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Not the time to be pushing Medicaid growth

healthcareVirginia politics, into June, was embroiled in a political stalemate over expanding Medicaid, a top campaign priority of the new governor, Terry McAuliffe.

The stalemate only broke when a Democratic state senator, Phil Puckett, suddenly resigned, citing another logjam involving judicial appointments that just happened to also keep a pending appointment for his daughter to a state judgeship on hold. (And then there was the issue of whether or not Puckett was also offered a job on a state commissioned control by Republicans as part of a quid pro quo. Not sure where that one stands, though we probably haven’t heard the last on it.)

Until the Puckett switch in time, McAuliffe seemed to have the upper hand in the dispute. Absent action by the General Assembly, McAuliffe was making the claim that he could act unilaterally to expand the state’s Medicaid rolls, pulling in federal dollars available through the Affordable Care Act to do so.

Not long after the stalemate broke, we started getting word that state finances weren’t quite what we’d been expecting them to be. In early July, in fact, it was revealed that the state was facing a $438 million shortfall in general fund collections, which analysts in the administration are blaming on the lingering effects of federal government fiscal-cliff discussions in 2012 and 2013.

Whatever the cause, the numbers are off, with revenues down 1.6 percent in fiscal-year 2014, well behind the forecast 1.0 percent growth that budget writers had been working from.

Getting back to Medicaid expansion, then, how can we look at something that will push our spending upward when we have less money coming in, and have to anticipate that things are going to remain tight for the foreseeable future?

No question we’re leaving money on the table under ACA; no question that hundreds of thousands of Virginians left on the outside looking in as far as healthcare coverage will continue to be.

No question, as well, that hospitals across the state are left holding the bag, as are private individuals and taxpayers who have to pay more as a result and receive less in the way of services as the system crumbles under the weight of mandated responsibilities to provide care and fiscal responsibilities to make their own ends meet.

A solution is to look at tax increases, revenue enhancements, however you want to term them, ways to get more money flowing into the state coffers. The voters of this Commonwealth, like voters nationwide, continue to split representation at the various levels of government, with Virginia mirroring right now the split in Washington, with a Democratic-controlled executive branch and a Republican-controlled legislature.

(I’m presuming, like many other analysts are right now, that Republicans will take control of the U.S. Senate in November. The writing is on the wall there.)

Our split-personality voters have given us a split-personality government, with executives who feel they have a mandate to push for growth in healthcare coverage, education, business development and other areas, and legislatures controlling the checkbook who don’t want to spend money on much of anything.

And therein lies our dilemma. We have less money coming in than we’d projected, we have an executive branch and legislative branch that can’t agree most days on what day it is even is, much less seeing areas for possible agreement on anything substantive, and we have this push to add more to the plate for the government and for taxpayers with no sense of how we can pay the bills.

This is no time to be pushing Medicaid growth, unfortunately, though that time needs to come soon.

– Column by Chris Graham