Medicaid fight in Virginia takes off

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The new Democratic governor of Virginia, Terry McAuliffe, is pushing hard for Virginia to join 26 states and the District of Colombia which have signed onto the Affordable Care Act's (ACA's) Medicaid Expansion Program.

But although Democrats occupy all three top executive offices of state government (besides McAuliffe, Ralph Northam was elected lieutenant governor and Mark Herring state Attorney General in November), Republicans have a solid majority in the House of Delegates (the lower house of the Virginia legislature) and a decision of the majority in the Virginia Senate depends on a recount of Northam's former Senate seat, which was won by Democrat Lynwood Lewis by only 9 votes.

The Republican leadership is solidly against Medicaid expansion. Nevertheless, McAuliffe says he may push for executive authority to implement Medicare expansion, if the legislature does not act.  

Virginia politician brag about theirs being a prosperous state with a low unemployment level (5.4 percent). However, this seeming prosperity is obtained at the cost of low wages and benefits for many workers. Virginia is a so-called "right to work state" with an extremely low level of unionization (4.4 percent in 2012, compared to a national average of around 11 percent).

The average weekly wage in Virginia is higher than the national norm, but this is deceptive. The higher wage levels are all concentrated in the Washington D.C. suburbs and exurbs in Northern Virginia and a few other places, and result to a large extent from economic activities of the federal government and its contractors. In much of the rest of the state, including the depressed coal mining areas of Appalachia and rural, agricultural communities, wages are low.

In other words, Virginia is a state with a large number of working poor.

One of the things that this implies is that many workers in Virginia do not have access to workplace-sponsored health insurance, a thing generally associated with strong unions and higher wages. This means that the Medicaid expansion, covering poor and disabled people, was meant for places like Virginia.

The Republican legislative leadership sees Medicaid expansion as a wasteful giveaway that might spoil Virginia's attraction for investors. Like the right in other areas of the country, they also take the attitude that the poor have only themselves to blame for their poverty and get too much government help as it is. And they have invested so much political capital in attacking "Obamacare" that switching to supporting Medicaid expansion might seem like a climb-down.

It is no wonder that Virginia is in 48th place in state spending for Medicaid, with a million of its 8.3 million residents lacking health insurance. Should Medicaid be expanded in Virginia, about 400,000 of these would be qualified for coverage. Not only labor but the state Chamber of Commerce supports expansion. The sequester cut federal help to health care institutions, which see Medicaid expansion as making up for that loss. As many as 30,000 jobs in the health care field could be created via Medicaid expansion, increasing the income tax flow to both state and federal governments at a very low cost.

During the 2013 Virginia elections for governor, lieutenant governor, attorney general and the House of Delegates, gubernatorial candidate McAuliffe and other Democratic Party candidates ran on a platform that included Medicaid expansion under ACA, which had been opposed by then Governor Bob McDonnell and the Republicans. If the Democrats get a majority in the Senate, they can make headway there, but in the House of Delegates, there will be a real problem.

On Monday January 20, Governor McAuliffe went on the offensive. He announced that if the legislature's body working on the issue, the Medical Innovation and Reform Commission (MIRC), does not, by the time the legislative session ends in March, authorize expanding Medicaid to 400,000 more people, the legislature should authorize him to do the job.

The governor's statement immediately generated a hostile response from Republicans, who essentially said that they want the task to stay in the hands of the MIRC as a way of killing Medicaid expansion.

This seems to indicate a prolonged standoff. But a new study by the state's office in charge of Medicaid, released on Thursday, may give McAuliffe more ammunition. It shows that the expansion of Medicaid would save the state almost a $1 billion through 2022, instead of costing it $137 million as previously thought. Under the law, the federal government pays for the whole of Medicaid expansion for the first three years, and the states kick in up to a maximum of 10 percent thereafter.

The Republican Chairman of the House of Delegates' Appropriations Committee, Delegate Chris Jones, told the media that he had not had a chance to study the new report, but that he would oppose Medicaid expansion anyway, on principle.  

Image: Virginia AFL-CIO

 

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