The House of Delegates and state Senate set themselves up Thursday for a multibillion-dollar budget battle over health insurance for low-income Virginians and hundreds of millions of dollars of other state spending.
The House of Delegates broke with four years of strong opposition to Medicaid expansion in a budget that includes a version. The vote split the once-overwhelming and unified Republican caucus into two, while Democrats united, despite some members’ earlier reservations about imposing conditions on Medicaid recipients.
The state Senate, on the other hand, initially split on strictly party lines, 21-19, to reject Medicaid expansion.
The House Appropriations committee has proposed using $2.9 billion in federal funds to expand Medicaid in order to cover all Virginians with incomes less than 138 percent of the federal poverty level. For a single person, that cutoff is $16,642 a year.
The House proposed doing so if the state can win federal approval to require adult Medicaid beneficiaries who are not disabled to find work or enroll in a training program.
Senate Finance Committee Co-Chairman Emmett Hangar, R-Mount Solon, said it would not be prudent to base the entire budget on an uncertainty of federal dollars coming through. He also objected to the House’s idea of a hospital tax to help cover part of the cost.
Hospitals footing some of the bill was what helped Del. David Yancey, R-Newport News, vote in favor of expansion on Thursday. He opposed the issue last year because that proposal didn’t include a trigger switch to halt the program if federal dollars don’t come in. He also opposed using state dollars to foot co-pay bills.
“He didn’t want that to come out of (the) state budget because he didn’t think we had the money to support it,” said Gretchen Heal, Yancey’s legislative aide. “With hospitals picking up that tab, it was a game changer.”
The trigger switch is also in this year’s proposal.
“I spent yesterday and much of the week before thinking about school funding and teacher salaries and deputy salaries … without this Medicaid expansion, all of that would have been gone,” said Del. Gordon Helsel, R-Poquoson, who voted for the House budget and expansion.
“This is going to help the people who need the help.”
The House approved its version of the budget in a 68-32 vote and a companion bill by 69-31. Although House Speaker Kirk Cox, R-Colonial Heights, supported the move, 31 conservative Republicans, including Majority Leader Todd Gilbert, R-Shenandoah County, voted against expansion.
“We were faced with the reality that in a majority of 51 people, not everyone feels as strongly about (rejecting Medicaid expansion) as I do,” said Gilbert after the vote.
Del. Ben Cline, R-Lexington, was one of those chief opposing voices. His fear, shared by several of his colleagues, was that the federal government will not live up to its end of the bargain in helping fund the cost.
That would leave the burden on taxpayers, they argued, and mess up what Cline described as the state’s “sound fiscal policy.”
“If we continue down this road of Medicaid expansion, we do run the risk of crowding out other core functions of government — public safety, roads …,” said Cline, who is running for Congress.
Del. T. Scott Garrett, R-Lynchburg, reassured the chamber that there is a provision allowing the state to de-enroll people from the program if the federal government does not follow through. Garrett, a doctor, pointed out that he’s voted against Obamacare-related legislation six times over the last six years, but this bill prioritizes some conservative ideals.
“In my opinion this is not Obamacare Medicaid expansion,” Garrett said. “This is putting into place realistic achievable goals that are laudable for all Virginians.”
Del. Chris Jones, R-Suffolk, who is the chair of the House’s Appropriations Committee, said he respects his colleagues who cannot vote yes, but commended those who worked toward a compromise. At odds with Jones was Committee Vice Chairman Del. Steve Landes, R-Weyers Cave, who said this would be the first time in 23 years he would vote against a budget bill.
“I believe every member of this House wants to provide health care for our citizens,” Landes said. “We have made this a priority without entangling Virginia with a failed federal policy that comes attached with it.”
“This is a budget that our voters last fall voted for, and it’s a statement about our relentless optimism about the future of the commonwealth,” said House Minority Leader Del. David Toscano, D-Charlottesville. “I’ve been here 12 years and I don’t think I’ve seen a budget quite like this one.”
The House’s vote came as the Senate began considering a budget proposal by the Senate Finance Committee, which rejected any form of Medicaid expansion.
The vote signifies what everyone has known all along, that “we are sharply divided, that when you have this much of a divide,” long-held values can change, Gilbert said.
State Sen. Janet Howell, D-Fairfax, a member of the committee, proposed an amendment to its budget that would bring it in line with the House version.
“We’ve cut education, higher education and public schools, we’ve cut student aid, we’ve cut mental health, we’ve cut public safety, and why have we made these decisions? We’ve made the decision to deny access of low-income Virginians to health care,” she said.
She said using Affordable Care Act funds to expand Medicaid would allow more than 300,000 low-income Virginians to get health insurance and would free $422 million of state funds for other priorities.
“The aim is to strip Medicaid dollars from the budget, but in doing so we are doing long-term harm,” said state Sen. Creigh Deeds, D-Warm Springs, arguing against a Senate Finance Committee proposal to trim some mental health spending.
State Sen. Richard Black, R-Loudoun, spoke up for conservative members of his caucus opposing the expansion.
“This country has suffered enormously from government dependency,” he said, adding that expanding Medicaid would cover members of the middle class. Hanger said he expected discussions would continue.
Senate Majority Leader Thomas K. “Tommy” Norment Jr., R-James City, described some of the cuts the Finance Committee made as excruciating.
“Don’t suggest we don’t understand; we do understand,” he said. But he said the committee had no choice because of uncertainty about what the federal government will actually do about funding health care and other human services
“Our No. 1 priority should be proposing and delivering a balanced budget that meets the needs of the commonwealth predictably and assuredly,” Hanger, the finance committee co-chairman said.
In a passionate speech, Del. Nick Freitas, R-Culpeper, who is running for the U.S. Senate, said politicians and the media present opposition to expansion as letting sick people get sicker. He argued there can be a middle ground.
The Peninsula delegation split. Supporting Medicaid expansion were state Sens. Mamie Locke, D-Hampton, and Monty Mason, D-Williamsburg, and House members Gordon Helsel, R-Poquoson, Mike Mullin, D-Newport News, Cia Price, D-Newport News, Jeion Ward, D-Hampton, and David Yancey, R-Newport News. Middle Peninsula Del. Keith Hodges, R-Urbanna, also supported the House budget with its Medicaid expansion plan.
Opposing expansion were state Sen. Thomas K. “Tommy” Norment Jr., R-James City County, and House members Emily Brewer, R-Suffolk, and Brenda Pogge, R-Norge.
