VIRGINIA

Virginia Medicaid expansion tonic to some, toxic to others

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ANALYSIS

(WJLA) – Here’s the way health care meanderings went last summer on the Virginia gubernatorial campaign trail:

Democratic candidate Terry McAuliffe would resoundingly assure mostly supportive attendees at rallies by pledging his unyielding support for Medicaid expansion with a boost from the Affordable Care Act that would extend coverage for hundreds of thousands of un- or-under-insured Virginians.

Republican candidate Ken Cuccinelli would resoundingly assure mostly adoring attendees at rallies by pledging his unyielding intention to block Medicaid expansion because it merely was an extension of “Obamacare” that ultimately would prove disastrous for hundreds of thousands of Virginia tax-payers.

McAuliffe won, of course.

Yet here we are, several days before Saturday’s scheduled conclusion of the General Assembly session, with no agreement in reasonable sight to resolve the issue and get a budget deal.

It’s not as if McAuliffe didn’t see this coming, which is why he has spent the past several weeks visiting hospitals throughout the Commonwealth, sending his surrogates scurrying across the state to spread the word, wining and dining lawmakers at the Governor’s Mansion and doing everything if not anything drum up support for his signature campaign proposal – all this while knowing the GOP-controlled House of Delegates had scant – if any – interest in moving on Medicaid Expansion.

“I think that may have caught some people by surprise,” says Del. Mark Sickles (D-Fairfax). “He’s determined to get this done. What we have now is an unsustainable, idiotic policy position of the House Republican leadership, and the only way out, I believe, is for communities from all over Virginia, especially small-town Virginia, where rural hospitals are threatened even more so than our big hospitals in urban areas (to speak out)."

But a strongly opposing voice comes from Dick Black (R-Loudoun and Prince William), who on Thursday told Bruce DePuyt of NewsChannel 8’s NewsTalk he doesn’t trust the promise of federal funding, echoing the sentiments of former Republican Gov. Bob McDonnell.

“I’m not going to vote for Medicaid expansion ever,” he said. “. . .Obamcare is failing in almost every single aspect.”

Asked about similar talk from the GOP, Sickles is succinct: “That is the rhetoric that we hear every day from the leadership here (in Richmond), and to me, it’s not understandable how they can sustain their position. . .Every day in the House we hear this extreme rhetoric. I don’t understand why they’re doing it."

Larry Sabato does. He’s the chief of the University of Virginia’s Center For Politics.

“Medicaid expansion is closely associated with Obamacare,” Sabato says. “The Republican base is virtually united in opposition to Obamacare, and the GOP nationally is focusing tightly on the subject for the 2014 midterm campaigns. Virginia's House of Delegates is two-thirds Republican, and they are listening to their party's activists.”

Yet here’s the thing: Virtually every professional health organization in the state, as well as the Virginia Chamber of Commerce, has endorsed expanding Medicaid, even if through a Senate compromise of a marketplace scenario.

Wrote Victor Iannello, chairman of Carilion Medical Cente, in Thurdsay’s Roanoke Times, “. . . Already, Virginians have been paying, and will continue to pay, taxes to the federal government to support provisions in the ACA. By expanding Medicaid, the commonwealth would be able to recover some or all of that money.

". . .I do not believe that any member of the General Assembly is willing to risk the financial solvency of his or her local hospital, or the quality of services it can provide, simply to advance a partisan agenda. There is common ground to be found, and we stand ready to work constructively and diligently with the General Assembly and the communities we serve to find that solution.”

Alternatives to beating the deadline include extending the session, having a separate session or having a clean budget that skirts Medicaid expansion.

"We know we disagree on Obamacare (and) we know we disagree on Medicaid expansion, House Speaker Bill Howell (R-Stafford County) told reporters this week “And that's not going to change in the next three days.”

So there you have it.

Politics and Prose.

Or Politics and pose.

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