Senior members of Virginia’s House of Delegates declared Monday that eligibility for Medicaid will not be expanded this year, hardening their opposition to one of Gov. Terry McAuliffe’s top priorities for the legislative session.
“I believe Medicaid expansion is not going to happen this year,” House Speaker William J. Howell (R-Stafford) said.
“I’m just not going to expand Medicaid under the Obamacare act during this session,” James P. Massie III (R-Henrico) said.
Instead, Republicans, including Majority Leader M. Kirkland Cox (R-Colonial Heights) and appropriations committee Chairman S. Chris Jones (R-Suffolk), called for a broad outside audit of the fast-growing health-care program for the poor and disabled.
They said the federal government, with its own serious budget problems, can’t be trusted to cover its share of the long-term financial costs of the expansion. And they said that ongoing efforts to reform Medicaid in the commonwealth should be given time to bear fruit before expansion is considered.
Democrats and other backers of the expansion say hundreds of thousands of Virginians can and should be insured quickly using federal dollars. In a statement, McAuliffe said he would welcome an audit of Medicaid, another in a series of such studies intended to make the program more efficient.
“We cannot, however, afford to use an ongoing audit as the latest excuse to deny 400,000 Virginians access to quality medical and mental health care, to leave billions of dollars in federal funding on the table and deny taxpayers the savings that we would reap if we move forward immediately,” McAuliffe said, adding that efficiency is key, “but so is taking action to expand access to Virginia families.”
It remains unclear how McAuliffe (D) intends to find space for an agreement with Republicans, or how he might try to chip away at steadfast opposition in the House, which has the power to scuttle this and other parts of his agenda.
House Republicans have repeatedly said that the Medicaid program is growing too fast to be sustainable. They cite figures showing that Virginia’s yearly spending on the program has more than doubled in a decade, from $1.8 billion in 2004 to $3.7 billion this year. They also point to a jump in enrollment during that time of more than 70 percent, to more than 885,000.
Taking into account both Virginia and federal government spending — they split the costs 50-50 — Howell spokesman Matthew Moran noted that Medicaid is the largest line item in the state’s operating budget.
Given those numbers, it would be imprudent to expand the program “willy-nilly” during this session “or any time in the near future,” said Massie, who is also a member of the Medicaid Innovation and Reform Commission, which was set up by the legislature to find savings and new approaches.
Massie also said the Medicaid program is losing a large portion of its funds to “waste, fraud and inefficiency” in Virginia, making an outside evaluation crucial.
But other officials questioned the notion that Medicaid is a larded and broken program. Instead, they said, the program has been expanded, including by Republicans, to cover more-costly long-term care and other cases.
House Minority leader David J. Toscano (D-Charlottesville) said 30 percent of Medicaid enrollees are blind, elderly or disabled. Those individuals use 65 percent of the program’s funds. Half the enrollees are children, he said.
“When you’re talking about waste, fraud and abuse, you’re talking about those folks,” Toscano said.
Under the federal health-care law, the government promises to cover 100 percent of the costs of expansion for three years, eventually decreasing to 90 percent, officials said. But even covering that 10 percent could be a substantial burden in future years, House Republicans said.
But Democrats said that failing to seize federal money being offered to — and accepted by — many states would be a mistake. They also pointed to new estimates from state Medicaid officials saying that expanding the program would save the commonwealth more than $1 billion through 2022.
“The only prudent thing, the only responsible thing to do, is take the federal money, resolve the coverage gap, create jobs and keep the economy going,” Toscano said.