Ever since the U.S. Supreme Court ruled in June that states had the right to opt out of the federal Affordable Care Act’s Medicaid expansion, Bolling and McDonnell (R) have said Virginia should not expand the program until it is significantly reformed.
Now Bolling says the state should operate on two tracks: take steps to move ahead with expansion while seeking Washington’s permission to change how Medicaid is run in Virginia.
If Washington does not agree, Bolling said, Virginia would not go forward with the expansion. But if Virginia does not start preparing, he said, the state will not be ready when expansion becomes possible next January.
“I think the business case for Medicaid expansion has become a lot more compelling than we originally thought it would be,” Bolling said in an interview. “I think we have an opportunity to make this program successful.”
Bolling, who is exploring a run for governor against Attorney General Ken Cuccinelli II (R) and former Democratic National Committee chairman Terry McAuliffe, made his announcement just days before state House and Senate panels will vote on whether to include the expansion in the budget.
Bolling unveiled his position as news leaked that Cuccinelli strongly criticizes government entitlement programs in a forthcoming book, which focuses on his first-in-the-nation but ultimately unsuccessful lawsuit against the act establishing what is often called “Obamacare.”
“To some extent, [Bolling] seems to be staking out some middle ground,” said Carl Tobias, a professor at the University of Richmond’s law school.
Tobias said Bolling’s endorsement of Medicaid expansion fits the middle-of-the-road Republican profile that the lieutenant governor is trying to establish while positioning himself as a possible independent candidate.
“He’s saying if it’s run in a way that I want it to be run, then he’s willing to go forward,” Tobias said. “On the other hand, Cuccinelli’s book seems to be saying there are no compromises.”
Cuccinelli’s campaign declined to comment. McAuliffe spokesman Josh Schwerin said, “Terry joins Lt. Gov. Bolling in urging the legislature to support this bipartisan solution that is good for Virginia taxpayers.”
Since quitting the race for the GOP gubernatorial nomination, Bolling has come out against uranium mining in south-central Virginia, arming teachers, and the
GOP’s surprise Senate redistricting plan.
His position on Medicaid seems to fit that same centrist territory, arguing that the state would save more than $300 million from 2014 to 2018 by expanding coverage. The state would save money, in part, by reducing the indigent-care burden borne by state-supported teaching hospitals.
The strings Bolling wants to put on the Medicaid expansion include seeking about a half-dozen waivers from federal rules, allowing the state to run the program more like an HMO.
William A. Hazel Jr., McDonnell’s secretary of health and human resources, has been pressing Washington for those waivers. The difference is that McDonnell does not want to go ahead until they have been approved; Bolling wants to move forward on establishing the program while the state pursues the waivers.
“At this time the Administration continues to believe that any real discussion of Medicaid expansion, absent first making serious reforms within the existing program, is premature and would be financially unsustainable for the taxpayers of Virginia,” McDonnell spokesman Tucker Martin said in an e-mail.
Under the Affordable Care Act, states can open their Medicaid programs to people with incomes up to 138 percent of the federal poverty level, and the federal government will pick up the entire tab for the first three years. The federal share gradually declines to 90 percent.
McDonnell has said he is skeptical that the federal government will be able to make good on that promise, given its fiscal troubles. Bolling said the state could opt out if Washington did not hold up its end of the deal.
Fredrick Kunkle contributed to this report.