The 2014 session of the General Assembly ended last Saturday without a new state budget. The issue of contention is whether expanding the Medicaid program to include an additional 400,000 Virginians should be included in the budget or considered separately. Expanding Medicaid would entail a new, ongoing state spending commitment of up to $1 billion per year.
Governor McAuliffe often refers to finding “common ground” and then moving forward on issues. He’s right. Except for Medicaid expansion, the differences between Democrats and Republicans on the budget are small and include substantial common ground on education, transportation, public safety, mental health and other programs. That’s why the General Assembly should pass a new two-year state budget as the Virginia Constitution requires, and continue consideration of Medicaid expansion. There is no reason to risk a state government shutdown when the current budget expires on July 1.
Today, the Medicaid program provides medical services to nearly one million low income and disabled Virginians, distinct from the federal Medicare program for seniors. Medicaid expansion aims to address the needs of certain people who don’t have medical insurance, but don’t qualify for the current Medicaid program either. Proponents assert that uninsured people often turn to hospital emergency rooms for medical care, which hospitals must provide even if patients can’t afford to pay. This raises medical costs for everyone else. It’s a problem that deserves serious attention.
Nationally, about half of the states have decided to expand their Medicaid programs as envisioned by the federal Affordable Care Act (aka Obamacare). Other states have considered this issue thoughtfully and deliberately, without political brinksmanship. There are some compelling reasons why it makes sense for Virginia to detach the issue of Medicaid expansion from the rest of the state budget.
There’s lots of political rhetoric, but there isn’t a detailed piece of legislation to consider. Governor McAuliffe, who is a leading proponent of Medicaid expansion, didn’t send legislation on this issue to the General Assembly for a vote during the 2014 regular session, which was just completed. The Virginia Senate approved a proposal to purchase private insurance for uninsured people rather than add them to the Medicaid rolls. That’s an interesting idea, but this proposal consisted of a three-page concept paper with details to be determined. In essence, legislators were asked to pass the measure, and find out later what it really entails. Congress did that with Obamacare; the Virginia legislature shouldn’t.
Medicaid expansion could increase long term dependency on public assistance. Medicaid expansion needs to be considered in the context of other federal, state, and local programs aimed at helping people in need. An analysis of social programs in Pennsylvania, for example, found that a single mother with two children earning $30,000 per year would qualify for assistance to pay for day care, school lunches, housing, and other benefits. But if she were to double her salary to $60,000 per year, she would actually be less well off financially because of the loss of these benefits and the taxes she would pay. The best social program is a good job. Virginia needs to examine whether expanding Medicaid might actually deter people from transitioning to self-sufficiency.
Expanding Medicaid means accepting more borrowed federal money. While Virginians are paying more in federal taxes as a result of Obamacare, it’s not enough to cover Medicaid expansion. Virginia’s Constitution prohibits the state from borrowing to pay for ongoing expenses. Medicaid expansion would use borrowed federal money, tacking more bills onto the $17 trillion federal debt that future generations will pay.
Virginia’s Medicaid program has grown at twice the rate of inflation and population growth — a 45 percent increase since 2008. All other general fund spending has remained flat. Because Medicaid is a federally chartered program, its bills must be paid first, ahead of schools, roads and other state programs. Growth in the Medicaid budget contributed to the need for a transportation tax increase last year. It consumed tax revenue that might have been used for transportation. Medicaid needs to be reformed to get costs under control.
Virginians are tired of partisan acrimony. They want elected officials to move forward on issues where there is agreement, and take the time necessary to deliberate on issues where we differ. There is wide agreement on the state budget apart from Medicaid expansion. The General Assembly should move forward on the common ground of funding for schools, transportation, public safety, mental health and other key government functions. Let’s pass the state budget when the General Assembly returns for a special session on March 24 and continue the discussion about medical insurance for people in need of it.
Jim LeMunyon, a Republican, represents portions of western Fairfax and eastern Loudoun counties in the Virginia House of Delegates.