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By Delegate T. Scott Garrett, M.D.
23rd House District
The 2014 session of the General Assembly has adjourned – without a budget.
Last month, the House of Delegates and the state Senate passed separate budgets for the 2015-16 biennium. These two budget proposals differ by less than one-tenth of one percent, a difference that could easily be remedied by conversations between budget conferees, in a few hours. But, Governor McAuliffe and the Virginia Senate Democrats would rather hold the state budget hostage in order to get their way on ObamaCare and the statewide expansion of Medicaid.
And there is even talk of a Washington-style shutdown of state government!
Last year, on a bipartisan vote, the House and Senate agreed to a process to take the Medicaid expansion debate out of the budget. The bipartisan “Medicaid Innovation and Reform Commission” was specifically created to reform Medicaid first and to remove the expansion question from the state budget process. I am deeply disappointed that our Governor and the Virginia Senate Democrats have improperly interjected the Medicaid expansion debate into the budget process.
A shutdown would mean schools, cities and counties, roads, public safety and other core functions of state government would have their funding either delayed or reduced. As our school boards and local governments rely heavily on state and federal support, they cannot finalize their own budgets, further hampering job creation and economic recovery. That is simply unacceptable.
Public health is one of our state government’s core essential functions, and I do believe government has a role to play in caring for those who cannot care for themselves. As a physician and legislator, I have been quite involved in the discussions on Medicaid expansion at a number of public hearings and committee meetings for months now, and am very familiar with the pros and cons of expansion.
Ensuring access to affordable, high-quality health care in a responsible and efficient manner will always remain a top priority for me as I serve you in Richmond. At this time, expanding Medicaid coverage would be inconsistent with this principle.
Although proponents of expansion passionately express their view that this will provide coverage to 400,000 Virginians (with the expectation that their overall health care will improve), the current plan before us does not anticipate this goal. Rather, this plan expects 250,000 Virginians to enroll (out of the 400,000 people in our state who would qualify by income requirements, and the almost 1,000,000 Virginians currently uninsured or underinsured).
We do not have enough health care providers today in Virginia to meet the needs, with few accepting new Medicaid patients and reimbursement levels for our hospitals at 70 percent of their costs.
The Virginia Senate’s Obamacare Medicaid expansion plan is merely conceptual, was poorly crafted, and leaves too many unanswered questions to move forward. The plan doesn’t address the fact that the federal government will not be able to keep its long-term commitment to pay for ObamaCare expansion, particularly as this will likely require shifting resources away from Medicare. It still puts Virginia taxpayers on the hook if the federal government backs out, and it still forces Virginia into a dangerous partnership with ObamaCare and the grave uncertainty coming out of a dysfunctional Washington.
The billions of dollars being promised by the federal government may go away, leaving our Commonwealth in the posture of either dis-enrolling those we have made a commitment to insuring, or further shifting state tax revenue dollars away from public education, public safety, and critical infrastructure needs. Virginia is already overly-dependent on federal funding and we simply cannot afford to use “free” federal funds to expand Medicaid at this time.
I firmly believe Virginians can build upon our current health safety net, including our Free Clinic, the Johnson Health Center, Centra, and hundreds of compassionate and capable health care providers. We need a health care system that is high-quality, affordable, and accessible. The current broken Medicaid system is none of these things- it is suffocating under waste, fraud, and abuse. I have urged Governor McAuliffe and Senate Democrats to put politics aside, pass a balanced budget, and debate the issue of Medicaid expansion in a separate setting. Our families and community deserve nothing less.