After ACA repeal fails, McAuliffe renews Medicaid expansion push

March 28--Following a GOP failure to repeal Obamacare, Gov. Terry McAuliffe said Monday he will again push Medicaid expansion in Virginia, an effort Republican leaders have declared dead on arrival for the umpteenth time but which will no doubt figure into coming state elections.

McAuliffe said he wants to amend the state budget passed during the recent legislative session to restore language allowing him to expand the insurance program to cover hundreds of thousands of poor and uninsured Virginians. He said Virginia sacrifices some $6.6 million a day in federal health care funding because it never expanded Medicaid, which was an important element of the now 7-year-old Affordable Care Act, also known as Obamacare.

"There are no excuses anymore," McAuliffe said, pointing to Friday's collapsed congressional effort to repeal the ACA. "I mean, we're done."

The political math in Virginia has not changed, though. McAuliffe's amendment and the underlying budget will go back before the House of Delegates during the April 5 reconvened session, and Republicans hold 66 of 100 the House's seats.

"The House will reject the governor's amendment when we reconvene on April 5 and ensure that Virginia does not expand Medicaid under Obamacare," House leadership said Monday in a joint statement.

Virginia's

The office of the Secretary of Health and Human Resources released a summary of the analysis to The Associated Press...

Virginia's Medicaid program stands to lose $1.8 billion over a six-year span under House Republicans' plan to overhaul the nation's health care system, a state analysis has found.

The office of the Secretary of Health and Human Resources released a summary of the analysis to The Associated Press...

If the House votes as promised, the issue won't even make it to the state Senate, where the split is 21-20 in favor of Republicans and past expansion proposals have shown signs of life.

McAuliffe, a Democrat, said he hoped Republican leaders would reconsider their stance now that it's clear the ACA will remain in place. Past concerns that the ACA's guarantee of at least 90 percent federal funding would be cut by Congress should be set aside, he said, after acknowledgments from President Donald Trump and Speaker of the House Paul Ryan that the ACA won't be repealed.

Virginia Republicans continued preaching caution Monday.

"The uncertainty of federal health policy underscores the need to be cautious over the long term," Speaker of the House William Howell and other members of the House leadership team said in their statement. "This is a very complex issue with many moving parts. It would be irresponsible to rush Medicaid expansion like Congress rushed Obamacare."

Virginia's current Medicaid program works off a 50-50 split between state and federal funding, providing health care to about 1.3 million people at a cost of about $8 billion a year. Most of that provides care to senior citizens and people with disabilities and Virginia's thresholds to qualify for Medicaid are among the nation's strictest.

McAuliffe reiterated Monday that Virginia is at a competitive disadvantage compared with states, including those with Republican leadership, that have already expanded Medicaid. He predicted more will expand now that the repeal effort has failed.

Without expansion, people who make too much money to be covered by regular Medicaid but too little to qualify for federal subsidies to help them purchase insurance through ACA exchanges fall into an uninsured loophole. McAuliffe makes both a moral and an economic case for expansion, wondering what it would mean for Virginia's economy to have more than $2 billion a year in federal expansion money pumping through its health care systems.

House Republican leaders said nearly every state that expanded Medicaid saw higher than projected enrollment and, in some cases, large budget deficits. Every dollar spent on Medicaid is one less for education, transportation and public safety, they said.

"Every federal dollar not spent on expanding a broken program is a dollar not borrowed from future generations," House Republicans said in their statement.

McAuliffe said Monday, as he has before, that expansion can be structured so that it doesn't cost the state any money. That's partly because expansion would free up money elsewhere in the state budget, starting with money spent reimbursing hospitals for indigent care.

McAuliffe and Secretary of Health and Human Resources Bill Hazel, who held the same position under Republican Gov. Bob McDonnell, also pushed back against Trump's claim that Obamacare will explode under its own shaky financial weight.

"It will not," Hazel said.

"Fake news," McAuliffe said.

McAuliffe has backed Medicaid expansion each year of his term, but the fight quieted down after his first year, which featured a concerted public relations campaign to convince Republicans to expand. When the the GOP majority held fast, the fight faded into the background, with McAuliffe putting expansion into his budget proposals and legislative budget writers stripping it out in an obligatory back-and-forth.

McAuliffe said he has no illusions about the chances his latest gambit has for success. He said he met with Howell, R-Stafford, before he even took office and that Howell promised expansion would never pass.

"That doesn't mean that you don't try," McAuliffe said. "I believe in the marrow of my bones this is the right thing morally and financially for the commonwealth of Virginia."

Fain can be reached by phone at 757-525-1759.

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