Last Thursday, the General Assembly took the next major step toward adopting Virginia's biennial budget. The process includes the House and Senate voting to approve their versions of the budget. Each body rejects the budget of the other (usually with an audible "grrrr") so that they can be placed into conference committee. Then the conferees go to work to iron out the differences and present a final budget for an up or down vote.
For the last few years, there have been relatively minor differences between the House and Senate versions of the budget. Not so this year as the House finally included expansion of Medicaid as authorized under the federal
Affordable Care Act (ACA)
. The ACA is designed to encourage states to expand Medicaid to cover those with incomes up to 138% of the federal poverty level ($16,643 per year for an individual and
$28,180 per year for a family of three)
. These individuals and families are caught in a catch-22. They make too much to be eligible for traditional Medicaid, but they do not earn enough to afford private health insurance. As an incentive, the federal government pays for 90% of the cost of expansion, where traditional Medicaid is a 50-50 cost share program.
Virginians already pay for the cost of Medicaid expansion in the form of federal taxes regardless of whether we expand or not.
Almost no one disputes that the problem is very real. According to the Virginia Health Care Foundation, 10.7% of Virginians under age 65 are without medical insurance. The vast majority (77.5%) are part of working families. These uninsured individuals have a higher likelihood of being diagnosed with late-stage cancer and are more likely to have preventable hospitalizations. They are also more likely to end up with debilitating debt due to an unexpected medical crisis. Much of the cost is ultimately passed on to the rest of us in the form of higher premiums.
Many arguments have been made for not expanding Medicaid. However, that hesitancy started to crumble when several members of Republican House leadership, including those representing the most economically distressed regions of Virginia, came out in favor of expansion. Their rationale? In addition to covering almost 400,000 low-income Virginians, expansion would free up about $422 million in Virginia's budget since federal money would supplant state money for many existing health care services. Timing is also key. Expanding under the current administration would make it more likely that Medicaid reforms espoused by many Republicans would be approved.
One of these reforms is the establishment of a Training, Education, Employment, and Opportunity Program (TEEPO). This is embodied in the House expansion plan. The program requires able-bodied, working-age adults to participate in employment training programs. This is different than a work requirement and is geared at helping provide recipients with the skills and training needed to eventually pay for their own insurance. Multiple exceptions are made, including:
(1) children under the age of 18 or individuals under the age of 19 who are participating in secondary education; (2) individuals age 55 years and older; (3) individuals who qualify for medical assistance services due to blindness or disability; (4) individuals residing in institutions; (5) individuals determined to be medically frail; (6) individuals diagnosed with serious mental illness; (7) pregnant and postpartum women; (8) former foster children under the age of 26; and, (9) individuals who are the primary caregiver for a dependent, including a dependent child or adult dependent with a disability.
In addition to TEEOP, the House expansion plan includes a kill-switch if the federal government does not live up to its end of the bargain. This is something I have long supported since there is no way Virginia can absorb the cost of expansion if federal support is significantly reduced or eliminated.
In the end, the House budget with Medicaid expansion passed on a vote of 68Y-32N, with the support of all 49 Democrats and 19 Republicans.
Will the House conferees be able to reconcile their differences with their Senate counterparts? Hold tight. It may be a bumpy ride.
Other Budget Items
While Medicaid expansion was the biggest item, the House budget addresses a number of other priorities. This includes 825 new Medicaid disability waiver slots, more than $560 million for education (including the state's share of a 2% salary increase for school positions), $234 million for an increase in state employee salaries (including 2% for university faculty), and $45.5 million for need-based financial aid for higher education. The Commonwealth Institute puts together a great summary that compares the Governor's introduced budget with the House and Senate budgets. You can find that here.
Gun Safety Legislation
Finally, I want to thank everyone who has written to me regarding gun safety legislation in the wake of the mass shooting at
Marjory Stoneman Douglas High School. My father strongly believed in teaching me how to properly handle a firearm when I was growing up. He was equally adamant in teaching me that my Second Amendment right came with a deep and solemn responsibility for safety. This session, bills were introduced to ban bumpstocks, implement universal background checks, and keep guns out of the hands of people who have been deemed a threat to themselves or others. I support these measures. However, none of them advanced past the subcommittee level. Yes, this is a complex issue and there is no easy solution. However, I am committed to working to make changes that will make our community safer. As always, I welcome your feedback and ideas.
It is an honor to serve you! Do not hesitate to contact me if I can be of service or answer any questions.