Medicaid expansion is coming to Virginia. All legislators are dickering over now is their price for making it so.
Sen. Frank Wagner (R-Virginia Beach) said he’s willing to expand Medicaid if his conditions are met.
Meanwhile, Sen. Emmett Hanger (R-Augusta) stiffened his support for expansion. In an op-ed, Hanger wrote he had “no intentions of voting for a final budget that does not include a plan to access the additional dollars that are available to us currently under Medicaid.”
Let’s add to the mix Sen. Jill Vogel (R-Fauquier), the GOP’s lieutenant governor nominee in 2017, who hasn’t ruled out voting for expansion.
And for good measure, we can add a weekend op-ed from former senator Jeff McWaters, who wrote that once congressional Republicans failed to repeal Obamacare, Virginia Republicans had little choice but to draft an expansion plan of their own.
Even with all these cracks in the Republican façade, Senate Republicans insist they will prevail in the expansion fight.
The Senate Republican leadership’s press release on Wagner’s proposal shows they’ve already lost.
They call Wagner’s plan “well-intentioned” but “neither well-conceived nor well-designed.”
That’s a gentlemanly way of casting shade and admitting he’s left the anti-expansion fold.
But one of the biggest outside players in the Medicaid debate, the Virginia Hospital and Healthcare Association, isn’t ruling out Wagner’s idea.
Julian Walker, the group’s vice president of communications, told me Wagner’s proposal “identified a critical issue facing Virginia families and businesses today – the ever escalating growth in health insurance premiums.”
“This is a true kitchen table, quality-of-life issue for Virginians,” Walker said.
Walker argues the data show the big cost drivers aren’t doctors or hospitals, but individual health insurance premiums, which he said have risen “between 34 percent and 81 percent.”
“We look forward to working with Senator Wagner to address this incongruity,” Walker said.
Perhaps more importantly, especially to someone like Hanger who has staunchly opposed assessing hospitals to help pay for the state’s share of Medicaid expansion, Walker said that while the VHHA has “traditionally opposed the provider assessment concept, Virginia’s hospital community is willing to consider an assessment in an effort to support a compromise on coverage expansion.”
That’s a big deal. But it is also not a blank check legislators could use to fund whatever sort of programs they wish:
“It is imperative, however that statutory protections be in place to ensure that money raised from such an assessment is used solely for Medicaid reimbursement and rate improvement,” Walker said.
So once again, the discussion has moved from not expanding Medicaid at all to what expansion will look like and who will pay for it.
Others backing the Senate leadership, including Americans for Prosperity, will still mobilize their members to pressure lawmakers to stand firm against expansion.
They are fighting expansion as if Barack Obama and Terry McAuliffe were still in office.
Their hopes of winning were dashed when Democrats flattened Republicans in Virginia’s 2017 elections.
They may still hold some hope of resetting the battlefield in 2019, mounting primary challenges to Republican lawmakers backing expansion.
Given the death of the incumbent protection act, it is conceivable the anti-expansionists could do well and put forward a slate of new faces.
If the upcoming special session delivers Medicaid expansion, those new faces will be running to repeal expansion.
In a state where Democrats are ascendant, and Trump animus is likely to be on the upswing in advance of the 2020 presidential election, a repeal platform will result in catastrophic failure.
Republicans could also accept political reality and try to forge the most palatable Medicaid expansion deal they can get. And then move on.
And if it’s any comfort at all, they can think of such a deal this way: It tweaks their old nemesis McAuliffe, who wanted but couldn’t get expansion.
The Macker will love having to explain that one to prospective presidential primary voters.