Supporters of expansion dismissed the planned vote as a meaningless gimmick. Even after its expected defeat Thursday in the House, the plan to expand Medicaid will live on in the Senate’s proposed budget.
But the move is an effort to strengthen the House’s hand for negotiations with the Senate, where Democrats and a few moderate Republicans in that evenly split chamber support expanding the health-care program for the poor and disabled. The vote is yet another indication that House Republicans have only stiffened their opposition to expansion, despite the energetic outreach from McAuliffe (D) and the creation of a “private option” plan meant to be more palatable to Republicans.
S. Chris Jones (R-Suffolk), chairman of the House Appropriations Committee, plans to propose an amendment to the House budget adding the Senate’s Medicaid expansion plan. He said the vote will be a clarifying moment, making plain that rank-and-file Republicans stand with House leadership in their opposition to “Medicaid expansion, Obamacare, the Arkansas plan or the Virginia Way — whatever you want to call it.”
“There are many who say it’s just the leadership. We want everyone to see where the House stands,” Jones said. “We have stated, all along, our caucus is opposed to Medicaid expansion. We want reforms first.”
Some Democrats were blasé about the move.
“It’s their party. They can do what they want,” said Senate Majority Leader Richard L. Saslaw (Fairfax).
“I look forward to voting for it. I like working on a bipartisan basis,” said Del. Mark D. Sickles (D-Fairfax), referring to the fact that the so-called Marketplace Virginia plan was proposed by a Republican, Sen. John C. Watkins (Powhatan).
But there was no mistaking the message the vote is intended to send: Republicans are not budging.
“Apparently, some Republicans are eager and willing to go on the record as willing to deprive hundreds of thousands of Virginians of affordable health care, continue to have our own tax dollars shipped out of state and to further put our rural hospitals at risk,” Sen. A. Donald McEachin (D-Henrico).
All session, GOP House members have spoken out against expansion in floor speeches and weekly radio addresses. Speaker William J. Howell (Stafford) has opposed it in at least four op-eds he has penned for newspapers across the state.
This week, House Republicans organized a telephone conference call with Arkansas House Majority Leader Bruce Westerman, who said his state had “buyer’s remorse” over its own private-option Medicaid expansion plan.
And Majority Leader M. Kirkland Cox (R-Colonial Heights) took to the House floor to predict that budget negotiations would deadlock over Medicaid, suggesting that the impasse would lead to a government shutdown and blaming Democrats for that possibility.
The next day, House Minority Leader David J. Toscano (D-Charlottesville) responded with his own floor speech, urging Republicans to tamp down the rhetoric on Medicaid.
“We haven’t even had a vote on either budget, and already the accusations are flying that the body down the hall is attempting to shut down the government,” Toscano said. “We’ve got a long way to go, folks. Let’s roll up our sleeves and see what we can do, working together, to get things done for the commonwealth of Virginia.”
“I think it’s a gimmick,” said Don Harris, a lobbyist for Inova Health System, who called the House’s push against expansion “very aggressive.”
“This is a way to force people to go on the record early, before the conference committee,” he said. “I think it gives the House conferees more confidence in their position if they go in with a recorded vote from the House on that particular part of the budget.”
Some supporters suggested that the vote might be a chance for the House to seriously consider expansion.
“I certainly have the utmost faith in trust in Delegate Jones . . . when he says we’re going to have a thoughtful policy discussion about this issue,” said Katharine M. Webb of the Virginia Hospital and Healthcare Association. “I’m taking him at his word that this is an opportunity for that to happen.”
Under the Affordable Care Act, states have the option to expand Medicaid eligibility to people making below 138 percent of the poverty line, which is $23,850 for a family of four. McAuliffe has said expansion would provide health care to 400,000 Virginians and create more than 30,000 jobs. Republicans have said they doubt that the federal government can afford to pick up most of the cost, which in Virginia would be $2 billion a year.
Senate budget writers have embraced Watkins’s plan — Marketplace Virginia, which would use federal Medicaid money to subsidize private insurance premiums.
Watkins and other supporters describe that plan as a rejection of Medicaid expansion because it would not operate like traditional Medicaid.
The plans would include some combination of deductibles and co-pays. The goal is to keep costs down by giving patients a reason – the impact on their own pocketbook – not to waste health-care dollars.