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Daily Press: House Republicans reject Medicaid alternative Print

BY  DAVID RESS

Created:  September 18, 2014

RICHMOND — The House of Delegates on Thursday took a bit less than an hour to debate, and dispose of, the one proposal on expanding coverage for low-income Virginians to come before it during its special session on Medicaid.

It voted 64 to 33 to kill the measure, with virtually all Republicans opposing the proposal and virtually all Democrats supporting it.

Republican Del. Tom Rust's bill would have set up a temporary bridge program to cover low-income Virginians using Affordable Care Act funds that would expire at the end of 2016. At that point, which is when states that have expanded Medicaid are supposed to being paying a small portion of the costs, Virginia should have readied a sweeping reform of its entire Medicaid program, including moving toward block grant funding. Block grant funding is an approach long proposed by Republicans for welfare programs, in which Washington cuts a lump sum check to a state, and leaves it to the state to design the program.

"This is not trying to plug the holes in a sinking ship, it's a whole new ship," said Del. Glenn Davis, R-Virginia Beach. He and Rust were the only Republicans to vote for the measure.

Davis said the bill's real purpose was a top-to-bottom reform of the whole Medicaid system, the health care system for low-income Virginians – mostly children and pregnant women, but also including some people with disabilities – that is half paid for by Washington and half by the state. Under the Affordable Care Act, also known as Obamacare, the federal government would pick up almost all the cost of covering all adults with incomes up to 138 percent of the poverty level, a total of more than 350,000 Virginians.

Most Republicans say that expansion would put too heavy a burden on the state finances unless Medicaid is reformed first. Many object to the idea of providing free health care to able bodied adults, no matter how poor.

Rust's idea of packaging a short term expansion with a longer term reform didn't ease their worries.

"This plan is unworkable," said Del. Steve Landes, R-Weyers Cave.

He said too much depends on what the federal Centers for Medicare and Medicaid Services decide to do with each of the several elements of the plan, and worried that its mechanisms would cut the legislature out of any decision making.

Del. Tim Hugo, R-Fairfax, said the bill linked Virginia's finances too closely to the Affordable Care Act – "the rough waters of Obamacare," as he put it, adding: "And this bill is a leaky boat."

"I think the big concern in my caucus is that it's a huge entitlement," said Speaker William Howell, R-Stafford. "And that $2 billion, where's it going to come from in the end?"

Del. Gordon Helsel, R-Poquoson, said what Rust hoped to accomplish – improving access to health care for low income Virginians — was laudable, but that he had too many concerns and unanswered questions about the complicated bill.

"I think he's got some good ideas, but it's a very expensive path," he said.

Democrats, saying there were parts of the bill they didn't like, urged its passage anyway – but added that they felt the effort, like the special session's promise of a full debate of Medicaid expansion, was futile.

"I can feel the sharks starting to circle on (Rust's) side," said Del. Patrick Hope, D-Arlington.

Del. David Yancey, R-Newport News, said even though he voted against Rust's bill, he felt it was a good start, and said he wanted to work on the issue of coverage for low income people. The bureaucraqcy required, and uncertainty over whether federal officials would go along, were big concerns, he said – especially given the state's difficult financial situation.

"I've got people in my district who are in need and I want to do something about it," he said.

Earlier, Democrats and Republicans traded accusations about not being serious about the issue of covering low income Virginians, with each criticizing the other for not presenting proposals.

"Let's have a discussion that leads somewhere and that starts with a plan," House Minority Leader David Toscano, D-Charlottesville, said. "We've offered a whole slew of them over the past eight months," and called on Republicans to offer ideas for coverage..

But Majority Leader M. Kirkland Cox, R-Colonial Heights, said Democrats had proposed no legislation for the special session, either.

"We've made it very clear, we're not for Medicaid expansion," Cox said, adding that the House Republican leadership called the special session to accommodate expansion advocates' desire to consider proposals for coverage.

"We can count," Del. K. Rob Krupicka, Jr., D-Arlington, said in reply, referring to the Republicans' 68 to 32 margin. "We understand your side has the numbers.... We assume you wouldn't call us together if you didn't think there was a way to do something, otherwise it seems frivolous and wasteful to just say no again."

Del. C. Todd Gilbert, R-Woodstock, shot back saying Democrats couldn't count since, he said, they discounted the rising cost of Medicaid even as they proposed adding more people to coverage.

"This program was meant for the truly impoverished and we're going to expand it to people who don't need it," he said.

Del. Jennifer McClellan, D-Richmond, replied that Medicaid expansion would mean the adults in a family of four earning $24,000 or less could get coverage.

"I think we could agree they are impoverished," she said. "We are talking about people who are one accident or one illness away from disaster."

The Medicaid fight spilled into an otherwise uncontroversial budget amendment vote Thursday, helping to delay action in the state Senate. A number of conservative senators wanted to see language tacked in to block potential future Medicaid expansion spending.

This language was similar to a clause inserted in the state budget earlier this year to block any Medicaid expansion spending without an explicit vote in the General Assembly. Republicans added that language, despite some in the party who dubbed it redundant, to keep Gov. Terry McAuliffe from attempting expansion on his own.

In the end Thursday the budget amendments passed without this new language, which was offered by state Sen. Richard H. Black, R-Leesburg. These amendments cut funding for state departments, universities and local governments to balance the state budget after revenues came in lower than expected.

They passed the House 93-4 and the Senate 35-2, and McAuliffe has said he'll sign them into law.


 



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