A bipartisan solution to Va.’s Medicaid standoff

March 6

Virginia Republicans and Democrats are talking past each other on Medicaid expansion. GOP leaders bristle at federal bureaucratic demands regarding Medicaid. We get it; we don’t like to be pushed around either. Democrats bristle at suggestions they are willing to cut and run on President Obama. We get that; no one likes being charged with cowardice under fire.

It is time for both sides to relax and download Patti LaBelle’s breakthrough 1985 hit “New Attitude,” with the key lyrics: “I’ve tidied up my point of view, I got a new attitude.” They may be singing from the same script after all.

Republicans believe state finances will be hard pressed in coming years to fund the existing Medicaid state program due to projected population growth and health-care cost inflation.  The future is admittedly unknowable.

Democratic policy experts believe the bigger risk is failing to enhance the program, thus saddling state government with a health-care system crushed by unbearable costs from those without health insurance. This too is a legitimate concern since these same projections suggest the status quo leaves taxpayers responsible for rising health expenses from indigent residents unable to get cost-saving preventive care only available from insurance programs.

Republicans counter the Democratic position by calling their political rivals spendthrifts willing to spend now and cross their fingers later. Democrats respond charging Republicans are being penny-wise and pound-foolish.

This seems like an unbridgeable gap. But it is really an imagination gap, not a fiscal gap.

We believe there is bipartisan common ground to begin bridging the imagination gap in the state budget — if lawmakers take Ms. LaBelle’s tuneful advice.

First, Democrats should agree there will be no expansion in the amount of state money spent on Medicaid except what would normally be expected in the new biennial budget. This satisfies the Republican demand for not expanding Medicaid. Why? Republicans concede that new people will get Medicaid in the future under current program eligibility rules. Population growth and health-care inflation drive Medicaid spending.  Thus, “no Medicaid expansion” can only logically mean no new state money on people not currently eligible for the program.

Democrats should be able to accept this parameter in the next budget provided Republicans grant Gov. Terry McAuliffe the right to enter into a cost-saving health insurance plan with the federal government we label Pilotcare.

What is Pilotcare? No, you don’t have to be aviator or astronaut to get it. Under federal law, a governor can ask the Secretary of Health and Human Services to give Virginia an opportunity to be a Jeffersonian “laboratory” to explore innovative health-care insurance systems exhibiting promise to deliver more accountable, accessible and efficient care.

President Obama currently wants to add 400,000 needy Virginians to traditional Medicaid. We understand his concern for these fellow Americans. Virginians are already obligated to pay federally imposed taxes that can be used to fund 100 percent of their health-care needs.

But what if traditional Medicaid isn’t the best choice? We believe McAuliffe, a businessman, should be given an opportunity to put his expertise to good use.  Thus Pilotcare envisions McAuliffe using the executive branch’s flexibility – subject to oversight from an independent state board that includes General Assembly members — to negotiate with the federal government to design the best possible system to serve these needy Virginians using the 100 percent cost coverage.

And to encourage immediate action,  the program would expire, by law, in two years unless both sides agree to carry on.

This produces the bipartisan agreement both parties claim they want. Republicans achieve their objective: Virginia Medicaid doesn’t expand to spend money in the future on anyone not currently eligible for the program. This meets the common-sense definition of “expansion” used by a Virginia taxpayer: Learn how to manage the program within current parameters.

Democrats achieve their objective: Pilotcare.com provides the care they want to deliver to those 400,000 needy Virginians without any new state money. McAuliffe says he can do it with the federal government’s promised backing. We believe he can.

If Pilotcare proves successful, combining its cost saving innovation with traditional Medicaid might give both parties a whole new attitude.

Norman Leahy is an editor of the conservative Web site BearingDrift.com and producer of the political radio show “The Score.” Paul Goldman is a former chairman of the Democratic Party of Virginia. They are blogging together on All Opinions Are Local during Virginia’s 2014 General Assembly session.

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