Va. Senate panel proposes alternative to Medicaid expansion

Senate budget leaders said Sunday that they were rejecting Medicaid expansion as they approved a state spending plan that would nevertheless tap $2 billion a year in federal Medicaid funding to extend health insurance to low-income and disabled Virginians.

Instead of expanding Medicaid as it has traditionally operated, the Senate Finance Committee proposed helping up to 400,000 Virginians buy private insurance through a program that would be known as “Marketplace Virginia.”

Expansion of traditional Medicaid could probably get through the evenly divided Senate, where every Democrat and a handful of moderate Republicans have expressed support. But with the GOP-dominated House opposed to increasing Medicaid rolls, Senate budget leaders touted their approach as an outright rejection of expansion.

“Medicaid expansion is based upon too many uncertainties under the ACA to go down that road,” Sen. Walter A. Stosch (R-Henrico), co-chairman of the Finance Committee, told a packed meeting room on Capitol Square. “Thus, we reject Medicaid expansion in favor of a Virginia solution — private insurance that we refer to as Marketplace Virginia.”

The state would subsidize private insurance premiums, following the “private option” approach taken in states such as Arkansas. If it can get Washington’s blessing, Virginia would pay for that using the $2 billion a year that the federal government has offered for expanding Medicaid under the Affordable Care Act, the health-care law known informally as Obamacare.

Those who oppose Medicaid expansion, a top priority for Gov. Terry McAuliffe (D), said the only difference is semantics.

“You can put all the lipstick you want on this pig and call it by another name; it’s still Medicaid expansion,” said Sen. William M. Stanley Jr. (R-Franklin).

The Senate panel approved the Marketplace Virginia plan as part of a two-year, $96 billion spending plan it adopted ahead of a midnight deadline to get its budget out of committee. The House Appropriations Committee, facing the same deadline, passed a spending plan of its own — one that did not include Medicaid expansion — by that name or any other.

The House proposal makes some overtures to hospitals, which have pushed for Medicaid expansion in part to help them cover some charity care reimbursements that they lost under the ACA. The House bill provides about $81 million to help hospitals cover inflation and an extra $6 million to free health clinics around the state.

The House and Senate panels were working from a budget plan that then-Gov. Robert F. McDonnell (R) proposed shortly before leaving office in January. Both added about $5 million to provide “cost of competing” funds for non-teaching staff in Northern Virginia schools. The money is used to boost the salaries offered to staff in that expensive job market. McDonnell offered the funds for teaching staff, but not other school personnel.

Both chambers’ plans add money for higher education, giving raises or bonuses to state employees and funding the state employee retirement system — although the two budget plans vary on the specifics, which eventually will have to be ironed out in a conference committee.

The House and Senate plans call for tearing down the 11-story General Assembly Building on Capitol Square and having a new one in place by 2019. The plan, which also includes renovations to the Old City Hall Building next door, would cost $280 million to $300 million.

Each panel voted after presentations that briefly summarized the spending plans for a large crowd of lobbyists and activists, who lined up to get thick stacks of budget documents and began poring through them for the nitty-gritty details that mattered to them.

Anna Scholl, executive director of ProgressVA, objected to language deep in the House budget that would eliminate support for Planned Parenthood and prohibit state funding of abortions performed in cases of severe fetal abnormalities.

“It’s not that they’re not continuing their attacks on women’s health care,” she said. “It’s that they’re trying to do it under the radar.”

House leaders, who have been trying to combat Democrats’ accusations that the GOP is waging a “war on women,” highlighted that they have provided about $5.5 million in extra funding for domestic violence and sexual assault services.

The House and Senate panels made note of economic uncertainties in a state with a large population of federal employees and defense contractors. But each panel offered different prescriptions for addressing the issue, with the conservative House stashing more money away as a contingency and the more moderate Senate spending in ways intended to boost the workforce.

“It is imperative to ensure that we have adequate cash reserves on hand as we continue to emerge from one of the weakest recoveries in memory,” said Del. S. Chris Jones (R-Suffolk), the appropriations committee chairman.

“With this murky recovery, we remain convinced that we must invest in our citizens to grow a dynamic, competitive workforce,” Stosch said. “We can’t afford to lose a single individual to unemployment or underemployment. To this end, in public education, you will see investment in early childhood education, support for year-round schools and enhanced funding for programs designed to improve student success.”

Laura Vozzella covers Virginia politics for The Washington Post.
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