As the General Assembly heads back into Special Session on May 23 to continue work on the biennium budget impasse, I looked back at how long we’ve been fighting to expand Medicaid–the major sticking point in our current budget standoff. Here’s what I wrote in September 2014 — nearly four years ago!
Recently the New York Times editorial board wrote about the “health care showdown in Virginia.” Their comments were not favorable. “In Virginia, there are 400,000 low-income people who can’t afford health care coverage but don’t qualify for federal subsidies,” they wrote. “If they lived across the state line in Maryland, West Virginia or Kentucky, which have expanded their Medicaid programs, they could get the coverage they need.” The reason they cannot; “a group of recalcitrant Republicans in the House of Delegates” have blocked Medicaid expansion at every opportunity.
Highly regarded retired editorial writer for the Virginia Pilot, Margaret Edds, wrote about the current impasse in Virginia two weeks ago. Drawing on her extensive command of Virginia’s history, Edds points out that Virginia was the last state to join Social Security in the 1930s.
She argues that there is a moral imperative that “we cannot afford to take this risk” of not expanding Medicaid. She writes that “designing a health care system that embraces everyone is the right thing to do.” Reston resident, Elliot Wicks, in a recent letter to the editor makes the same argument that closing the coverage gap morally is the right thing to do.
In an unprecedented move, the Virginia Chapter of the American Association of Retired People (AARP) called a press conference to announce that letters sent by the Speaker of the House and other Republican lawmakers to their constituents over age 60 contained “inaccurate information about changes in Medicare.”
These letters from Speaker Howell and other lawmakers implied that expanding Medicaid in Virginia would hurt Medicare beneficiaries. “Expanding Medicaid to uninsured Virginians won’t harm the Medicare program or its beneficiaries,” the AARP spokesperson said.
Revenues for the Commonwealth are expected to fall short of projection for this year by as much as $300 million. Ironically, Virginia is losing $5 million a day amounting now to three-fourths of a billion dollars paid by Virginians that could be returned to the state through Medicaid expansion. The money could not be used to balance the budget in the current year, but in future years more than $200 million that Virginia pays for indigent care from its general tax revenue could be paid by Medicaid.
State and local chambers of commerce, medical and healthcare associations, and editorial boards of the major newspapers in the state have endorsed Medicaid expansion. A major compromise in the form of Marketplace Virginia, proposed by three Republican senators and endorsed by all Democratic legislators, has been introduced. The compromise proposed in Marketplace Virginia addresses the Republicans’ stated concerns by including a provision to discontinue the program if the federal government reneges on its commitments.
It is time for Republicans in the House of Delegates to agree to the compromise. Their insistence on separating Medicaid from the state budget is a costly stalling tactic that is hurting a large number of Virginians and threatens to hurt even more if the budget stalemate continues.
While the players have changed — it’s now Senate Republicans resisting Medicaid expansion — the song remains the same.
Celebration of the first day of spring had to be delayed last week with a record-breaking spring snow fall. The unusually wet snow that clung to the trees and filled the branches of evergreens with a holiday-like cover was spectacular even with the inconveniences it brought with it. The earliest spring flowers have a way of surviving late season cold snaps and some snow. When the spring flowers emerge, they will be as beautiful as they always are even if a bit delayed.
Spring is not the only thing that is late this year. Completion of the state budget continues to be delayed, although a date has now been set for a special session; the special session will be held in the State Capitol on April 11. The immediate outcome of that session is predictable. The House and Senate will replace the budget that has been sent down by Governor Ralph Northam with the budgets each passed at the end of the regular session, each will reject the budget of the other, and we will send both budgets to a conference committee to resolve the differences.
The big spring snow of last week melted in a week to let spring emerge. It is difficult to envision the thaw that will happen to let a budget be adopted. The major difference is the Senate leadership’s refusal to agree to any form of Medicaid expansion regardless of facts or reason that are presented.
Recently The Commonwealth Institute found that Medicaid expansion in Virginia “would improve the lives of more than 118,000 women in the Commonwealth who are uninsured …Expanding Medicaid would not only save the state millions of dollars, it could save an invaluable number of women’s lives.” That is on top of the mound of evidence that has been presented already for the economic and quality of life advantages of Medicaid expansion.
