Republican-Democratic budget battle heats up
Toscano says GOP should allow Medicaid expansion, Moran accuses Democrats of holding up budget negotiations
“We saw what happened when House Republicans in Washington said ‘no’,” Democratic Del. Toscano said. “‘No’ is not a policy.”
“They’re the ones who are not going to do anything on the budget,” Republican spokesperson Moran said.
Last Wednesday brought increased tensions to the already heated debate about Medicaid expansion, as state Republicans and several local leaders called on Democrats to pass a budget and consider Medicaid expansion afterward. Democrats held Republicans were ignoring a good case for giving more Virginians health insurance.
The 2010 Affordable Care Act, also known as Obamacare, required states to expand Medicaid, a health insurance program for low-income individuals. A 2012 United States Supreme Court ruling gave states the choice to expand or not expand Medicaid, and Virginia has, thus far, chosen not to do so. Gov. Terry McAuliffe, however, campaigned on expanding Medicaid and has been vocal about his desire to do so.
In a conference call Wednesday morning, Minority Leader Del. David Toscano, D-Charlottesville, Democratic Caucus Chair Del. Mark Sickles, D-Fairfax, and Democratic Caucus Vice Chair Del. Jennifer McClellan, D-Richmond, said Republicans have cost Virginia $5 million per day in lost federal funding.
“This obstructionism has already cost $355 million of our own federal tax dollars this year,” McClellan said. “The House Republicans are continuing to put the tea party ideology first.”
Toscano said Chambers of Commerce leaders, hospital executives statewide and other business leaders had come out in favor of Medicaid expansion.
“The House Republicans’ response to this continues to be ‘no’,” Toscano said. “We saw what happened when House Republicans in Washington said ‘no’. … ‘No’ is not a policy.”
House Republican spokesperson Matthew Moran said Democrats are obstructing progress by holding up a budget to consider ACA issues after attacking Republicans for holding up the federal government’s budget for ACA issues last fall.
“We think it’s very hypocritical for [McAuliffe] now,” Moran said. “They’re the ones who are not going to do anything on the budget.”
Republicans and local leaders have called on Democrats to separate Medicaid expansion from the normal budget process — with resolutions in Virginia Beach, Shenandoah County and New Kent County asking Democrats to separate the two issues. The chair of the Loudoun County Board of Supervisors also called for the separation. Moran said there was a sense of urgency from local officials.
“Local governments are already working on their budgets, and they kind of need it now,” Moran said. “School boards are required to adopt a budget May 1.”
Sickles said separating Medicaid from overall budget discussions was infeasible, given the program’s sizeable budget impact. According to the nonprofit Kaiser Family Foundation, Virginia’s Medicaid spending was nearly $7 billion in 2012, and the state paid 43 percent, or about $3 billion, of that total.
“This is just another tactic for delay,” Sickles said. “The governor and the Senate understand that [delay] is not an option.”
Moran said the Democrats’ Medicaid expansion proposal lacks details.
“The plan that the Senate has put forward … is three pages,” Moran said. “What you’re talking about is a $2 billion expansion of Medicaid. … We’re not going to hold up the entire budget over a three-page concept paper.”
Toscano said Democrats are seeking a “Virginia way” to expand Medicaid. The Democrat-controlled Senate’s current plan, called “Marketplace Virginia,” would give subsidies to newly eligible individuals for health insurance through a private health insurer. The federal government will pay most of the cost to insure newly eligible individuals.
“We’re talking about 1.7 billion dollars a year that we’re turning away,” Sickles said.
Most newly eligible individuals are non-disabled parents and childless adults. ACA requires many adults in Virginia who make less than the federal poverty line — $11,670 for a childless adult — to purchase health insurance. Without Medicaid expansion, they have no government subsidy to do so.
A family of four making between $23,850 and $95,400 already receives money from the federal government to purchase health insurance on this exchange, unless they get their insurance from their employer.
Marketplace Virginia is similar to a plan already in place in Arkansas, which requires newly eligible individuals to purchase insurance through the federal government’s health insurance exchange, a website that allows people to shop for and compare health insurance plans.
Traditionally, Medicaid recipients have no choice in their state-mandated insurance plan, and the federal government and state share the plan’s cost. Those promoting private market-driven plans hope additional competition will drive down cost.
To implement a private market-driven plan, the state needs Kathleen Sebelius, the Secretary of Health and Human Services, to approve and sign an 1115 waiver. Sickles said the state needed to act quickly to start the program in 2015.
“It’s going to take a while for the federal government to review it and approve of it,” Sickles said. “We need to have a sense of urgency about this.”
Moran said many Republican House and Senate members would have a difficult time passing a plan similar to the one in Arkansas. Moran said Sebelius has not approved a program to encourage employment through Medicaid and has not allowed states to require those receiving Medicaid to pay some of their own medical care costs. In addition, Moran said Sebelius wanted states to wait seven months before discontinuing Medicaid expansion if the federal government stops funding for the program in the future.
“I think our position on Medicaid expansion generally is that reforms should come first,” Moran said. “We’re certainly happy to look at anything that the governor wants to put forward. … All we’ve seen is a 3-page concept paper.”
Republicans want to see reforms of Virginia’s current Medicaid program to drive down costs over time, Moran said. After those reforms, he said, Republicans would cautiously consider Medicaid expansion.
“We welcome the debate on whether or not Virginia should expand Obamacare,” Moran said.
McClellan emphasized the human cost of inaction.
“What I would encourage the House Republicans to do … is talk to the uninsured in their district,” McClellan said. “I think they’re expecting us to come up with some kind of solution.”