Still Time To Get To “Yes” On Medicaid Expansion

During this year’s legislative session the General Assembly’s most important responsibility is to send a well-thought out, balanced budget to Governor Ralph Northam’s desk. Working from an initial proposal introduced by former Governor Terry McAuliffe in December, the Senate Finance and House Appropriations Committees considered amendments to the “introduced budget” brought forth by legislators. The “money committees” unveiled their proposals in mid-February, and last Thursday the House and the Senate passed starkly contrasting budgets.

 Most notably, the House of Delegates finally decided to accept federal funds in order to expand Medicaid. The Senate, once again, did not. This dramatic change was a direct result of the 2017 elections and the resulting influx of over a dozen new Delegates who strongly campaigned on behalf of the 83% of Virginians who support expanding Medicaid.

By unlocking federal funds for Medicaid expansion, the House of Delegates budget was able to access over $422 million that was cut from the Senate budget. The focus of the remainder of this legislative session will be ironing out the differences between the Senate and House proposals. Budget negotiators from both chambers will hold a conference committee to reconcile a $650 million difference. The best way to close this gap is for Senate budget conferees to accept Medicaid expansion in the compromise budget.

Since 2014, the Commonwealth has forfeited more than ten billion dollars in federal funds, tens of thousands of well-paying healthcare jobs, and declined to provide coverage for approximately 400,000 currently-uninsured Virginians–including 6,100 in the 30th Senate District. This has meant higher costs for Virginia, which spends money to cover its uninsured by funding mental health visits to Community Service Boards (CSBs) and healthcare for incarcerated individuals, as well as higher health care costs for insured Virginians due to an excess of “charity care” cases whose costs are absorbed in their insurance premiums.

Federal taxes revenues would provide the funds for 90% of the cost of Medicaid expansion. Under the House plan, Virginia would institute a provider assessment for private hospitals to cover the remaining 10%. Although this costs the hospitals money, the reduced costs associated with a decrease in “charity care” visits more than offset the assessment.

While I would prefer “clean” Medicaid expansion, the House proposal includes a measure that requires care recipients to document their employment status and show job search efforts when appropriate. This work requirement was the key in securing the votes of a number of Republican Delegates. This proposal could be onerous for those affected, but a number of exceptions, including those for people under the age of 18 or over 55, pregnant women, and disabled individuals will result in the requirement impacting only 20,000 of the 400,000 Virginians to whom Medicaid would be expanded. I do still have concerns that this would leave  otherwise-eligible individuals with tenuous employment arrangements potentially exposed to risks of losing healthcare.

The Senate’s decision to not expand Medicaid would result in a number of missed opportunities in public safety, education and mental health. Relative to the introduced budget, the Senate budget would eliminate 7.7% of the state funding to support local police departments and forego a proposed 2% raise for teachers (despite Virginia having a statewide teacher shortage). When compared to the House budget, direct per-pupil aid given to local school districts is reduced by $170 million. The Senate budget disadvantages college students by eliminating nearly $23 million in financial aid. Funding for innovative projects like Cyber X, an initiative to draw business and talent to Virginia by funding cyber studies and advanced computing, was also eliminated.

The Senate budget also fails to deliver much-needed mental health services. It cuts $8 million to address overcrowded facilities, reduces funding for supportive community-based housing, and eliminates $7 million for primary care outpatient screenings.

A series of floor amendments from Sen. Janet Howell (D-Reston) would have incorporated Medicaid expansion into the Senate Budget. Many Democratic Senators, including Sen. Howell’s fellow Finance Committee member, Sen. George Barker (D-Southern Fairfax), detailed the negative public health and economic consequences of continued resistance to accepting healthcare funds.

I spoke on the unsettling absence of adequate funding for the smooth and efficient administration of our elections in the Senate budget. Funding that would have shored up the electronic voter registry and ensured that those who call into the Department of Elections could have their questions answered was removed. Given the current climate, it is essential that we take all available measures to ensure the integrity and fairness of our elections. We cannot wait for a catastrophic failure before we take the necessary steps to fund, secure, and update our elections systems.

On the floor, I also took an opportunity to force votes on whether we should defund proposals to ban bump stocks, assault-style weapons and require universal background checks. These proposals to keep guns out of the wrong hands were defeated on a party-line vote.

Disappointingly, both the House and Senate budgets stripped $20 million from the introduced budget that would have assisted with efforts underway by the City of Alexandria to address major sewer renovations. The project will cost nearly $400 million and costs will increase by an estimated $30-$50 million as a direct result of the legislative mandate that passed last year requiring completion by 2025. The General Assembly has helped fund similar projects in both Richmond and Lynchburg. I am hopeful that, with a good-faith demonstration of rapid progress by the City, future state funding for the project will be forthcoming.

One bright spot last Thursday was women’s health. The Senate voted down an amendment, introduced by Sen. Dick Black (R-Loudoun), that would have removed an option for low-income women who are faced with the decision of whether to carry grossly deformed fetuses to term or have an abortion. Sen. Jennifer McClellan (D-Richmond) spoke eloquently regarding this heart-wrenching decision on the Senate floor. Funding was also included for a pilot program for long acting reversible contraceptives .

There is still time to get to “Yes” on Medicaid expansion while the budget is in conference. I will continue to do all I can to see that 400,000 Virginians will finally have access to affordable healthcare coverage.