Senior GOP legislator breaks with party on Medicaid expansion

Feb. 16--A senior House of Delegates Republican has broken with his caucus's staunch opposition to Medicaid expansion, but after a two-hour closed-door meeting, his colleagues were tight-lipped about their reaction or whether they would join him.

Del. Terry Kilgore, R-Gate City, chairman of the powerful Commerce and Labor Committee, says he would support expanding Medicaid by using Affordable Care Act dollars, with one key change not normally allowed by Washington.

He is the first House Republican to go public saying so, though some quietly hint that they're looking hard at it.

And GOP leaders who say they still oppose full Medicaid expansion, from House Appropriations Committee chairman Chris Jones, R-Suffolk, to Senate Majority Leader Thomas K. "Tommy" Norment Jr., R-James City County, and Senate Finance Committee co-chairman Emmett Hanger, R-Mount Solon, have all said the General Assembly needs to do something to expand low-income Virginians' access to health insurance.

Full Medicaid expansion, with the federal government picking up 94 percent of the bill, would mean insurance for some 300,000 Virginians with incomes less than 138 percent of the federal poverty level -- for a single person, that cutoff is $16,642 a year.

For the past five years, House Republicans have said they oppose full expansion, citing a variety of concerns including the cost of the state share of that bill to worries that Obamacare would collapse and funds wouldn't be available in the future. Some feel it is wrong to give a taxpayer-funded benefit to able-bodied adults.

Del. David Yancey, R-Newport News, has tried to address his fellow Republicans' worries about finances with two highly technical bills that have stalled. Yancey, who worries about finding money for Newport News' aging schools, has been saying some expansion of Medicaid could draw federal money that would free up state funds used for other health programs, making those funds available for other critical state needs like education.

In southwest Virginia, the economically hard-hit region Kilgore represents, the opioid crisis and the need to improve health care have led legislators there there to rethink their opposition to Medicaid expansion.

"I think this is the time," Kilgore said, several hours before the caucus meeting.

Kilgore, who earlier in the day joked that he wasn't sure if he was in trouble with Republican caucus leaders, would not comment when asked about the caucus' discussion Thursday afternoon. Majority Leader Todd Gilbert, R-Shenandoah County, also declined to comment.

"Speaker (Kirk) Cox respects Del. Kilgore's decision to publicly support a form of Medicaid expansion," spokesman Parker Slaybaugh said.

Slaybaugh would not say whether the caucus had reached any new decision about a common stance on the issue, or even whether Kilgore's new position was debated.

Cox has been talking about health-care coverage access with Gov. Ralph Northam, who has called for Medicaid expansion, Slaybaugh said.

The speaker has said he would like to see any agreement on access to health-care coverage include a work requirement for those able, and for Medicaid beneficiaries to contribute to the cost of their care, through co-payments, for instance.

Cox wants the state to secure a federal waiver to allow those measures, since Washington's Medicaid regulations currently do not allow them.

In addition, Cox wants to see incentives to encourage healthy behavior, tough fraud prevention measures and a promise that people added under any Medicaid expansion would be removed if federal support fell below 90 percent.

Kilgore announced his support for Medicaid expansion in an op-ed essay in The Roanoke Times.

"Too many Southwest Virginia families struggle for access to health care often out-of-reach due to cost. As a result, preventable health concerns often become serious problems causing employees to miss work and families to suffer even greater financial strain," he wrote. "It is time to act."

In his essay, he said Kentucky had shown a way forward by enacting a work requirement for able-bodied adults covered by Medicaid.

"This model is a path forward, and one we can support," he wrote.

Kilgore said any Medicaid expansion would have to have an escape hatch in case the work requirement didn't work or costs ballooned.

Figuring out what to do about Medicaid now falls to the House Appropriations and Senate Finance Committees, which are considering changes to the final budget for the next two years. Former Gov. Terry McAuliffe proposed that budget in the final weeks of his term, and it relies on full Medicaid expansion using Obamacare dollars to free up funds for other critical state needs.

Kilgore said he had not floated the idea with Jones.

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

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