The Roanoke Regional Chamber of Commerce held its annual legislative session breakfast roundup last week, inviting area delegates and state senators to weigh in on goings-on in Richmond during the regular General Assembly session that ended a few weeks ago.
This was just before lawmakers headed back to the capitol to tackle the bi-annual budget and the issue of health care coverage via Medicaid expansion. There is also a private insurance option being pushed by some in the Senate.
In general it’s a Democrat vs. Republican issue: Democrat lawmakers generally side with Governor McAuliffe, who wants to expand Medicaid coverage to around 400,000 lower income Virginians under the Affordable Care Act (Obamacare), claiming the Commonwealth is leaving many millions of dollars in federal money on the table if it doesn’t do what more than a dozen other states have already done.
Many Republicans object, saying expanding Medicaid is a costly boondoggle even if the Federal government pays 100% of the bill for the first several years before scaling back to 90%. Some would like to see the committee appointed by former Governor Bob McDonnell to look at Medicaid waste and fraud finish their work first, with systemic changes made before the state would consider expansion – or a private insurance alternative promoted by some in the State Senate known as “Marketplace Virginia” that could also qualify for federal funds under Obamacare to help get the program off the ground.
State Senator John Edwards (D-Roanoke) said at the Chamber breakfast meeting that, “It’s not fiscally responsible to split off the expansion of Medicaid – or the Senate plan from the budget. It is a budget issue. Over twenty percent of the budget deals with Medicaid. How do you split it off?”
Edwards said the current proposed budget already pulls funds from public safety, education and other sectors for payments to hospital systems that will lose money if Medicaid expansion is not passed into law, with automatic cuts looming. “We’ve got to expand Medicaid in order to save our hospitals.”
Republican Franklin County delegate Charles Poindexter said an example of a hospital closure often cited by Governor McAuliffe as related to Medicaid funding cuts – Lee County Hospital – was really due to a poor business model at a small rural facility and not to the hotly contested Medicaid expansion. “I don’t see us coming to a conclusion,” said Poindexter ahead of what was scheduled to be a three-day special session.
Indeed, earlier this week the Republican-dominated House killed a budget bill that contained Medicaid expansion. There’s a public hearing set for April 1 but the State Senate won’t meet again in session until April 7, so the issue will remain undecided for at least several weeks.
The two chambers will probably wind up passing their own bills said Poindexter, with the Democrat-controlled Senate again featuring Medicaid expansion. “We’ll put them in conference and see where we’ll go from there.”
There is very little difference elsewhere in the two budgets said Poindexter; public safety sectors, schools and everyone else “are depending on us to pass a budget.” Historically other governors have placed contentious issues in their own special sessions he added, which is what Poindexter hopes will eventually happen with the health care issue.
Botetourt County delegate Chris Head, a Republican who also represents part of the Roanoke Valley, said supporters of Medicaid expansion are not “looking at the real numbers. We will ultimately separate the issue out of the budget [debate]. We need to look at Medicaid reform [separately]. No one from the supporters have ever been able to identify what this really is going to cost – and who is really going to pay for it. Even if we’re only responsible for ten percent [of the cost].”
Eventually it could cost the state around $250 million a year, said Head for Medicaid expansion: “We don’t have that right now. What school systems do we close? What programs do we want to cut out? What kind of law enforcement do we reduce? It’s a fool’s errand.”
Head isn’t sold on the private insurance option either, since it involves taking federal funds and still places it under the Obamacare umbrella. “Its absolute baloney. It’s still broken…and doggone expensive.”
Delegate Sam Rasoul (D-Roanoke) has stated in the past that he could support the Marketplace Virginia private option, which would cover fewer Virginians than direct Medicaid expansion. “We certainly need to come to a conclusion – especially with all of the savings on the table.”
It appears however that any conclusion is at least several weeks away.
By Gene Marrano
