Bill Botts of Stafford County served as the region’s Affordable Care Act navigator after retiring as director of Rappahannock Legal Services.

November 22, 2015 12:00 am

Here are 10 Republican reasons to support Medicaid expansion with reform in Virginia, or why it need not be the GOP’s bitter pill.

1) Taxes: Republicans believe that federal taxes paid by Virginia residents should be returned to the commonwealth to benefit its citizens. Virginians are already paying for Medicaid expansion through their federal taxes at the rate of $5 million per day, but that money is going to other states, which are implementing Medicaid expansion. Those dollars should benefit Virginia. A five-state September 2015 poll sponsored by Community Catalyst and SEIU indicates that 74 percent of likely voters in Virginia want their state to accept federal dollars and expand Medicaid.

2) Fiscal savings: Republicans believe in achieving fiscal savings in the state budgets and in practicing pay-as-you-go. Budget analyses indicate that Medicaid expansion would save the state about $264 million annually, including $114 million in hospital care for the poor, $33 million in prison healthcare, $29 million in mental health and substance abuse programs, $11 million in programs serving vulnerable populations, and $77 million to replace the state-funded GAP program with federal dollars. More recent analyses also suggest that Medicaid expansion may pay for itself, even once the federal contribution decreases to 90 percent in 2020.

3) Pro business: Republicans are a pro-business party and believe in protecting the interests of the private sector. The Virginia Chamber of Commerce and numerous local chambers around the state—including the Fredericksburg Regional Chamber of Commerce—publicly support Medicaid expansion with reform. To them, it makes economic sense. To Virginia’s hospitals and healthcare providers, it’s a matter of the bottom line: about half of the state’s rural hospitals were in the red in 2013 and Medicaid expansion would help their bottom line. Locally, Mary Washington Hospital has struggled without the benefit of Medicaid expansion and has had to lay off employees, some of whom ironically have fallen into the Medicaid coverage gap as newly unemployed through no fault of their own. The business community also recognizes that healthier employees with access to affordable health care are more productive. In a competitive business climate, companies considering staying (and expanding) in Virginia or relocating to the state will consider many factors; the neighboring jurisdictions of Kentucky, West Virginia, Maryland and D.C. have expanded Medicaid and experienced economic and budgetary stimulus and significant reductions in their uninsured population with improved physical and mental health indicators.

4) Jobs: Republicans believe in the creation of private sector jobs and in expansion of the private economy. Expansion of Medicaid will support more than 20,000 new jobs in Virginia, spur economic growth, and generate an estimated additional $530 million in state revenues.

5) Pro-life: Republicans are pro-life and believe in the sanctity of human life. A number of studies have shown that anywhere from 20,000 to 45,000 Americans die annually as a result of not having access to affordable health care; it is estimated that mortality increases by as much as 40 percent for the uninsured. Expansion of Medicaid will not only improve health but will also save lives.

6) Pro-family: Republicans are pro-family and believe that strong families, not big government, are the essential building blocks for a strong America. Republicans also know that Medicaid expansion with reform has the potential to improve the health and life expectancy of adults, including parents and their children.

7) The poor: Republicans believe that the poor need to be more responsible and self-sufficient and that they need to make better choices; if they will not be so dependent upon government and accept a hand up rather than a hand out, they can escape their circumstances. Medicaid expansion, with the reform aspects outlined in No. 9 below, offers the opportunity with strings attached for better physical and mental health leading to more responsible and self-sufficient lives.

8) Faith: Faith, and especially Christianity, is central to the lives of most Republicans. While cynics say that the political interpretation of the Golden Rule is “Gold rules,” Christians know it as the second great commandment. Christ ministered to the poor, the sick, and the outcasts of society. Our faith teaches us that we should love, care for, and help all children of God and that, when all Americans are treated equally, we are all more Christ-like and more free. God’s grace gives us the opportunity to practice these principles at any point in our lives, but it is up to us, through our faith, to do so. In the end, our faith can make us whole. Republicans have the opportunity to reach out in a responsible but faithful fashion to those 195,000 eligible Virginians in the Medicaid coverage gap to help them heal and become whole. (Locally, House Speaker Bill Howell has an estimated 1,900 such constituents, and state Sen. Bryce Reeves has 9,100).

9) Reform: Republicans believe that an expanded Medicaid needs to be reformed, improved by state-level ideas. This has, in fact, already happened in at least six states where federal HHS waivers have been approved to permit states to reform Medicaid expansion through use of such Republican-friendly ideas as private option, managed-care plans, the charging of premiums (with penalties for nonpayment) and other cost-sharing features, special eligibility requirements for those at 100 to 138 percent of poverty, the waiver of retroactive eligibility, wellness programs, HSA-like features, and employment and job search features. In addition, Virginia Republicans are already on record as stating that any acceptance of Medicaid expansion should be conditioned upon federal support not dropping below 90 percent after 2021.

10) Political pragmatism: Republicans understand that Virginia is purple and trending blue. They must appeal to moderate, centrist and independent voters to retain full control of the General Assembly; they also understand that the benefits of gerrymandering will not last forever. The party’s image must reflect its principles, but there are creative ways to seize the initiative on any number of issues, including on Medicaid expansion with reform. If the party believes in American exceptionalism and the can-do spirit and understands that the gloom and doom of being the party of No is ultimately self-defeating, it will find a way to seize the initiative and say Yes on its own terms, even on issues such as Medicaid expansion with reform. Other deeply red states have already done so. Virginia should follow with acceptance coupled with tough-minded reforms under a federal waiver.