Reading another column about the failure of the Virginia General Assembly to expand Medicaid may be as painful for you to read as it is for me to write. I know I have been predicting for months that a biennial budget would be passed for the Commonwealth and that it would include an expansion of health care coverage for those who are not now eligible for Medicaid. Nervously I stand by that prediction. Even the Majority Leader of the Senate whose members have been holding up the budget in opposition to Medicaid expansion has been quoted in news accounts that a budget will be passed and that it will include Medicaid expansion. So, what is the problem? And as many constituents ask me, what is the hold up?
Historically, biennial budgets for the state have passed by near-unanimous numbers. Not everyone has agreed with every number or every provision of the budget; the document is always a bundle of compromises that satisfies as many people as possible when there are always strict limitations on resources. Ironically, the addition of an expanded Medicaid budget brings hundreds of million dollars to the budget and frees up hundreds of millions of dollars that can be used for education and other needs.
By not adopting an expanded program of Medicaid, Virginia has foregone about ten billion dollars of federal money that required no state match. The funds coming to Virginia would not add to the national debt because of the tax funding included in the Affordable Care Act to support the program.
But I have explained the economics of the program in many past columns. It is a good deal for the state and a wonderful expansion of health care to those who are most in need. What is the hold up? Many of you have already figured out that it is the politics of the issue. For many years it was opposition to anything that had to do with Obamacare.
The former President has gone on to another career, but there have been many unsuccessful attempts in the Congress to undo his legacy as it relates to health care. For those who were part of the opposition to the expansion for many years there may be a problem pivoting to supporting it even if there are thousands of constituents who would benefit in better health care from it. For an even more conservative constituent waiting in the wings to challenge the legislator in a primary there is an opportunity to accuse the incumbent of flip-flopping on the issue.
House of Delegates members had a “refreshing” meeting with their voters last November. Some of the strongest incumbent opponents to Medicaid expansion lost their seats. A majority of the newly elected House voted weeks ago to pass the budget with Medicaid expansion in it. A majority of senators support it and should be allowed to vote. Those who do not can explain their position to voters in the next election cycle leading up to the election in November 2019. I hope I do not have to explain this one more time.