I was told by people I trust–including people close to passage of the legislation that enabled consideration of Virginia Medicaid expansion under Obamacare–that such an expansion would never happen.
To hear them tell it, the enabling legislation was simply a gesture of compromise to get Democrats on board with the tax and transportation bill, but with little practical chance of actually leading to imminent Medicaid expansion in Virginia. News from Richmond suggests the reality is something quite different from the sales pitch. You’re shocked, I know.
The “Taxportation” bill that brought us the largest tax increase in Virginia’s history came as part of a deal that established a mechanism to expand Medicaid (i.e., free healthcare) for an additional 400,000 Virginians. The General Assembly did not actually expand Medicaid as authorized by the Obamacare law. Instead, they kicked the can to a bipartisan commission of five delegates, five senators, and a couple of expert ex-officio members to explore ways to implement a set of reforms required by the law before expansion could be implemented. They will then make a recommendation to the Governor, who has ultimate authority to decide on the expansion. CORRECTION: According to the implementing legislation, as soon as the commission says the reform conditions have been met, that is all that is required for implementation. The Governor no longer has anything to do with the decision.
Governor McDonnell has said he defers completely to the commission.
But the governor made clear that the decision ultimately rests with the new commission, which will meet again in October and December, with a public hearing expected before the next meeting.
“If they say ‘done,’ Medicaid expansion goes into place,” he said.
So, if the commission is successful in devising a way to implement the reforms, then presto…Medicaid expansion.
And that’s the trouble. Those who were confident that this commission would be the place the Medicaid expansion would go to die were relying on an expectation that the Obamacrats in Washington would stymie the fairly aggressive reform requirements. Because any new strings attached to the expenditure of federal money under the Obamacare law must be approved by the administration, it was envisioned that the high reform bar set by the taxportation bill would be a sort of poison pill. But it appears that the reforms have had pretty smooth sailing in Washington.
Legislators and state health officials say they have made major strides in getting federal permission to carry out significant reforms to the program, such as coordinating the care of people eligible both for Medicaid and Medicare benefits.
Members of the commission, including Chairman Sen. Emmett Hanger (R-24) who is a proponent of expansion, think progress toward administration approval is moving along quite nicely. “I’d say we are a little more than halfway there,” Hanger says.
Skeptics (myself included) believed that the administration’s interest in seeking to permanently entrench expanded benefits would grease the wheels for approval of state-level implementation requests, almost regardless of how those requests might water down or temporarily frustrate full-on dependence by the new recipients. There is just too much on the line for the left to let the red tape get in the way.
It’s starting to look like the skeptics were right, as it appears the chief remaining roadblock is concern about the very real possibility that, if the feds at some point in the future renege on their funding commitments, Virginia would be left holding the bag.
The budget language adopted this year directs Virginia to reverse the expansion if the government reduces its commitment, but Del. R. Steven Landes, R-Augusta, the commission’s vice chairman, said that wouldn’t be as easy as it sounds.
“Once you enroll these individuals, isn’t there an expectation that you continue to provide services to these individuals?” Landes asked.
[Former Michigan Medicaid director Vernon] Smith said the point is well-taken. “Once adopted,” he said, “it’s very difficult to un-adopt it.”
Indeed. But the composition of the commission does not give me any confidence that the mere possibility of future spending growth is a sufficient deterrent to latching on to the federal teat now. I’m hoping someone can tell me I’ve got it wrong somehow, but I fear it really may be too late…looks like we’ve truly been had, again, and even more so than we feared.
08-24-13 UPDATE: House Speaker Bill Howell spoke at today’s Republican Party of Virginia State Central Committee meeting in Richmond. He was adamant that Medicaid expansion would be disastrous for Virginia’s fiscal health, and maintained that the special Medicaid commission to consider the reforms set forth in last spring’s budget includes no one from the House of Delegates who currently supports Medicaid expansion. Speaker Howell stated firmly that “Medicaid expansion isn’t going to happen.” This is indeed heartening news, though I am not as confident as the Speaker that three of them won’t bow to pressure or come to the conclusion that the mandated reforms make the expansion fiscally palatable. The Bull Elephant will report more on this story in the coming days.
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