session "was essential to resolving the budget standoff."

"Although I remain to be persuaded that Medicaid expansion would be the right financial decision for Virginia, any decision to enact a change this major would require the General Assembly's approval," Norment, R-James City, said in the release.

Virginia's budget standoff was resolved only after a surprise resignation that tilted control of the state Senate slightly in the GOP's favor, making Norment the chamber's majority leader again.

That resignation is also part of a federal criminal investigation.

Emails released through the Freedom of Information Act indicate that Del. Terry Kilgore, R-Gate City, was lining up a job with the Tobacco Indemnification and Community Revitalization Commission for former Democratic state Sen. Phil Puckett in the weeks before Puckett resigned. Federal subpoenas show that a grand jury is looking into the issue.

The House will go back into session the week of Sept. 22, Howell announced Wednesday. The Senate will be in session that same week. The two chambers may also go back into session before September to elect judges. Those meetings may include a decision on Puckett's daughter, who is awaiting final word about her judgeship in southwest Virginia. Senate Republicans held up on that vote earlier this year, citing a policy against naming close family members of sitting members to the bench.

The General Assembly's Medicaid Innovation and Reform Commission, set up last year to follow Medicaid reform efforts and debate expansion, will also meet before the Medicaid session, according to state Sen. Emmett Hanger, who chairs the commission.

MIRC's role has changed, though. As part of this year's budget deal, Republicans stripped potential funding language from the budget, which a number of experts said gutted the commission's role in an eventual expansion decision. McAuliffe responded with a promise to go it alone on expansion, and said he'll have a plan to do so by Sept. 1.

He also ordered his administration not to cooperate with MIRC, which is made up of legislators.

Hanger, R-Mount Solon, has a bill meant to ease expansion's path through the commission, and he said Wednesday that the bill's survival was part of the budget deal. He said he hopes that it, or something similar, will pass the state Senate and head to the House for debate this September.

He's also eager to discuss various reform pitches for the existing Medicaid program, he said. Howell expressed some hope Wednesday that the commission will come up with new recommendations to rein in rising costs.

Hanger and two other Senate Republicans -- John Watkins and Walter Stosch -- were key budget votes after Puckett's resignation. Their GOP colleagues convinced them to set aside a push for a quasi-privatized version of expansion, which opened the door on a budget deal.

Without an unfinished budget to dangle, expansion supporters have lost a lot of leverage.

Hanger, Watkins and Stosch have said they still hope to find a compromise that allows some form of expansion. Virginians are already paying higher taxes through the Affordable Care Act, and it doesn't make sense not to bring that money home, Hanger said Wednesday, echoing an argument many, including McAuliffe, have made.

"I hope we're not at square one," Hanger said.

But Hanger noted Puckett's resignation and U.S. House Majority Leader Eric Cantor's surprising primary loss earlier this year, both of which strengthened the position of conservatives dead set against expansion.

"I fear we really are going to have to reset the table," Hanger said. "Politically, I think we have been pushed back a bit."

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