Virginia Legislature Sends Medicaid Expansion To Governor’s Desk

FALLS CHURCH, VA - OCTOBER 31: Ana Elsy Ramirez Diaz holds her son, Milan Rojas Ramirez as he is seen by Dr. Margaret-Anne Fernandez during a check-up visit at INOVA Cares Clinic for Children on Tuesday October 31, 2017 in Falls Church. A portion of the clinic's patients are insured through the Children's Health Insurance Program. (Photo by Matt McClain/The Washington Post via Getty Images)
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After years of political battles and weeks of procedural delays, the Virginia House and Senate voted Wednesday to expand Medicaid to cover between 300,000 and 400,000 more low-income residents.

Four Republicans joined every Senate Democrat in voting for the expansion Wednesday afternoon. Later Wednesday evening, the House followed suite, passing a multi-year budget including the expansion by an overwhelming majority. Last-minute lobbying against expansion by Trump administration officials, former Sen. Rick Santorum (R-PA) and the Koch brothers’ group Americans for Prosperity was not successful.

When the bill is signed into law, as expected later this week, Virginia will join 33 states and the District of Columbia in expanding Medicaid under the Affordable Care Act — though Maine is currently fighting the expansion’s implementation.

Virginia State Sen. Emmett Hanger Jr. (R), the sponsor of the Medicaid expansion amendment whose support got the measure over the finish line, appealed to his colleagues Wednesday in a drawn-out, heated floor debate to vote yes.

“We have the ability to move something through that’s very sure in these uncertain times,” he said. “We can develop a uniquely Virginia plan. While it draws from the experience of many states that have been out there before us, it will serve our citizens.”

Now, the state’s House of Delegates has to vote to adopt the Senate bill or go to conference to resolve the differences between the two chambers, something that could happen within the next few days. Gov. Ralph Northam (D), elected last November in a “blue wave” election in which Medicaid expansion was a key campaign issue, has vowed to sign it into law.

The Affordable Care Act originally required states to expand their Medicaid programs to cover people with incomes up to 138 percent of the federal poverty line. But the Supreme Court later said the expansion must optional, not mandatory. Dozens of states, the majority of them Republican-controlled, refused to expand, including Virginia under then-Gov. Robert McDonnell (R).

More recently, a snag in the long, largely partisan battle over expansion has been the question of work requirements in the Medicaid program — a key priority of the Trump administration that is currently being challenged in federal court.

Virginia Republicans complained on the Senate floor Wednesday afternoon that the expansion bill’s work requirement wouldn’t be fully enforced until 2020, calling it a “work suggestion” that “isn’t remotely conservative.” Many Democrats, meanwhile, feel the law is too restrictive, and may deny health insurance both to those who are working and can’t document their hours and those unable to find work.

Delegate Alfonso Lopez, the chamber’s Democratic whip responsible for counting votes, told TPM Wednesday morning that work requirements were a pill Democrats were willing to swallow to get the long-sought expansion over the finish line.

“There are so many exceptions [to the work requirement] that you’re looking at a very small number of people that would be affected,” Lopez told TPM. “So even if we have closer to 310,000 people covered under this version rather than the 400,000 we originally wanted, that’s still a huge step in the right direction and something we’re perfectly willing to compromise on. I’m okay getting 310,000 people covered who didn’t have coverage before.”

“These are working Virginians who don’t have health care, who if they get sick or have an accident are devastated financially,” Lopez added. “I represent parts of Arlington and Fairfax counties, and out of all 100 delegate districts, there are in my district the fourth-highest number of folks who would benefit from expansion. So this would mean a great deal to me.”

One of the uniquely Virginian pieces of the Medicaid expansion bill that passed Wednesday is a tax on the revenue of hospitals and other medical providers. Many hospitals have actually been vocally in favor of the tax, noting that they are primed to get an influx of billions of dollars in federal funding as well as hundreds of thousands of newly-insured patients as part of of the expansion. Currently, many Virginia hospitals are losing money providing for many uninsured people across the state.

“Increased uncompensated care and federal funding cuts necessitate the exploration of even the previously unthinkable,” Virginia Hospital and Healthcare Association CEO Sean Connaughton said. “The status quo is unsustainable.”

Lopez touted the support of the medical industry on Wednesday, and told TPM that the Medicaid expansion will help both the hospitals and their surrounding communities.

“This is an economic development issue,” he said. “What CEO is going to move a factory or facility to Lee County knowing full well that if their workers get sick, the closest hospital might be 75 miles away in West Virginia, where they already expanded Medicaid? And think of all the businesses that rely on a hospital, that get harmed when it closes. So it makes economic as well as moral sense to expand Medicaid.”

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