Under the amended budget language, the legislature still appoints a commission with 10 legislators to oversee implementation of any Medicaid reform and expansion. But rather than empower the commission to expand Medicaid on its own, the General Assembly preemptively directs the commission to do so if certain reforms are implemented. Commission members will merely decide if the reforms have been accomplished, triggering expansion if and when they do so.
The language aimed to get around Cuccinelli’s objection that the legislature cannot delegate its budget authority to a smaller subset of the assembly. The amended budget directly appropriated any necessary funds for implementing the expansion, contingent on implementation of the reforms, so the commission would not be empowered to do so.
McDonnell said the Medicaid provision, which puts expansion at the discretion of the panel of 10 legislators, will “set a clear firewall against expansion.”
His reasoning is that it could be harder to get the commission to agree that Medicaid has been sufficiently reformed — particularly since the agreement specifies that a simple majority vote of the panel would not be enough to vote for expansion. At least three members from each chamber would have to agree that reform has been completed.
A simple majority of the panel might be more inclined to move ahead with expansion because the five commission members from the more moderate Senate would only need to convince one House member to join them. It is expected to be a tougher sell to convince three members of the more conservative House to go along.
Before Saturday’s budget vote, Republican leadership assured House members in a closed-door caucus meeting that they would appoint members to the commission who will take a very strict view of what constitutes reform, according to one GOP delegate and a Capitol staffer briefed on the plan.
“The caucus was given assurance that these would be people who would hold the line on Medicaid expansion,” said the delegate, who spoke on condition of anonymity in order to discuss private caucus matters. “This notion that we made it easier to expand Medicare is wrong. I think it’s the opposite.”
The delegate noted that without the budget language, Medicaid expansion was at the discretion of the governor. With a governor’s race this year and the possibility that a Democrat could win, the change in the rules could work against expansion.
“It takes the control away from the governor — where Terry McAuliffe could be the next governor — and puts the control in a body where House Republicans have the last say,” said the staffer, referring to the former Democratic National Committee chairman running for governor against Cuccinelli.