Bolling breaks with party line

Lieutenant governor seeks to expand health care access, announces conditional support for ACA

Shocking the party faithful, Lieut. Gov. Bill Bolling announced his qualified support for Medicaid expansion under the Affordable Care Act in a letter to state legislators Thursday.

In his letter, Bolling said there are potential economic advantages of Medicaid expansion in Virginia, but conditioned his support on the state’s ability to receive waivers from the federal government that would allow for “critical Medicaid reforms.” Bolling’s office could not be reached for comment on what these reforms would be.

Bolling’s policy recommendation did not change Virginia Gov. Bob McDonnell’s opinion on the matter, according to a statement emailed Thursday from McDonnell spokesperson Jeff Caldwell. “Expansion without reform will not help Virginians in need of quality health care, and it would put even further budgetary stress on the Commonwealth in the future,” he said in the email.

Last summer, the United States Supreme Court ruled that an expansion of Medicaid as part of the Affordable Care Act could not be forced on states, but instead was optional. The act would extend health care coverage to those making below 138 percent of the Federal Poverty Line by increasing Medicaid coverage. The federal government would initially cover all the costs of the expansion, but could later drop funding to as low as 90 percent of costs in later years.

Until now, Bolling — along with other Republicans in Richmond — has not supported the expansion because of these potential costs. “Following the Supreme Court’s ruling, I stated that I would not support moving forward with an expansion of Virginia’s Medicaid program,” Bolling said in the letter. “However, in recent months, we have developed a more complete picture of the overall business case for Medicaid reform.”

Bolling said Virginia could save $300 million between 2014 and 2018 under the extended plan. He added that cost estimates for implementing Medicaid expansion in the first 10 years fell from $2 billion to $137 million. Savings could be realized by assuring that 300,000 more Virginians have health insurance, allowing them to pay for emergency medical care that hospitals are currently required to provide for free.

University Medical Center Spokesperson Eric Swensen said in an email his organization supports the expansion of Medicaid because of the large number of federal dollars which would flow into Virginia. Roughly seven of every 100 patients the Medical Center treats currently are uninsured, he said.

But no matter how practical Bolling may think his conditional support of the expansion, Center for Politics spokesperson Geoff Skelley said it was a politically risky move that is unlikely to pay off. Bolling, who was at one point eying the Republican gubernatorial nomination, is now an outsider in his own party, Skelley added.

“Bolling is kind of in opposition right now,” he said. “He was going to lose [the nomination] to [Attorney General Ken] Cuccinelli in a convention format … [But] Bolling really may not even have a political future at this point.”

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