“I believe an important part of that [reform] process is evaluating the impact of those reforms in the months and years ahead,” Landes wrote in a letter dated Monday. “With the timeline for reform implementation already extended well into 2014, it is very unlikely we will be in a position to move forward with Medicaid expansion in the near future.”
Potential expansion of the program for the poor and elderly has become a central issue in the governor’s race, with Republican Attorney General Ken Cuccinelli II opposed and Democrat Terry McAuliffe in favor.
Under the federal Affordable Care Act, states can open their Medicaid programs to people with incomes up to 138 percent of the federal poverty level, about $32,000 for a family of four. The federal government will pick up the full cost for the first three years, with that share gradually declining to 90 percent.
McAuliffe contends that the law would be a boon to Virginia, providing insurance to 400,000 citizens, creating thousands of jobs and pumping $2 billion a year into the state. He has premised much of his broader agenda, including increased education spending, on the financial windfall that he says expansion would represent. He has said several times on the campaign trail that he would not sign a budget that did not include Medicaid expansion, but softened his rhetoric after Republicans said that amounted to a threat to shut down state government.
Cuccinelli says that the federal government is too financially strapped to make good on its funding promise, likely leaving Virginia on the hook for the cost of new Medicaid enrollees.
Bitterly split over the issue this year, the General Assembly struck a compromise, creating a panel empowered to expand Medicaid, but only if Washington agreed to let Virginia reform the way the program operates in Virginia.
Landes, an opponent of expansion, serves as vice chairman of that panel, the Medicaid Innovation and Reform Commission. In his memo to House Republicans, he said that expanding the program could eventually cost the state more than $1 billion a year if the federal government only reimbursed the state for 50 percent of the cost, as opposed to the promised 90 percent.
“The national debt is nearly $17 trillion,” Landes wrote. “Eventually, the federal government is going to have to address its spending problems. When it does, Virginia taxpayers will almost certainly get stuck with the bill for Medicaid expansion.”
But Sen. Janet D. Howell (D-Fairfax), who also serves on the panel, said in an interview that she is optimistic that Medicaid can be expanded in the budget that begins in July. She said Bill Hazel, the state’s secretary of Health and Human Resources, has been working with the federal government to win approval for the reforms that the General Assembly required as a condition for expansion.
“Secretary Hazel has been working diligently to have us ready to accept Medicaid expansion next year,” Howell said. “He’s on track and doing exactly what he was requested to do in the state budget. So I am optimistic that we will be ready to go.”