More than 600 members of faith communities from throughout the Commonwealth have been advocating for the House version of the budget as it contains Medicaid expansion. Last week three former Republican members of the House of Delegates who among them have 60 years of combined experience in the legislature–Tom Rust, Joe May and Harvey Morgan–endorsed the House budget in a newspaper column: “The House budget proposal meets any common definition of conservative budgeting.
It is a Republican-led fiscal plan that makes responsible use of public resources. It funds core services and creates conditions for the private sector and general population to succeed and thrive, while limiting the reach and power of government…This is prudent budgeting in action. It deserves the support of every Virginian, officeholder or not, who professes to favor a responsible philosophy of government.” (Richmond Times Dispatch, March 21, 2018) I too support the House budget and am doing all I can to get it passed! It is a bipartisan effort.
If you would like to join the advocacy effort for Medicaid expansion, I invite you to go to virginiainterfaithcenter.organd look at the suggestions for your involvement. Act now to ensure that the legislature considers your position by April 11. In the meantime, enjoy the emerging spring!
Last week Democrats in the House of Delegates were able largely to sit on the sidelines as Republicans debated among themselves whether Virginia should expand access to medical care through the federal Medicaid program. Arguments that had been used by Democrats to support Medicaid in the past were now being used by Republicans to support their newly found support for expansion.
The news is good since Medicaid expansion could only come about with bipartisan support. When the final vote was taken on the issue, only 31 Republicans voted “nay” and all Democrats voting “aye” with 20 Republicans making the total for passage 69 votes. There was a sense of relief as a goal for which we had been working for more than a half dozen years moved closer to realization.
The news was not so good on the other side of the Capitol. The Senate passed a budget that did not include further Medicaid expansion. While there was an effort to amend the Senate bill to include the expansion of access to health care, it failed along a straight party line vote. Final passage of a budget for the next two years requires that the bills passed in each house be identical. A conference committee made up of House and Senate members must resolve the largest imbalance in the budget that I have ever seen before its final adoption.
If I had predicted before the session where we would be at this point I would have said that the Senate would have passed a version of Medicaid expansion but the Republicans in the House were maintaining their opposition. At least that’s what the public pronouncements and the rumor mill suggested.
How could we have been so wrong? I believe that the predictions on the outcome of the session left out one very important consideration: the results of the 2016 elections. The House’s 66 to 34 Republican control was diminished to a close margin of 51 to 49. For weeks it appeared that Democrats might take control. Among the losses were senior members and committee chairs who were opponents of Medicaid expansion and were expected to win re-election easily. The Speaker who opposed expansion retired.
The voters in 2016 sent a clear message that they supported Medicaid expansion. For most it simply did not make sense to leave more than ten billion federal dollars on the table when there were so many people without access to health care. Many more people went to the polls than usual to send the message to legislators. Whether it was public opinion polling or common sense that showed the Republican majority they were in trouble and needed to change the stance on issues, the public speaking through the ballot box brought about this very important change for Virginia.
How to explain the Senate vote? Senators with four-year terms have not been before the voters since 2014. They have not had a recent message from the electorate and could be in for a big surprise if they do not re-evaluate their positions. The real heroes in all this are the Indivisibles and other groups that mobilized voters in 2016 to elect responsive candidates. These new members are bringing balance to public policy as well as to the budget.
Virginia’s first governor, Patrick Henry, was elected to four one-year terms. Henry’s reputation as a leader was well established before he became governor with his famous “Give me liberty or give me death” speech made in St. John’s Church in Richmond before the Revolution.
Virginians honored his memory about a decade ago when the renovated Library of Virginia/Supreme Court building was named the Patrick Henry Building and became the office location for the governor and his staff and cabinet secretaries.
Henry would have been proud when one of the former reading rooms converted to a public meeting room was the scene last week of a press conference by Gov. Terry McAuliffe announcing his plan to expand Medicaid to the extent that he could within the constraints of the law.
Henry in his day railed against oppression and taxation without representation. McAuliffe spoke on behalf of Virginians who are paying billions of dollars in taxation while the legislature is refusing to act on a plan that would bring that money back to the Commonwealth to provide health insurance to the poorest working people.
