Roughly 12,200 people in Prince William County would be able to get health insurance through Medicaid if Gov. Terry McAuliffe’s latest push to expand the program is successful, but stiff Republican opposition makes any change in Virginia unlikely.
McAuliffe is readying for one final fight over the issue during the General Assembly’s one-day “veto session” April 5, proposing a budget amendment that would expand Medicaid eligibility under former President Barack Obama’s signature healthcare law, the Affordable Care Act. The Democratic governor argues that the recent failure of Republican efforts to repeal the ACA helps dispel Republican arguments that Virginia would wind up on the hook for funding the entirety of the expansion costs should Obama’s law be undone, providing the rationale for one more push for Medicaid expansion before he leaves Richmond.
“Failing to expand Medicaid has cost Virginia $10.4 billion and has left 400,000 of our residents without healthcare,” McAuliffe said in a statement. “President Trump’s attempt to repeal the Affordable Care Act failed and even Speaker Ryan has said that Obamacare is the law of the land for the foreseeable future. The time has come for us to bring our taxpayer dollars back to serve the individuals who need them the most.”
Indeed, the coverage expansion would be particularly meaningful for people in Prince William — the county stands to gain the third largest number of people covered under Medicaid of any locality in the state, according to an data from the nonprofit Commonwealth Institute for Fiscal Analysis.
Researchers with that group also found that the expansion would cover an additional 2,000 people in Manassas, 1,300 in Manassas Park and 2,300 in Stafford County. Fairfax County tops the institute’s list, with 30,000 people set to gain coverage.
But House Republicans remain resolute in their opposition to the expansion, and stand ready to block the coverage expansion for the fifth year running. GOP House leaders — including Speaker William Howell, R-28th District, and Majority Whip Del. Jackson Miller, R-50th District — wrote in a statement that “the uncertainty of federal health policy underscores the need to be cautious over the long term.”
“Nearly every state that expanded Medicaid saw higher than projected enrollment, which in some cases led to large budget deficits,” they wrote. “Virginia can barely afford our current program, much less an expansion. Every dollar spent on Medicaid is one less that can be spent on education, transportation or public safety. Every federal dollar not spent on expanding a broken program is a dollar not borrowed from future generations.”
Prince William Republicans like Del. Scott Lingamfelter, R-31st District, share those sentiments. Lingamfelter says that the 66-34 GOP majority in the House views the governor’s move as “pure politics,” and isn’t interested in reversing course on Medicaid expansion even though Congressional Republicans have floundered.
“Taking an I.O.U. approach in more entitlement programs is bad idea,” Lingamfelter said.
But Prince William Democrats counter that Republicans are being obstinate, and putting the health of thousands of Virginians at risk in the process. Sen. Scott Surovell, D-36th District, went so far as to call their actions “legislative malpractice.”
“We have compromised the health and lives of thousands of Prince William County residents,” Surovell said. “I hope my colleagues will be more open to expansion given that it is clear that the Medicaid expansion isn't going away and we're hurting Virginia.”
Sen. Jeremy McPike, D-29th District, argues that “we’ve heard the same excuses [from Republicans] year after year,” and found ways to make Medicaid expansion meet their concerns. He notes that Medicaid’s “cost per recipient has remained flat for the last several years,” and points to Republican governors finding more conservative solutions to expanding the program (like Indiana governor turned Vice President Mike Pence) as evidence that there is a middle ground for the two sides to reach.
“We made all the reforms Republicans asked for,” McPike said. “It’s time to put whatever partisanship issues there are aside. It’s time to move this forward.”
If the General Assembly can’t move the program forward, McPike worries that many of his constituents will continue to rely on emergency rooms or urgent care center in lieu of any doctor’s visit, driving up demand for those services and driving up costs of even employer-provided insurance plans.
“I’ve met people that have to travel hours to the University of Virginia medical school for any procedure,” McPike said. “They’re taking time off work, and losing income. It’s a cycle that’s got to be broken.”
But even with the failure of President Donald Trump and House Speaker Paul Ryan to repeal the ACA, McPike worries that McAuliffe’s latest effort to expand the program will prove to be just as quixotic as his others.
“What’s clear out of the action in Washington is there’s bipartisan support for Medicaid, except for the far right,” McPike said. “That’s true in Virginia as well. The far right controls the General Assembly, and we’re beholden to them, just as Congress is beholden to the far right in Washington.”