Behind Virginias Medicaid fight lurk roads, politics By Julian Walker The Virginian-Pilot © April 5, 2014 The Virginia General Assembly’s Medicaid fight isn’t really about health care. It’s about transportation. And bare-knuckle politics. As much as Republicans oppose expanding the program to more low-income Virginians, an equally powerful motivation is keeping control of caucuses and like-minded constituents. Holding the line on Medicaid allows the GOP’s House of Delegates and Senate leaders to atone for, or distract from, conservative anger caused last year when taxes were raised to pay for new roads. “A good number feel that way – to reassure the folks that last year was a necessity, we’re going to stop Medicaid this year,” said one Republican legislator, speaking on the condition of anonymity. Although Democrats control the Senate and the Governor’s Mansion, Republicans wield outsize influence in the budget-shaping process because of how they set up themselves, and Democrats, last year. At that time, Democrats wanted a transportation deal. So did Republican Gov. Bob McDonnell, who sought a legacy-capping achievement in his final year. Many Democrats represent Virginia’s most populous, traffic-jammed regions in the “urban crescent” spanning Northern Virginia, Richmond and Hampton Roads. For years, they had pushed for new taxes – whether on gasoline or other transactions – to raise road money. They also wanted a path to Medicaid expansion, a central element of President Barack Obama’s Affordable Care Act. Both were on the table during the 2013 General Assembly session. Democrats used the transportation bill as a bargaining chip with McDonnell in the session’s final days in late February: They threatened to withhold support from transportation legislation unless the governor agreed to let Medicaid expansion language survive in the budget. McDonnell’s commitment to the transportation bill sealed a compromise. The transportation bill was approved with GOP support, over objections from fiscal conservatives, and a new state Medicaid panel was created. The Medicaid Innovation and Reform Commission, with 10 voting members, emerged with a three-phase mandate to seek cost-control reforms for Virginia’s Medicaid program. It was empowered to help expansion move forward. Democrats said it paved the way for as many as 400,000 low-income Virginians to become eligible for Medicaid. “We have put Virginia on a clear path to expanding Medicaid,” Sen. Janet Howell, D-Fairfax County, said. The next day, House Republicans named to the Medicaid panel doused that optimism. “I have serious concerns about the costs of Medicaid expansion,” said Del. Jimmie Massie, R-Henrico, who lobbied for reforms first to ensure Virginia isn’t left with a “big bill … when the federal government breaks its promise to pay. I have been around long enough to know there is no such thing as free money from the federal government and no such thing as a bigger program that costs less and works better.” More than a year later, divided partisans on the Medicaid panel haven’t agreed to proceed toward expansion, and the General Assembly is at loggerheads. Expansion, to Gov. Terry McAuliffe and fellow Democrats, is the morally and fiscally sound choice. They seek expansion as a condition of approving a budget. Republicans say Democrats are risking a state government shutdown over a policy debate that shouldn’t be part of budget talks. The Medicaid debate fits in budget negotiations, Democrats say, because the state’s health care programs for low-income residents are part of its fiscal plan. Democrats’ options are limited now because Republicans legislated via the budget last year, enshrining the Medicaid panel in the state code, so it endures after the two-year budget expires June 30. That same section of the budget is where a bipartisan Senate majority has proposed inserting the “Marketplace Virginia” private-option expansion alternative that’s been rejected in the House. The Republicans’ statutory change inhibits McAuliffe’s ability to unilaterally proceed with expansion. “There’s no doubt the Senate feels like they got a number done on them,” said one legislative Republican familiar with last year’s negotiations. The lawmaker disputes the idea that Democrats got a raw deal but concedes, “if I was in their position, looking back at it, I might have buyer’s remorse.” Several Republican lawmakers believe there are 10 to 20 members of the House GOP caucus open to voting for a Medicaid expansion plan. The enmity over the transportation vote wasn’t apparent until June 11, when veteran Republican Dels. Joe May and Beverly Sherwood lost primary elections from challengers on the right. While both voted for new transportation taxes, Sherwood’s defeat by Mark Berg in a Winchester-area district was the one that sent shockwaves through the GOP. Sherwood had a conservative voting record. She was a budget negotiator. Her loss invigorated a conservative insurgency, one whose members nearly attempted a coup of House Speaker William Howell, who sponsored 2013’s transportation bill, a few months back. Howell, R-Stafford County, has never faced a formal challenge for leadership since becoming speaker in 2003. But Republican sources say he came within an hour of one in November when the House GOP caucus met. Rockbridge County Del. Ben Cline was the purported challenger, with support from Berg and Del Bob Marshall, R-Prince William County. Berg did not return a message seeking comment, and Marshall would say only: “One thing about me is I don’t mind getting in fights, and it doesn’t matter with whom.” What’s clear now, said Cline, who declined to comment on the reputed challenge, is that the sometimes fractious House GOP is unified on this issue: “Right now we’re working together in opposition to Medicaid expansion. And I’m very supportive of the leadership’s current efforts.” Julian Walker, 804-697-1564, julian.walker@pilotonline
Posted on: Sat, 05 Apr 2014 17:56:58 +0000
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