Bang or whimper? Medicaid showdown could slip behind closed doors

WASHINGTON –  The latest showdown over expanding Medicaid in Virginia to cover about 400,000 more people could come down to private meetings between Gov. Terry McAuliffe and Republican finance leaders in the General Assembly.

“What I’d like to do, as I did with the budget, you know the chairs the Republicans [finance committee chairs] Chris Jones and Walter Stosch who I negotiated with, we did it privately, behind closed doors on the budget [this year]…I assume it’ll be the same, lets come and talk,” McAuliffe said on WTOP’s Ask the Governor this week.

Republicans have flat-out rejected McAuliffe’s proposals to expand Medicaid for the last two years, and have promised to do so again during the General Assembly session that begins Jan. 13. GOP leaders say they have concerns about the existing program’s costs and execution, and about whether the federal government would actually provide the promised money to support the expansion as required under the Affordable Care Act, or Obamacare.

Earlier this month, the association representing Virginia hospitals said the hospitals would be willing to pay a tax to cover the state’s costs of expanding Medicaid.

McAuliffe, a Democrat, says that means the state would have no new financial obligations for the program over his two-year budget.

Hospitals will put up that difference, you know they get a multiplier back for every dollar they put up,” he says.

Many of the people who would be covered under the Medicaid expansion do not have insurance coverage now, so hospitals expect they would get more income. Medicaid costs are split between the state and federal government.

“We’re in a totally different place today,” McAuliffe says, compared to the last two years.

Republican leaders like Del. Kirk Cox, however, are not convinced.

The House majority leader told reporters earlier this month that Medicaid expansion is something the House will not budge on.

“There are philosophical differences and I think that’s good for the system I gotta tell ya, I mean I think there are certain things we just have very strong beliefs on, and so you’re probably not going to see a lot of cooperation [on those],” Cox said.

Republicans control both houses of the General Assembly.

McAuliffe suggests he does not want the upcoming 60-day session to be completely dominated by the Medicaid expansion fight.

“This is about $150 million I can save in our biennium budget that I just introduced, keep in mind it’s a $109 billion budget, I don’t want people to get all caught up in $150-plus million dollars, but it’s important, it’s important for these folks,” he says.

Asked whether he needs to have his boxing gloves ready, McAuliffe responded: “I hope not, but you know you’ve got to fight for what you believe in.”

McAuliffe and Republican leaders all say that despite differences over Medicaid, they expect to work together on issues like economic development.

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