Senate finally moves forward with Medicaid expansion

healthcareThe Senate of Virginia finally listened to the people of Virginia, voting 23-17 on Wednesday to pass a two-year state budget that includes funding for Medicaid expansion that will cover 400,000 low-income residents.

The House of Delegates will still have to take action on the measure passed by the Senate. The House had voted 68-32 earlier this year to back a similar budget bill expanding Medicaid.

Virginia joins 32 states and the District of Columbia in expanding its Medicaid system under the terms of the Affordable Care Act, which calls for benefits to be made available to anyone earning up to 133 percent of the federal poverty level, or $16,750 a year for an individual or $28,700 for a family of three.

The current Medicaid system in Virginia, one of the more restrictive in the nation, prevents able-bodied single individuals from qualifying for benefits, and sets the upper income limit for a disabled individual at $9,700 a year, and for a family of three at $6,900.

The current program covers 1 million people, so adding another 400,000 to the rolls will be a significant increase, at 40 percent.

The federal government, under ACA, provides a floor of 90 percent of the funding for the expansion, a tab expected to reach $2 billion a year in Virginia.

The issue with expansion was, as most things are these days, largely political. ACA was passed by a Democratic Congress, signed into law by then-President Barack Obama, and was christened ObamaCare by Republicans dead-set on using healthcare reform as an odd wedge with voters heading into the 2012 election cycle.

It didn’t work to keep Obama from winning a second term, but Virginia Republicans kept the fight going anyway, blocking four years of efforts from former governor Terry McAuliffe, a Democrat who had made Medicaid expansion a centerpiece of his 2013 campaign, citing fears that the federal government would eventually cut its funding and leave states on the hook for having expanded their Medicaid programs.

You’re supposed to pretend that you don’t know it would be a Republican effort in Congress that would gut funding, and that you’re not aware of the concept of self-fulfilling prophecy, so that you can play along there.

The current governor, Ralph Northam, also a Democrat, vowed to continue the fight for Medicaid expansion, and had in his political arsenal something that McAuliffe could only have wished for. Democrats had held only 34 seats in the 100-member legislative body going into the 2017 election cycle, but started 2018 with 49, with only a couple of near-misses keeping them from winning a majority.

That’s why the House voted for a budget with funding for Medicaid expansion. The Senate, with a bare 21-19 majority for Republicans, didn’t go before the voters in 2017, which is ostensibly why the GOP caucus there played the deliberations a little more hardcore.

The end result will reflect compromise in the form of work requirements pushed for by Republicans that will ultimately add a layer of bureaucracy and thus more costs to the expansion.

You’d like to say that Republicans have a hard time getting out of their own way on these kinds of things, but we can keep it positive and just say that they had enough sense this time around to get out of the way of the will of the people, and that, bottom line, in the end, hundreds of thousands of Virginians currently without healthcare coverage will be left exposed no more.

And you thought elections didn’t matter.

Column by Chris Graham


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