In Va., fight over Medicaid expansion continues

Gov. Terry McAuliffe hit the road to sell Medicaid expansion Monday, touring a Northern Virginia hospital to make the human and business case for insuring more poor and working people — and to pressure House Republicans who have pledged to block the effort.

Launching a two-week media blitz, McAuliffe (D) sharply rapped the GOP-led House of Delegates for its role in the current impasse. He told doctors and administrators at Inova Loudoun Hospital that as a businessman and a person of deep faith, he finds Republicans’ refusal to expand coverage nonsensical economically and “very disturbing” morally.

McAuliffe pointed to the 400,000 additional people who would qualify for Medicaid in Virginia under the Affordable Care Act, 70 percent of whom are in households where at least one person has a job. Under a plan written by moderate Republican Sen. John C. Watkins (Powhatan) — and rejected by the House — uninsured people earning up to 138 percent of the federal poverty level would quality for coverage. (The poverty level for a family of four is $23,850.) The proposal would use $1.7 billion a year in federal taxes collected in Virginia under Obamacare to buy private health insurance for those individuals.

“They come home from work on a hard day. They sit on their couch. And they think, ‘I could get health care for the first time. I can provide for my family. It’s already paid for,’ ” McAuliffe said in an interview. “How do you look that person in the eye and explain this? How? These are working folks. They work hard. I just have a hard time with it, to be honest with you, a hard time with it. We owe it to them, and they’ve waited long enough.”

McAuliffe also acknowledged what was obvious 120 miles south in Richmond on Monday: that the solution to the deadlock over Medicaid is unlikely to come quickly. There, dueling business groups joined the fray by casting the proposed expansion as either a helpful jolt to the economy or an irresponsible increase in spending. The governor said it is likely the issue won’t be resolved before the scheduled March 8 end of the General Assembly session.

The Virginia Chamber of Commerce endorsed an approach similar the Senate’s “private option” plan, which would require enrollees to have a job or be looking for one. The chamber’s plan would require an audit and reauthorization every four years, something not in the Senate proposal. And it endorses the two-year audit of Medicaid the House is pushing for, although, unlike the House version, it would not wait for the audit’s completion before expanding the program.

Barry DuVal, president of the chamber, ticked off the details on the 11-point plan and said it would allow Virginia to tap into federal tax dollars to lower health-care costs and improve the health of its citizens.

“We understand it’s politically difficult, but the business case is compelling,” said F. Kevin Reynolds, president of Cardinal Bank and one of several business leaders who attended the news conference.

An hour later in the same room, House Speaker William J. Howell (Stafford) and other Republican legislators joined the National Federation of Independent Business to warn against expansion and criticize the Senate’s decision to fold Watkins’s plan into its budget proposal.

Howell said Medicaid, which without expansion has grown at 8 percent a year — and 1,600 percent over the last 30 — is already a budget-buster. “It’s gonna break us,” he said.

“Not everybody in the business community thinks expanding Medicaid is a good idea,” said Nicole Riley, state director of the independent business federation, which is headquartered in Tennessee. “Many business leaders prefer complete reform of Medicaid before tossing more money on a raging wildfire.”

McAuliffe said that many hospitals in rural parts of the state are facing existential financial troubles and that even in Loudoun, one of the state’s wealthiest jurisdictions, failing to bring home billions of dollars in tax dollars collected under Obamacare would have far-
reaching consequences at the local hospital. Tens of millions of dollars that could be used for every­thing from high-tech research to covering the poor would be missing, hospital officials said.

“It’s like the federal gas tax you pay every time you fill up the car,” McAuliffe said. The message from House Republicans is “we don’t want it,” McAuliffe said.

To try to take the edge off of pain being felt by the state’s hospitals, Republican delegates have proposed $118.6 million in additional Medicaid payments over two years.

But Katharine M. Webb, senior vice president of the Virginia Hospital & Healthcare Association, said the offer falls far short of what the hospitals would receive if there were 250,000 people newly insured under Medicaid.

That would bring hospitals $692 million, Webb said. “The difference is vast,” she said.

Virginia’s hospitals have been aggressive proponents of Medi­caid expansion. Hospital executives and their backers point to the hundreds of millions of dollars a year they are set to lose because of cuts that were part of the Affordable Care Act.

As part of the restructuring of federal health-care spending under Obamacare, certain Medicare cuts were accompanied by efforts to insure more people. But the U.S. Supreme Court ruled the Medicaid expansion optional, rather than a requirement, as originally written.

Covering hundreds of thousands of new patients in Virginia under Medicaid could help the hospitals’ bottom lines by adding new customers.

Sixty-six of the 67 Republicans in the House of Delegates voted against the Medicaid expansion plan.

Republican opponents say that the federal government is an unreliable long-term partner, given its own budget woes. The federal government has agreed to pay 100 percent of the Medicaid expansion costs for the first three years, and, after a gradual reduction, would pay 90 percent of those costs in the future. But even the 10 percent would be a costly hit to Virginia’s budget, House Republicans say.

Barbra Jill McCabe, a top pediatric emergency physician and manager, helped show McAuliffe around the pediatric ER in Loudoun, where a child screamed behind a glass partition. Regardless of the different opinions on how to improve America’s health system, she said, “I think expanding care for the folks who need it has to be part of the solution. . . . I’m faced with patients every day who are struggling because they don’t have that access.”

She said that with more patients on Medicaid, her emergency room would be less busy, which would benefit the children they treat.

“They’d be on medication to manage their asthma. They would have good preventative care. They would get their immunizations. . . . They would address their obesity. All of the epidemics that are coming along, primary care wants to try to address that,” McCabe said. “But if they don’t have access, how are they going to get that taken care of? They end up in here because they have complications that aren’t being addressed.”

Mike Laris came to Post by way of Los Angeles and Beijing. He’s written about the world’s greatest holstein bull, earth’s biggest pork producer, home builders, the homeless, steel workers and Italian tumors.
Laura Vozzella covers Virginia politics for The Washington Post.
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