NUMBER CRUNCHERS for Virginia's state legislature publish an annual study, "Virginia Compared to the Other States." Generally speaking, the state hovers around the middle of the 50-state pack — somewhat wealthier, more lightly taxed and stingier with public spending than the competition.
But by one glaring metric, Virginia is close to the bottom: per capita Medicaid spending on the poor, the disabled and others, including children, who are unable to afford health insurance. By that standard, Virginia is a laggard — 47th and 46th in the nation in the 2016 and 2017 reports, respectively — and a disgrace. The average per capita Medicaid spending among the 50 states is $1,575; Virginia spends just $967 — and refuses to cover most single adults no matter how poor they are.
Blame falls squarely on Republicans, who for the past four years have blocked every legislative effort to expand Medicaid under the Affordable Care Act, which would cover 300,000 to 400,000 uninsured Virginians. They did so despite the fact that the federal government would have absorbed the vast majority of the cost and even as other GOP- controlled state legislatures found creative ways to expand Medicaid coverage.
Now, following a statewide pummeling in last fall's elections, the new GOP speaker of the House of Delegates, M. Kirkland Cox (R-Colonial Heights), last week gave word he was open to a "dialogue" on expanding Medicaid. That was an encouraging sign, but it came with a discouraging asterisk.
The asterisk is Mr. Cox's insistence that any overhaul be freighted with a work requirement — not just for the several hundred thousand who might be covered if Medicaid is expanded but also for the existing 1 million recipients. Neither Mr. Cox nor anyone else in Richmond seems to know precisely how many people that would affect, and in what ways. While such a requirement may make expansion politically palatable for some Republicans, it seems largely gratuitous and self-defeating.
Once you subtract adults who would be exempt from work requirements even under legislation proposed by Richmond Republicans — those enrolled in college; sole caregivers for small children; the disabled and others physically or mentally unable to work — what's left is probably a very small cohort of current recipients. And while no firm figures are available, no one doubts that a large majority of them already work, as do an estimated 70 percent of uninsured Virginians. Many Medicaid recipients are already subject to work requirements stemming from their participation in other federally funded programs, such as food stamps and welfare.
Moreover, people need health care whether they work or not; the alternative to Medicaid is the emergency room, which is more costly. Would it really behoove the state to disqualify those who don't work from Medicaid eligibility, thus putting them at risk of inadequate health care?
There may be room for a compromise between Republicans and Democratic Gov. Ralph Northam, a doctor who won a near-landslide victory last fall partly by promising to expand Medicaid. If a deal can be struck whose burdens don't outweigh its benefits, it wouldn't be a Democratic victory or a Republican loss. It would be a triumph for the neediest Virginians.
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