I went to the Governor’s press conference last week as a way to demonstrate my support for the actions he is taking to expand Medicaid. Because of legal constraints, his plan is modest. It extends coverage to about 25,000 persons who do not have health insurance including 20,000 Virginians with serious mental illnesses.
The number eligible for health insurance under the federal programs is 400,000, but to reach that number requires an act of the legislature. In the meantime, the Governor has instituted a program to aggressively enroll eligible persons in the federal insurance marketplace.
“While the plan that I am announcing today will do a lot of good for a lot of people, it does not solve the larger problem of providing health insurance coverage to low-income Virginians,” the Governor said. “The General Assembly has made it perfectly clear that they unequivocally are the ones that have the power to expand and close the coverage gap. With that power also comes responsibility.”
The General Assembly is scheduled to go back into special session on Sept. 18 to discuss Medicaid expansion. Neither the Republican leadership that controls the House or the Senate’s Republican majority has indicated a willingness to approve any kind of expansion of health benefits. Rather, they continue to follow the direction of the Koch Brothers-financed Americans for Prosperity and their Tea Party constituents to refuse to accept anything related to what they call Obamacare.
The insanity of refusing to take $5 million a day of Virginia taxpayer monies while thousands go without insurance coverage defies a reasonable explanation.
As Governor McAuliffe clearly stated, it is up to the legislature. I bet Patrick Henry would have been even more forceful; we have taxation of Virginians to support health insurance programs in other states but not ourselves!
To learn more about the Affordable Care Act, sign up for a webinar at Innovate Virginia.
Ken Plum represents Reston in Virginia’s House of Delegates. The views and opinions expressed in this column are those of the author and do not necessarily reflect the views of Reston Now.
By the time you are reading this column, Virginia will have reached the milestone by having refused to accept a billion dollars of monies paid by Virginia taxpayers to close the coverage gap for 400,000 working poor Virginians who cannot afford health insurance. A $1,000,000,000 is a lot of money!
We got to this point by the Republican majority in the General Assembly refusing to pass a plan for Medicaid expansion that would bring more than $5 million dollars a day to the state, produce as many as 30,000 new jobs in the health care industry, insure as many as 400,000 of the working poor, and enhance the quality of life for Virginia’s workforce and their families.
What is the alternative proposed by the Republicans? Speaker of the House Howell was quoted last month as saying that House Republicans propose to help the uninsured through “free clinics and community health centers and through expanded hospital services.” Hospital representatives are saying that they need the Medicaid money in order to expand services. One hospital in the state has closed, and others report financial stress. The free clinic serving this region is reported to be in economic difficulties.
Last week, Stan Brock’s Remote Area Medical (RAM) set up its mobile clinic in Wise County, VA, as it has been doing one weekend a year for more than a decade. More than 1,000 people who do not have medical insurance or access to regular medical services show up and stand in line for hours to be seen by one or several of the more than a hundred medical care professionals who volunteer each year to run this free clinic. Brock, who achieved fame for his television series Wild Kingdom, has described health care needs and services in the Appalachian region that includes Southwest Virginia as being like that of a third-world country.
The General Assembly majority has been able to stymie efforts by the Governor to get a plan for Medicaid expansion approved. While the legislature is still in special session, it is not expected to meet again until Sept. 22. There is little optimism that there will be a change of heart on the part of Republicans as the national organization Americans for Prosperity threaten a primary challenge to anyone who breaks rank. Two senior Republican committee chairs were defeated in primaries in the last election cycle by Tea Party Republicans as was House Majority Leader Congressman Eric Cantor defeated this year. Unfortunately, the desire to keep one’s legislative seat seems stronger than the moral call to do the right thing and provide health care to people who need it.
The billion-dollar give-away is money paid by Virginians under the Affordable Care Act that goes to Washington and is not returned because of the legislature’s refusal to act. Write to your friends, family, and colleagues and encourage them to contact their legislators to support legislation that will keep $5 million a day that will add up to another billion dollars by early next year in the state for the benefit of Virginians.
Ken Plum represents Reston in Virginia’s House of Delegates
“Despite what you may have been reading on Republican blogs and some inaccurate press reports, I am not in Africa,” she wrote to Restonians in an e-mail and on Facebook Tuesday. “Today, I am in Reston. Yesterday, I was in Richmond working with other Senate negotiators on the budget. Thursday, I will be in the Capitol for a Senate Finance Committee meeting and the session.”
