Health insurance reform heads back to governor

April 18--State Senate votes on health insurance reform left Gov. Ralph Northam with a big stick to end Virginia's budget impasse, but it is unclear if he will wield it.

In mainly party-line votes Wednesday, senators rejected Northam's requests for delay in enacting four measures that Senate Republicans say would help Virginians cope with the soaring prices of Affordable Care Act insurance policies.

The vote means lower cost policies could be available later this year -- unless Northam vetoes the measures, as the Senate rejection of his amendments now allows him to do. His amendments called for a second vote before the bills took effect and for a study group to tackle health insurance challenges in Virginia.

Senate Republicans have argued the four measures all tackle a health insurance gap they feel as strongly about as Northam does about Medicaid expansion to cover 300,000 low-income Virginians. The four Senate bills would make lower cost short-term and catastrophic coverage more available and allow associations to buy lower cost coverage for members.

"Let's address the No. 1 issue that is on our constituents' minds," said state Sen. Frank Wagner, R-Virginia Beach, who is one of two Senate Republicans who has gone public saying he might support Medicaid expansion if the state could also tackle the soaring premiums Virginians buying Obamacare individual coverage now face.

He said there was no reason to delay. Neither he nor any other Senate Republican voted for Northam's amendments.

"The governor is saying 'let's look at the market comprehensively,'" replied state Sen. Barbara Favola, D-Arlington, adding: "I'd point out that states that enjoyed the lowest rate increase are states that enacted Medicaid expansion."

But that sounded like playing politics to State Sen. Siobhan Dunnavant, R-Henrico, who sponsored two of the bills Northam wanted to amend.

"This is not about Medicaid expansion," she fired back at Favola.

Rejection of the governor's amendment leaves open the threat of a veto of the health reform bills, but "I don't expect there to be any gamesmanship," said Senate Majority Leader Thomas K. "Tommy" Norment Jr., R-James City.

While the amendments may have been intended as a feeler to Senate Republicans like Wagner who have linked possible support for Medicaid to efforts to bring down the cost of Obamacare insurance policies, Norment said Wednesday's vote would not affect efforts to resolve the standoff between the House and Senate over the budget one way or the other.

The House and Senate have approved radically different positions on the budget, all turning on the question of using $3 billion of federal Affordable Care Act money and a new tax on hospitals to cover some 300,000 low-income Virginians through Medicaid

The House's approach -- endorsed again on Tuesday -- would shift to Medicaid some $370 million of costs that currently fall entirely on state taxpayers, mainly for mental health and medical care for the indigent and for prisoners. That in turn freed those funds for politically popular spending, including 2 percent raises for teachers and state employees in fiscal year 2020. The Senate rejected Medicaid expansion during the regular session which meant its budget included none of the additional spending the House wanted.

Norment said he is confident the House and Senate will agree on a budget before June 30. If there is no budget by then, the state government must shut down, since Virginia governors, unlike those in some other states, don't have power to spend money if the legislature has not approved a budget.

There was no immediate reaction to the amendment rejections from Northam.

"The governor will review the bill when it returns to him and we'll announce his actions when he takes them," spokesman Brian Coy said.

Northam did not use a veto threat on Norment's top legislative priority -- a sales tax surcharge for the Historic Triangle -- to wrangle concessions on Medicaid expansion, despite talk inside Capitol Square and in the community that a deal was in the works. Instead, he proposed an amendment, based on a suggestion Norment brought him that originated with James City County supervisor John McGlennon, a Democrat, that the surcharge not be applied to groceries. Norment supported the change, and so did the Senate and House.

As expected, the General Assembly did not override Northam's vetoes of several bills, including one that aimed at keeping so-called sanctuary cities from declining to cooperate with federal immigration officials. There are no sanctuary cities in Virginia -- but they have emerged on campaign flyers in recent years, including in attacks on Northam last year.

The Senate sustained Northam's veto of a bill requiring state investigation when the number of registered voters in a locality exceeds the official count of residents older than 18 years old, a pattern that can emerge in college towns.

The House sustained his veto of bills that barred the state from participating in a regional cap-and-trade program for greenhouse gases, a measure that would allow the General Assembly to change legislative district lines more often than once a decade after a census, and also one that would shield franchisees from union agreements negotiated by nationwide franchise operations, such as fast food restaurants.

Ress can be reached by telephone at 757-247-4535

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