Decisive Medicaid battle looms Wednesday in Virginia Senate

The Virginia Senate finally has a budget to consider, but it doesn’t include Medicaid expansion — yet.

Seven weeks after the General Assembly convened in special session to adopt a state budget, the decisive battle looms on Wednesday. The Senate is expected to consider a package of amendments proposed by Sen. Emmett Hanger, R-Augusta, that would expand Medicaid with billions in federal funding and a pair of new taxes on hospital revenues to pay for it.

The Senate Finance Committee narrowly rejected that same proposed package on Tuesday. It voted instead for essentially the same budget it adopted during the regular 60-day legislative session without expanding health care coverage to more than 300,000 uninsured Virginians.

The committee’s budget, proposed by Senate Majority Leader Tommy Norment, R-James City, includes an additional $120 million in income tax collections; raises for teachers, state employees and sheriff’s deputies contingent on sufficient revenues; and new spending on priorities such as economic development. It also includes a trio of amendments committee members proposed to prevent any state funding of abortions and to give big pay hikes to state troopers, who got one last year, and general district court clerks.

Hanger’s substitute

Hanger already has given senators copies of a substitute budget he negotiated with House Appropriations Committee Chairman Chris Jones, R-Suffolk, more than a week ago. Hanger plans to offer it on the Senate floor Wednesday, in an effort to get it directly to Gov. Ralph Northam to sign without having to reconcile differences in a conference committee.

“There’s support there to do this, I believe,” said Hanger, who is prepared to join with the Senate’s 19 Democrats and at least one Republican, Sen. Frank Wagner of Virginia Beach, to vote for a budget to expand Medicaid under the Affordable Care Act.

Northam said Tuesday that he has listened to excuses for not expanding Medicaid for more than four years at a cost of billions of dollars in federal aid the state has refused for expanding health coverage under the federal-state program for the poor, elderly, disabled and children.

“Let’s put the excuses aside. At the end of the day, I need a budget,” the governor said after speaking at a Virginia Health Care Foundation celebration to mark 100,000 enrollments in the state’s health insurance program for children.

The Senate is scheduled to convene on Wednesday at 9 a.m., followed by the House of Delegates at 2 p.m. The budget proposals the Senate Finance Committee adopted — one for the current fiscal year that ends June 30 and the other for the two years beginning July 1 — will be in a position to be amended, if Hanger has the votes to first reject the committee’s proposed amendments.

Norment’s gambit

Norment, R-James City, who co-chairs the Finance Committee with Hanger, tried to move reconsideration of the defeated Medicaid proposal so the panel could potentially bar it from being introduced on the floor as a substitute budget.

But Hanger, who presided over the committee meeting, declared Norment’s motion out of order and banged the gavel to abruptly adjourn it, prompting advocates of Medicaid expansion in the audience to applaud.

After the meeting, Hanger said he wasn’t sure whether a second vote against his proposal in committee would prevent him from introducing it on the Senate floor. “Just to be certain, I’m leaving,” he said with a chuckle.

Later, he said the Senate rules forbid a legislative proposal to be raised a third time after being defeated twice on the floor, unless the entire body agrees. However, he said the rule does not extend to action in committee.

Senate GOP opponents

A majority of Senate Republicans are still trying to block Medicaid expansion in the budget on Wednesday. They plan to hear from former U.S. Sen. Rick Santorum, a Pennsylvania Republican who lost his seat in 2006, about renewed efforts in Congress to repeal the Affordable Care Act and its support of expanded Medicaid eligibility with enhanced federal funding.

After talking to Republican senators, Santorum is scheduled to appear at a news conference at 10:30 conducted by Americans for Prosperity, a national conservative policy advocacy organization backed by billionaires Charles and David Koch.

When Republicans in Congress tried and failed to repeal the health care law last year, Hanger said they had proposed a block-grant approach that would have hurt Virginia and other states that had refused to expand their Medicaid programs. Currently, 32 states and the District of Columbia have expanded their Medicaid programs under the law, which ensures the federal government will cover 90 percent of the cost, compared with 50 percent under Virginia’s current Medicaid program.

Two tracks

Hanger’s proposal to make Virginia the 33rd state to expand Medicaid under the law would take two tracks. One would amend the state Medicaid plan to expand eligibility to people earning up to 138 percent of the federal poverty limit, or less than $17,000 a year. The other would be to seek a waiver from President Donald Trump’s administration to impose a series of conditions on eligibility, including a work requirement and cost-sharing provisions for recipients.

Hospitals would pay the proposed provider assessments in taxes on revenues, but it would result in a net benefit of almost $880 million over two years for private acute care hospitals, according to Finance Committee staff members. The benefits would include revenue from expanding Medicaid eligibility to people who currently receive uncompensated care and from raising the reimbursement rate for providers.

Public hospitals, such as the VCU and University of Virginia health systems, would not pay the assessments. Sen. Ryan McDougle, R-Hanover, contended that such hospitals would not share in the same benefits as private hospitals.

The Virginia Hospital & Healthcare Association said private hospitals already are shouldering the cost of uncompensated care, bad debt, and reduced reimbursements for Medicaid and Medicare patients. “We’re talking about a billion dollars every year in reimbursement shortfalls,” spokesman Julian Walker said.

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