General Assembly Republicans have capitulated on the issue of Medicaid expansion. All that remains to be decided is the terms of their surrender.
Speaker of the House M. Kirkland Cox, R-Colonial Heights, has signaled his willingness to “dialogue” with Governor Ralph Northam about Medicaid expansion if the Governor is willing to accept the condition that would require able-bodied recipients to work or be actively seeking employment.
Wrote Cox to the Governor in a letter that House leadership distributed publicly:
The House is willing to begin a dialogue on health care that includes significant reforms and strong taxpayer safeguards, but I want to be clear that the 51-member House Republican Caucus has taken a binding caucus position against ‘straightforward’ Medicaid expansion.
If your position is to pass straightforward Medicaid expansion without work requirements or other reforms, then you will be responsible for the failure to provide health care coverage to more Virginians.
Republican bills, reports the Richmond Times-Dispatch, also would require periodic checks of the recipients’ household income, and would include exemptions for adults attending college, acting as sole caregivers for children under six, receiving long-term disability benefits or otherwise proved to be “physically or mentally unable to work.”
A spokesman said Northam was “encouraged” that Republicans were willing to begin discussion about Medicaid expansion but not happy with Cox’s proposed restrictions.
Bacon’s bottom line: Republicans have held the line against Medicaid expansion on fiscal grounds for four years. It’s difficult to imagine any explanation for the about-face other than fear and trembling over the 2017 election results, which came within a frog’s eyelash of evicting the Republicans from control of the House of Delegates. Cox has caved on the expansion and now he’s bargaining over the fine print. It will be exceedingly difficult politically for him to backtrack.
But Medicaid expansion still will be bedeviled with the same problems that afflicted it when former Governor Terry McAuliffe was pushing for it.
Even with the federal government funding 90% of the budget for expansion, Medicaid expansion still will cost Virginia nearly $190 million a year more by 2022, according to the Heritage Foundation, putting the squeeze on other budget priorities. All for what? Yes, expansion will provide “insurance” to more poor and near-poor people. But what quality of coverage will they receive? Will Medicaid expansion help them find a doctor in a country plagued with primary care physician shortages, or will recipients continue to clog emergency rooms? And who benefits financially? The patients themselves — or the hospitals that will see a great reduction in the treatment costs they have to write off as charity or uncompensated care? Will legislation expanding Medicaid ask anything of the hospitals, many of which, like Scrooge McDuck, are rolling around in piles of money? Or will they just fatten their profit margins? Finally, is there any evidence that Medicaid recipients’ health will improve? Or will physicians dish out more painkiller prescriptions, as is said to be the case in other states, and risk aggravating the opioid epidemic?
If past is prelude, it really doesn’t matter if Medicaid expansion actually helps anyone. People are suffering, and people want to “do something” — regardless of what it costs or whether it works.