Va. Medicaid policy panel learns it’s not alone

RICHMOND, Va. (AP) — The Virginia policymaking panel with its hand on the throttle and foot on the brake of Medicaid expansion learned Monday that theirs isn’t the only Republican-led state still wrestling with the issue.

In a three-hour meeting, the Medicaid Innovation and Reform Commission learned little not already known other than how other states are handling the issue.

Legislatures in Michigan and Ohio, where Republican governors advocate expansion, are still pondering funding to expand the federal-state program that helps pay for health services for low-income families, the elderly, the blind and the disabled, said Vern Smith, a health finance expert who got his start in Medicaid in 1967 under GOP Gov. George Romney in Michigan.

Smith said that by opening up Medicaid to households with incomes up to 33 percent greater than the federal poverty level — or about 400,000 people in Virginia — the state would benefit initially from the federal government covering 100 percent of the increased enrollment. He noted that Republican governors Rick Snyder of Michigan and John Kasich of Ohio have both offered Medicaid expansion packages. Republican backing for Medicaid also has a precedent, he said, recalling that President Ronald Reagan supported a Medicaid expansion to women and children in the 1980s.

Neither the Ohio nor Michigan legislatures, he said, has written expansion into those states’ budgets.

Commission member Del. Johnny Joannou, D-Portsmouth, pressed Smith on consequences to Virginia should a federal government deeply in debt someday default on its Medicaid obligations.

“The short answer is if that were to happen, the state would be on the hook. The longer answer is that something like that has never happened,” Smith said. “It, in my judgment, would be extremely unlikely that something like that would happen because the consequences would ripple out across the country.”

Del. Steve Landes, R-Augusta and a commission member, later picked up Joannou’s thread about the reliability as Medicaid funding partners of a Democratic White House and a Republican U.S. House in a game of fiscal brinksmanship that has blocked passage of a federal budget for years.

“You mentioned that you believed that the funds would be here from the federal government’s standpoint,” Landes said. “Have you ever heard of the ‘sequestration’ that wasn’t supposed to happen and, in fact, it did and it is having an impact on Virginia?”

Landes referred to the federal government’s automatic budget cuts that took effect this year.

Democratic state Sen. Janet D. Howell, a Medicaid expansion advocate and one of three Democrats on the 10-member commission, said it could be equally hard to explain to Virginia taxpayers why millions of dollars they pay in federal taxes would go to other states that adopt Medicaid expansion, while Virginia gets back none of it if Medicaid isn’t expanded.

“Some of my constituents would be suffering serious health consequences from our failure to take that money,” she said.

Security in the General Assembly Building was tight as hundreds of conservatives sporting green Americans For Prosperity T-shirts queued in a long line for standing-room-only spots in the meeting room. Others made do with an overflow room offering audio of the meeting or a hallway connecting the two.

Earlier, they had rallied in the rain on Capitol Square in opposition to Medicaid expansion and the 2010 Affordable Health Care Act that authorized it — also known as Obamacare. Some carried placards saying “Hands Off My Health Care,” ”MIRC — Say No! To The Medicaid Expansion Trap” and “Keep Va Free. No Obamacare.”

“We are here to fight and to repeal Obamacare,” Dave Schwartz, Virginia state director for AFP, told the crowd.

But after three hours of health-industry jargon, bureaucratic acronyms and spreadsheet slide shows, the fight was out of them. One by one or in small groups, the standing-room shoulder-to-shoulder crowd made for the exits, leaving only lobbyists, policy wonks and journalists there for adjournment.

The commission’s next meeting is scheduled for Oct. 21 on Capitol Square.


Associated Press Writer Larry O’Dell contributed to this report.



Reports presented to MIRC on Aug. 19, 2013 (PDF format):

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