RICHMOND — A state budget that would expand enrollment in Virginia’s Medicaid program cleared a Republican-led House committee for a second time Friday, with new provisions aimed at shoring up the individual insurance market and imposing tougher work requirements on Medicaid recipients.
The House Appropriations Committee’s action came three days into a special General Assembly session on the state budget, which Gov. Ralph Northam (D) called after the legislature failed to pass a two-year spending plan in the regular session that ended March 10. The state needs a budget by July 1 to avert a government shutdown.
Budget talks collapsed in March over a standoff about Medicaid, the federal-state insurance program for the poor. The House wanted to let an additional 400,000 low-income Virginians enroll; the Senate was opposed. The GOP controls both chambers by slim margins.
On Friday, the committee passed essentially the same House budget that died in March — but with a handful of amendments meant to make expansion more palatable to the Senate. Two Republicans in that chamber have said they would team up with Democrats on Medicaid under certain conditions.
After the meeting, House Appropriations Committee Chairman S. Chris Jones (R-Suffolk) declined to say whether he thought the plan would satisfy the two senators, Emmett W. Hanger (Augusta) and Frank W. Wagner (Virginia Beach).
“I don’t know if this is my ninth or 10th budget conference, and what I have learned is that the least said, the better,” Jones said. But he was optimistic that the two chambers could reach a deal.
Hanger and Wagner did not immediately respond to requests for comment.
The plan did not win over Senate Majority Leader Thomas K. Norment (R-James City), who has opposed Medicaid expansion. But in off-the-cuff remarks to a handful of reporters days earlier, he sounded resigned that it would eventually pass. On Wednesday, Norment said the House might win over a few Republican senators if it developed a plan in collaboration with GOP senators with expertise in health care.
“Potentially there could be a conservative, fiscally responsible plan that could attract the support of two, maybe three [senators],” Norment said Wednesday. Jones said he was “encouraged” by those remarks.
But in a written statement Friday, Norment said: “The few changes to the House’s original proposal approved by the Committee today do not narrow the chasm between our respective proposals.”
Northam, who ran for governor last year on a promise to expand Medicaid, said at an appearance in Richmond on Friday that he had seen no details about the stricter work requirement but had two concerns.
“One is we don’t want to create more bureaucracy. That would just be, I think, an irresponsible use of the funding that we have available,” Northam said. “And the other thing is that we want to move forward with a carrot rather than a stick and we want to do everything we can to help people, to encourage them to get back into the workforce.”
But the governor also told reporters that “everything is on the table.”
Under the Affordable Care Act championed by President Barack Obama, Washington encouraged states to allow more people to enroll in Medicaid by offering to pick up most of the tab. Thirty-two states, including Maryland and the District of Columbia, accepted the offer.
Virginia’s legislature staunchly resisted “Obamacare expansion” for four years under Northam’s predecessor, Terry McAuliffe (D).
Opposition softened in the House after Democrats nearly took control of the chamber in a November election wave widely viewed as a rebuke to President Trump.
But the Senate, which does not face voters until 2019, did not budge.
Hanger has supported expansion for years but objected to aspects of the original House plan. Wagner recently said he was open to expansion in some form.
It would take two Senate Republicans to pass expansion on a budget vote, the most conventional route for passage.
Both Hanger and Wagner have expressed dissatisfaction with the House’s original work requirement, which critics had derided as a “work suggestion” because it would have operated on the honor system. Wagner wanted it to have more teeth. Hanger wanted the state to help recipients comply, by connecting them with work or educational opportunities.
The plan approved Friday, which goes to the full House for a vote Tuesday and then to the Senate Finance Committee, addresses both issues. It calls for able-bodied recipients to lose Medicaid benefits for a time if they fail to participate in work, training or education programs. Exceptions would be made in certain cases.
The plan also calls for about $40 million — half of that federal matching funds — to help people comply, as the state already does for certain welfare recipients.
“I think if we’re saying, ‘You lose your insurance if you don’t comply’ . . . I think that puts a little pressure on us to make sure, ‘Hey, how about this education program?’ ” said Del. Mark Sickles (D-Fairfax), a member of the House Appropriations Committee.
The new budget plan also calls for the creation of a high-risk insurance pool, a move meant to control the cost of plans for individuals and small businesses.
That measure seemed intended to address Wagner’s concern for people who have insurance but struggle to pay premiums and deductibles. Wagner had proposed a $250-a-year health-care tax credit for people with incomes between $30,000 to $50,000.