Efforts to expand Medicaid to about 300,000 low-income adults in Virginia continue to gain momentum, as Republican House leaders on Sunday publicly embraced a form of expansion that includes work requirements and copays.
The House of Delegates' budget panel included Medicaid expansion in its roughly $100 billion two-year spending plan , which also includes a 2 percent raise for state workers and teachers and a $50 million new cybersecurity training initiative. The proposed budget of the Republican-controlled Senate Finance Committee did not expand Medicaid or tax hospitals to help pay the state's share of expansion costs like the House version. That left the Senate with less money to spend in areas like education and its budget makes pay raises for state workers subject to available funding.
The support for Medicaid expansion in the House is a dramatic departure from past years. Republican House leaders had steadfastly blocked past Medicaid expansion efforts - a key part of former President Barack Obama's health care law - saying its long-term costs were unsustainable. The change of heart comes after several new Democratic House lawmakers won election last year on a pro-expansion platform and the House GOP majority went from 66-34 to a 51-49 lead. New Democratic Gov. Ralph Northam has also made expansion a top priority.
"There's no question that the political dynamics have changed," said House Speaker Kirk Cox.
House Republicans said they are more comfortable expanding Medicaid because of President Donald Trump's support for work requirements and because multiple attempts by the GOP-led Congress to repeal Obama's health care law last year were unsuccessful.
"It's here to stay and we felt the timing was right," said House Appropriations Chairman Del. Chris Jones.
There have been several signs that the House GOP's opposition to Medicaid expansion was softening. Sunday's budget unveiling comes a few days after Republican Del. Terry Kilgore, a powerful lawmaker from the state's southwest coal country, publicly voiced support for Medicaid expansion.
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Northam said in a statement that he "respects" House Republicans' insistence on work requirements and cost-sharing provisions, even if he doesn't prefer that they be part of any expansion.
"I am encouraged by and supportive of our work together to bring about a new 'Virginia Way' on Medicaid,'' Northam said.
Under Obama's health law, states had the option of expanding Medicaid. Thirty-two states did, while Virginia and 17 others rejected it, forgoing billions in additional federal dollars for hospitals and medical service providers.
But Medicaid expansion in Virginia is still far from a done deal and plenty of Republican lawmakers remain steadfastly opposed. The House and Senate will have to negotiate a compromise budget before the legislative session ends next month.
Senate Republican Majority Leader Tommy Norment said it's unwise for Virginia to expand Medicaid given the uncertainty over whether the federal government will continue to pay at least 90 percent of expansion costs.
"There are so many uncertainties about Medicaid and Medicaid expansion right now that a more fiscally constrained approach is to not expand it at this point,'' Norment said.
Republicans hold a 21-19 advantage in the Senate. Republican Sen. Emmett Hanger supports Medicaid expansion and Democratic Lt. Gov. Justin Fairfax holds the tiebreaking vote, meaning there's enough support for Medicaid expansion in the Senate to pass on an up-or-down vote.
Hanger said he thinks Medicaid expansion will happen this year, but said he's not willing to hold the budget hostage to make it happen. Lawmakers could adjourn in March without passing Medicaid expansion but take up the issue in April when they consider the governor's amendments and vetoes.
"That might be a better plan,'' Hanger said.