Bob McDonnell opens the bidding on Medicaid expansionPolitics

Gov. Bob McDonnell presented his final budget proposal for the commonwealth on Monday and buried in it was an apparent shot across the bow regarding Medicaid expansion:

Virginia must achieve structural reforms that bend the cost curve before we decide to expand Medicaid. Therefore, my budget continues the operation of the MIRC and also includes language that sunsets any potential Medicaid expansion on June 30, 2016, in order to allow a full evaluation of Medicaid reform efforts and whether Virginia can afford expansion.

As you may recall, Terry McAuliffe has made Medicaid expansion a priority, and has sought to dragoon Virginia’s business community into supporting this effort. The Republican House of Delegates is, ostensibly, against any such expansion. But McDonnell’s budget proposal looks like both a hedge against faint hearts in the GOP caucus and a bargaining chip — if Gov. McAuliffe really must have expanded Medicaid, then it will be for a limited time only.

The idea that Medicaid can be expanded for a brief time and then be shrunk is highly debatable. But it’s McDonnell’s opening, and closing, bid.

The full text of McDonnell’s remarks can be read below:

BiennialBudgetPresentation_Monday121613

  • Not Harry F. Byrd

    Rather clever by the Governor. Didn’t see that one coming.

  • David McKissack

    “…if Gov. McAuliffe really must have expanded Medicaid, then it will be for a limited time only.”

    How does that “limited time only” thing work? Do the GOP’s House members spend six months wearing a devil mask in the media, and then fight with the split Senate? And, if successful, does the McAuliffe administration send out 400,000 letters to the new folks added to Medicaid, telling them they’re no longer covered?

    I’m just asking, ’cause this stuff is kind of a mystery to me.

  • http://thebullelephant.com/ Steve Albertson

    I’m pleased to see there is not more in the budget that lays groundwork for expansion, but the sunset clause is really just wishful thinking, for two reasons. First, this budget will be modified by McAuliffe as soon as he takes over. Although the sunset provision is a good marker for the GOP caucus, it likely won’t be part of the incoming governor’s proposal. Second, as you note, Norm, it is akin to fantasy to think that the General Assembly will extend coverage to hundreds of thousands of people and then yank the rug out from them at a later date. It’s a good idea in theory, and seems like a prudent measure, but highly dubious in practice.

    At the end of the day, barring extraordinary action by the executive, Medicaid expansion only happens this session if Speaker Howell wants it to happen. He and other leadership in the House have made it clear they don’t want to see that. But given how much of a priority this is for McAuliffe, he’s going to be in deal-making mode. Let’s hope nothing disturbs the resolve of the House Republicans on this.

    • MD Russ

      The most compelling argument that I have read for not expanding Medicaid is that the Federal government, faced with mounting deficits, will renege on their pledge to fund Medicaid expansion. This sunset clause allows Virginia to expand Medicaid with the safety net of terminating coverage if the Federal government stiffs the Commonwealth.

      Can we do that to newly-entitled beneficiaries? Of course, the Federal government does it all the time. For example, military retirees who were promised “free health care for life” now pay thousands of dollars a year in TRICARE premiums, deductibles, and co-pays. And it took action by the Congress last year to stop the DoD from doubling those expenses every year for the next four years. The budget compromise voted on by the Senate today includes a reduction of cost of living raises for all current, not just future, retirees until the age of 62 when future COLA increases will be a percentage of reduced retirement pay. Believe me, if the Feds can stick it to military retirees, including combat wounded medically retired persons, they can refuse to fund Medicaid and let Virginia drop enrollees people.

      (Memo to Congressman Eddie Munster, who like his fellow chicken hawk colleagues never served a day in the US military: I turned 62 this year, so you won’t be getting your grubby little fingers on my hard-earned retired pay. But thanks for screwing all the younger folks who fought the war on terror.)

    • midwestconservative

      Medicaid expansion happened in Ohio without the GA’s approval, and opposition to it was high in both chambers. It can happen in Virginia, with or without Howell’s approval. The Legality of it might be called into question, but that didn’t stop John Kasich, and I highly doubt it will stop Terry McAuliffe who risks far less then Kasich in expanding Medicaid.

    • midwestconservative

      The same thing goes for a State run Exchange, and I offer you the example of neighboring Kentucky, which is in the news for being the only state to have a marginally functioning website. KY Governor Steve Beshear set up the Exchange without either funding or approval from his Legislature.

  • BrianKirwin

    Can someone report the groups of people that Medicaid expansion is supposed to include?

    • David Obermark

      Brian,

      I am not an expert, but since nobody who knows more is going to jump in I will offer my understanding.

      Under ObamaCare, states are supposed to expand Medicaid to more lower income level people then currently qualify. Subsidies from the federal government for medical coverage is not available for these people, because, believe it or not, they make too LITTLE money. If Medicaid is not expanded in Virginia were there will be a group of people who make too much to qualify for the current Medicaid but too little to qualify for government subsidies. They get no help and will probably remain uninsured.

  • mezurak

    May as well expand Medicaid. Once all the military retirees get kicked off Tricare they will have to go somewhere.