In a move ostensibly designed to give both sides of the budget standoff in Richmond something they want, Sen. Emmett Hanger (R-Augusta) earlier today proposed a deal that would give House Republicans a budget free and clear of Medicaid expansion, in exchange for giving the Democrats a clearer path to expansion via the special legislative panel set up in last year’s budget to pursue Medicaid reforms prior to expansion. In the end, however, the proposal substantively does very little to change the status quo.
Hanger’s proposal is to essentially make it easier for the Medicaid Innovation and Reform Commission (MIRC) to enact expansion. MIRC was a creation of last year’s tax increase and transportation deal, offered as a means to secure Democrat support for Gov. McDonnell’s signature achievement. Under the current rules, MIRC has five members of the Senate, and five members from the House, and majorities of each side must vote for Medicaid expansion in order for it to occur. Hanger’s proposal is to allow expansion on a simple majority of all of MIRC’s members, meaning that instead of needing three House members in addition to the five solid pro-expansion votes from the Senate side, expansion could conceivably go forward on just one vote from the House side (assuming the Senate members are unanimous in support).
Hanger’s deal also includes provisions to implement what appear to be some fairly modest additional reforms to Medicaid before the revamped MIRC could vote for expansion.
The additional reform benchmarks involve screening applications; tightening up on use of nursing homes, a major cost to the system; measures to make sure Medicaid recipients aren’t discouraged from boosting their income by finding work; and continuous auditing.
This should be a non-starter for the solidly anti-expansion House GOP caucus. But, recognizing it as a good faith offer to break the logjam, Speaker Bill Howell and other GOP leaders from the House quickly issued a statement welcoming Sen. Hanger’s proposal to separate consideration of Medicaid from the budget, and promising to give the rest of his proposal fair consideration.
Senator Hanger has made a productive offer that leaves us encouraged about the prospects of reaching an agreement on the state budget. He acknowledges the need to separate Medicaid expansion from budget deliberations in order to facilitate the prompt passage of a state budget, recognizes the need for continued reforms before we consider expansion, and emphasizes that any attempt by the Governor to spend money from the state treasury absent a budget law or to expand Medicaid without the legislature’s approval would be totally unacceptable. We will take a very close look at the proposal and immediately begin talking with Senator Hanger.”
From where I sit, this is really no different than the status quo, and doesn’t represent much of a deal. The budget is still held hostage to Medicaid expansion. The additional reforms Hanger proposes are laudable, and should probably be implemented with or without expansion of Medicaid, but still don’t address that the budget should be separated from Medicaid expansion FIRST, before a serious discussion of reforms can be undertaken. Moreover, the reforms actually probably don’t go as far as even the Senate’s “Marketplace Virginia” plan does in terms of controlling costs and introducing a modest element of market-based incentives to the program. It really does not move the ball.
When the House GOP rejects it, Governor McAuliffe and his allies (who include Sen. Hanger when it comes to Medicaid expansion) undoubtedly will use it to beat the House Republicans over the head for having rejected a compromise from even within their own party. In other words, this proposal looks to be more about gamesmanship than a serious attempt to break the deadlock.