Howell, a senior member of the Senate Finance committee, is responding to a Richmond-Times Dispatch story that was picked up by other media outlets and blogs saying the state budget may not be passed before the July 1 deadline in part because she will be on a vacation in Africa until June 24.
The Virginia General Assembly has been at a budget impasse for three months. The July 1 deadline is important because the commonwealth may face a government shutdown or deep cuts in state aid if a budget is not adopted by then.
Howell, who has represented Reston for more than 20 years, said she had a long-planned trip with her granddaughter, but that trip will now be shortened to attend to the budget issue.
“I have had to shorten a trip with my granddaughter that has been planned for a year and a half in order to live up to my responsibilities as a senator,” Howell wrote. “When I ran for office, I made a commitment to the people in the 32nd District to actively represent them. I will always keep that commitment.”
The General Assembly’s budget standoff comes over Gov. Terry McAuliffe’s plan to expand Virginia Medicaid to 400,000 uninsured Virginians. Republicans are opposed to the idea because there is no longterm plan to fund it, which may leave the commonwealth paying the bill in the future.
On Monday, Sen. Philip Puckett (D-Russell), resigned his seat. That gives the Republicans a 20-19 edge in the Senate.
McAuliffe says Puckett’s resignation had created uncertainty for his plan.
“I am deeply disappointed by this news and the uncertainty it creates at a time when 400,000 Virginians are waiting for access to quality health care, especially those in Southwest Virginia,” McAuliffe said in a statement. “This situation is unacceptable, but the bipartisan majority in the Senate and I will continue to work hard to put Virginians first and find compromise on a budget that closes the coverage gap.”
He held a press conference in Richmond to announce the details of expanding the Remote Area Medical program in Virginia. RAM already sponsors a once-a-year health clinic in Wise County in Southwest Virginia where thousands come on a weekend for the only medical care they will receive all year. The expanded effort in Virginia will be headed by Dr. Vicki Weiss, who has been providing volunteer eye care with RAM for over 15 years. Also participating in the press conference was Dr. Teresa Gardiner who serves on the Health Wagon in the region that was featured on 60 Minutes recently.
Stan Brock started RAM in 1985 primarily to help people in South America who did not have access to health care, but as he explained at the press conference, he soon expanded to this country for the needs in Appalachia, Virginia, and other parts of the country are as great as any third world country.
Last year, RAM served nearly 2,000 people in Virginia, but with the expanded program “Stop the Suffering” over the next two years RAM expects to have a clinic within driving distance of everyone living in Appalachia. Stan Brock talked about “the people we do not see but whose health care needs in Virginia could not be greater” with no references to politics, ideology, or partisanship.
In contrast, there were several informational meetings on Medicaid expansion held last week in locations throughout the state, including one in nearby Ashburn. From talking to persons who attended the meeting and reading press accounts, I was struck by the sharp contrast with the press conference I had attended.
These “informational” meetings were sponsored by the Koch Brothers-funded Americans for Prosperity that is spending millions in the state to defeat what it disdainfully refers to as Obamacare. Invited to participate in these meetings were only delegates opposed to any expansion of Medicaid. The meetings focused on legislative maneuvering, constitutional issues and placing blame for the budget impasse. There was talk of a “clean budget.”
By separating the budget negotiations and the expansion of Medicaid, Americans for Prosperity and their legislative puppets hope to defeat expansion of Medicaid in the state. What wasn’t said is that separating Medicaid expansion from the budget would ignore 20 percent of current expenditures and the potential for five million dollars a day in revenue to serve those most in need of health insurance. Noticeably absent from the delegates were real-life references to the people in need of health care.
It is time for legislators in Richmond to stop talking politics and start listening to the people in need of health care and to those in the community who have health insurance but are concerned for the people who do not. The contrast is stark between those who want to wage a partisan ideological battle to deliver a defeat to the President and those who want to help people who desperately need health care.
That also means that expanding Medicaid in Virginia — one of Gov. Terry McAullife’s top priorities — remains in limbo as well.
McAuliffe and other Democrats, including Reston legislators Sen. Janet Howell and Del. Ken Plum, want a budget that includes accepting federal Medicaid funds to expand coverage to close to 500,000 additional residents.
