Virginia’s lawmakers are returning to Richmond for a special General Assembly session where they’ll try to pass a state budget. The debate on thousands of line items and billions in spending really comes down to one issue: Medicaid expansion.
Governor (D) Ralph Northam supported a straight-forward expansion of the state funded health coverage for about 400,000 lower income individual. It’s a promise he campaigned on and something his predecessor, Governor (D) Terry McAuliffe, failed to achieve all four years in office.
This past session, the House of Delegates passed a spending bill with expanded employment requirements (not what Northam wanted, but has since conceded to) but the Senate shot it down, voting along party lines. On Tuesday, Northam said he thinks they’ll get it done this time, and glimmers of hope from across the aisle support that.
Last week, Republican Senator Frank Wagner said he would support expansion with more conditions. The GOP senator wants to collect a tax from hospitals to help the state cover its cost of expanding Medicaid. Republican Senator Emmett Hanger has supported Medicaid expansion in the past but doesn’t support a tax on hospitals.
With the House of Delegates already in support of Medicaid expansion - as introduced in their version of the state spending bill - the fight is in the Senate, where the GOP has a one-seat advantage.
The majority of Senate Republicans are vehemently opposed for a couple of reasons. There is a debate about whether or not Medicaid, philosophically, is performing, or being asked to perform, the way it was originally intended. Many Republicans, even across the country, believe Medicaid has become too broad and is asking too much of its respective state. This was amplified by the Affordable Care Act, or Obamacare, which leads into the other GOP concern: cost.
Under ACA, the federal government promises to refund states enrolled in Medicaid expansion for 90 percent of the cost. Republicans fear that a promise is all it will ever be and worry Virginia will bear the $2 billion per year burden.
Northam says that the state already relies on the federal government for funding to various departments and projects. Should Washington back out on its promise, his bill would give Virginia the ability to back out of expansion.
At that point, the Commonwealth would be out whatever money it has already spent on expansion.
Northam and the Democrats might already have the votes they need to pass a state budget with Medicaid expansion, if Northam attaches it as a budget amendment. A Senate majority is needed to pass a budget, but Lt. Governor (D) Justin Fairfax can cast a tie-breaking vote on amendments. Should the budget pass and a single Republican joins the Democrats in supporting an expansion amendment, Fairfax could push it over the top.
Virginia’s current spending bill expires on June 30. If a new budget deal isn’t reached by then, the state government would shut down for the first time ever on July 1. It’s expected the first version of a budget bill will be presented on the House floor next week.
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