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Virginia Medicaid Expansion Shot Down in Special Session

To no one's surprise, the politically charged partisan divide over Medicaid expansion in Virginia remains intact after a special General Assembly session called to debate the issue one last time in 2014.

By Bill Sizemore

To no one's surprise, the politically charged partisan divide over Medicaid expansion in Virginia remains intact after a special General Assembly session called to debate the issue one last time in 2014.

After a day-long debate Thursday, Republicans who dominate the House of Delegates shot down a compromise proposal from one of their own, Del. Tom Rust of Fairfax County, to extend coverage under the federal/state health insurance program to as many as 400,000 uninsured Virginians.

The vote to kill Rust's bill (HB5008) was 64-33, a near-perfect party-line split. Rust drew just three Republican votes: his own; that of his co-patron, Del. Glenn Davis of Virginia Beach; and Del. James Edmunds of Halifax County. All the rest of the "yes" votes were from Democrats.

One Democrat, Del. Johnny Joannou of Portsmouth, voted with the majority Republicans against the measure.

This is how little the needle has moved on the contentious issue in seven months: The vote was nearly identical to the 67-32 tally when the House rejected an earlier, Senate-passed version of Medicaid expansion in February.

Lawmakers had come prepared for a two-day session, but they dispatched the issue in one. The vote means Medicaid expansion -- Democratic Gov. Terry McAuliffe's top policy goal -- is dead for this year.

The issue will undoubtedly rear its head again when the Assembly convenes for its 2015 session in January.

By Dec. 31, Virginia will have forfeited nearly $2 billion in federal funds that would have flowed to the state for expansion. The federal government would have footed the entire bill through 2016, with its share gradually declining to 90 percent in 2020.

House Speaker Bill Howell, R-Stafford County, said after the vote that the House leadership had fulfilled its promise to allow a "full and fair debate" on the issue. Minority Leader David Toscano, D-Charlottesville, called the special session a "charade" and "mere window dressing. "The decision on this bill was made before we arrived in Richmond," he said.

The day of legislative activity cost the taxpayers about $40,000.

Rust's measure differed from earlier Medicaid expansion proposals chiefly in its reliance on existing employer-based health insurance plans. It would have provided subsidies to Virginians who have access to such plans but can't afford the premiums.

Rust cast the proposal as a reform measure. His intent, he said, was to "get as many people as possible off Medicaid and into the private insurance market."

But at its core, the bill sought what all of its predecessors did: the return to Virginia of the taxes being paid by state taxpayers and businesses under the federal Affordable Care Act.

The money would have been used to cover those Virginians in the "coverage gap" -- not poor enough to qualify for coverage under Virginia's stringent Medicaid eligibility standards, but with insufficient income to qualify for subsidized private coverage in the ACA-created federal insurance marketplace.

"We're sending $2 billion a year to Washington, of which we're getting back very little," Rust said.

That argument elicited the same objections from Rust's Republican colleagues that they have made all along: Medicaid is a broken, unsustainable program, consuming an ever-growing slice of the state budget, and the federal government can't be counted on to keep its promise to fund the lion's share of it indefinitely.

"Unfortunately, Del. Rust's bill is a leaky ship that we're going to put into rough waters," said Del. Tim Hugo, R-Fairfax County.

Republicans and Democrats alike saluted Rust for his courage in bucking his party's leadership, but none was under any illusion about the outcome.

"I can feel the sharks starting to circle on his side," Del. Patrick Hope, D-Arlington County, quipped. "He's a lonely man."

On the same day it rejected federal Medicaid expansion funds, the Assembly approved nearly $1 billion in additional cuts to the 2014-16 state budget in response to lagging tax revenues. Those cuts, which come on top of $1.5 billion in reductions earlier this year, include nearly $200 million in across-the-board cuts in state agencies, $90 million slashed from state colleges and universities, and $60 million in reduced aid to localities.

Advocates of Medicaid expansion said accepting the federal money would have eliminated the need for about one-quarter of those budget cuts because it would have freed up some $225 million the state is now spending on hospital care for the poor and prisoners, mental health and substance abuse services, and other programs serving vulnerable Virginians.

The House also passed, on a straight party-line vote, a measure from Del. Mark Cole, R-Spotsylvania County, authorizing the speaker to hire outside legal counsel to represent the House in efforts to halt any attempt by McAuliffe to expand Medicaid without the explicit approval of the Assembly.

Cole's measure would also authorize legal counsel to intervene in the pending litigation challenging Virginia's constitutional ban on gay marriage. That prohibition has been overturned at two levels in the federal courts, and the case could be headed to the Supreme Court. Democratic Attorney General Mark Herring has joined the plaintiffs, arguing that the law violates the federal constitution.

(c)2014 The Virginian-Pilot (Norfolk, Va.)

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