But Republicans control the House of Delegates, and they oppose expansion. They say the federal government can’t be trusted to keep its promise to fully fund the expansion and the bill will eventually be paid by the state.
GOP lawmakers say public opinion backs their position that the budget should be passed immediately and the Medicaid issue should be considered separately.
Howell and Plum are hosting a community conversation on Medicaid expansion at 7:30 p.m. Tuesday at South Lakes High School.
The legislators will return to Richmond to resume budget talks next week.
“The refusal of the House Republicans to accept federal money to insure 400,000 working Virginians has brought everything to a halt,” Howell wrote in an email to constituents on Monday. “We are giving up $5 million a day in funds that we Virginians have paid in fees and taxes intended to provide healthcare coverage in Virginia.
“As a member of the Medicaid Innovation and Reform Commission (MIRC) and as a budget conferee, I have been actively involved in trying to find a solution,” Howell wrote, adding that her work on Marketplace Virginia has the support of “most Chambers of Commerce and business groups, hospitals, religious organizations, medical groups and editorial boards, as well as McAuliffe, Senate Democrats, some Senate Republicans, and virtually all House Democrats.
“The House Republicans, standing alone, have said “No!” They have offered no alternative. Because the funding involved is so significant and ripples through the whole budget, we cannot approve a budget until this is resolved,’ said Howell.
Meanwhile, McAuliffe has been touring the state to promote the benefits of Medicaid expansion.
Virginia ranked 48th in per capita Medicaid spending last year, according to state figures.
“This is too much money,” McAuliffe said at an appearance at a clinic in Wise, Va., last week, according to the Associated Press. He said a state budget estimate projects the Affordable Care Act with expanded Medicaid for 400,000 residents would save Virginia $1 billion by 2022.
If Virginia chooses not to expand Medicaid, thousands of Virginians will fall into a ‘no-coverage ravine’– unable to enroll in Medicaid and barred from getting tax credits to buy coverage in the new health insurance exchange, says a report from The Commonwealth Institute.
In addition, at least 400,000 working Virginians will continue to be uninsured.
The 2013 session of the General Assembly created the Medicaid Innovation and Reform Commission (MIRC) to consider whether reforms to Virginia’s Medicaid program were sufficient to allow Virginia to proceed with some form of coverage expansion through the Affordable Care Act. MIRC members have been assured by staff that all requested reforms have been made, but the Commission members from the House of Delegates have refused to acknowledge the reforms and continue along with the Speaker of the House of Delegates to oppose expansion of Medicaid.
For otherwise fiscal conservatives to turn down $5 million of Virginia taxpayer dollars being returned to them to pay the full cost of Medicaid expansion shows the continued animosity that some Republicans have toward the Affordable Care Act that they refer to as Obamacare. To the concern that the federal government will not be able to continue funding the program into the future, Virginia could make a decision to withdraw at that time.
At the same time, the Virginia Chamber of Commerce business plan for the Commonwealth, “Blueprint for Virginia,” supports the Medicaid reforms that have been made and recommends Medicaid expansion. Chamber leadership has termed Medicaid expansion to be both an economic development as well as a workforce issue. Most of Virginia’s one million uninsured residents are employed. It is projected that the expansion would create an estimated 33,000 jobs and bring $21 billion dollars back to the Commonwealth.
Gov. Terry McAuliffe is a staunch supporter of Medicaid expansion. As he stated to the Chamber, “Let me be clear on one point. If Medicaid expansion is not the business community’s number one priority in your communication with the General Assembly, it will not happen.” He calls for “coming together, putting old ideological differences aside and focusing on what makes sense from a business perspective.”
The case for Medicaid expansion goes beyond the strong business case; it is also a humanitarian cause. Social justice organizations, faith communities, and individuals need also to give priority to making their views known to legislators. Give priority to writing or calling House and Senate leadership and members of the House Appropriations and Senate Finance Committees and ask them to approve the expansion of Medicaid. Contact information is available at House and Senate members.
Five million dollars a day is a lot of money. It is too much to turn down, especially when it can improve the health and well-being of Virginians. Please make sure your voice is heard on this issue.
Ken Plum represents Reston in Virginia’s House of Delegates. He can be reached at [email protected].