One debate over health care reform in Virginia has ended, but another one is just about to begin.

Gov. Terry McAuliffe’s latest bid to expand Virginia’s Medicaid program died on a party-line vote in the House of Delegates on Wednesday.

But Republican opponents left open the option of finding ways to improve health care for uninsured Virginians in impending discussions by a new joint legislative subcommittee.

“We need to do it in a fiscally responsible way that doesn’t bust the budget,” Del. R. Steven Landes, R-Augusta, said before the House voted 66-34 to reject the governor’s proposed budget amendment to allow him to expand Medicaid on Oct. 1 if the opportunity remains under the Affordable Care Act.

Landes is a member of the eight-person subcommittee created under the budget to monitor changes President Donald Trump and Congress may make to the health care law then-President Barack Obama signed in 2010 and consider ways for Virginia to reshape its own health care system.

The panel is shaping up as the successor to the Medicaid Innovation and Reform Committee, or MIRC, which went moribund in 2014 after a deadlock between House and Senate appointees over whether the state had met the conditions for reforming the Medicaid program sufficiently to justify accepting federal money to expand health coverage for up to 400,000 uninsured Virginians.

Senate Finance Co-Chairman Emmett W. Hanger Jr., R-Augusta, who co-chaired the MIRC with Landes, named himself to the subcommittee on Wednesday, along with Sen. Siobhan S. Dunnavant, R-Henrico; Sen. Janet D. Howell, D-Fairfax; and Sen. George L. Barker, D-Fairfax. Hanger, Howell and Barker have supported expanding health coverage under Medicaid, while Dunnavant has not.

The opposite is true with the House delegation, which is dominated by members who have steadfastly opposed Medicaid expansion — Landes; House Appropriations Chairman S. Chris Jones, R-Suffolk; and Del. John M. O’Bannon III, R-Henrico. The fourth delegate named to the panel is Del. Matthew James, D-Portsmouth, who has favored expansion.

“We are going to have to forge some bipartisan way of moving forward,” Hanger said in a floor speech on Wednesday.

Dunnavant, an obstetrician, said she is “very, very happy” about her appointment to the subcommittee. “Great aspirations,” she said.

Vetoes sustained

There was little evidence of bipartisan spirit as the Republican-controlled legislature returned to Richmond to take up the Democratic governor’s 27 proposed budget amendments and 40 legislative vetoes — in an election year in which the top three statewide offices and all seats in the House will be on the ballot.

House Majority Leader M. Kirkland Cox, R-Colonial Heights, opened the day by saying he could simply “copy and paste” his speech for the veto session last year. The House covered well-trodden ground by debating vetoed bills about guns, immigration, welfare, voting and school choice, but overturned none of the governor’s vetoes.

House Republicans have a 66-34 majority, one member shy of the two-thirds vote needed to override a veto. No vetoes were overturned in the Senate, where Republicans have a 21-19 edge, preserving McAuliffe’s perfect veto record in his final year in office.

McAuliffe released a statement in which he noted that the General Assembly sustained five vetoes of bills that he said would have weakened gun safety laws.

“I am pleased that the General Assembly sustained my vetoes on bills that would have needlessly endangered individuals across the commonwealth,” McAuliffe said. “These bills were disguised as means to increase safety, but they would have done just the opposite.”

With Republicans unable to power through legislation McAuliffe nixed, most of the day’s action centered on the governor’s recommended changes to nuts-and-bolts bills and the state budget.

Budget amendments

The House approved 15 of the 27 budget amendments McAuliffe proposed, including two-thirds of his recommendation for changing how services are provided under a birth-injury program that is under investigation by the U.S. Department of Justice.

The Senate also approved the 15 budget amendments that the House had accepted.

The debate over Medicaid expansion followed a predictable path to an inevitable conclusion.

Democrats urged the House to drop its steadfast opposition to expanding the health care program for the poor, elderly and disabled, and accept billions of dollars in federal funds.

“What do we call it when we walk away from $10 billion? We call it fiscally responsible,” said Del. Kenneth R. Plum, D-Fairfax. “I can’t get my mind around that.”

“The position we have taken to this point has left too many Virginians without adequate health care,” Plum said.

Opponents said Medicaid already consumes too much of the state’s budget. “I’m more convinced now than ever we made the right decision not to expand Medicaid under the Obamacare model,” said O’Bannon, a neurologist.

Senate Democrats did not get to debate the issue once the House voted down McAuliffe’s proposal, but they stated their case for expansion in floor speeches anyway.

“This is totally irresponsible not moving forward, totally,” Sen. Barbara A. Favola, D-Arlington, fumed.

Sen. Mamie E. Locke, D-Hampton, chair of the Senate Democratic Caucus, said, “Once again we are the state of ‘no.’”

However, both chambers agreed with McAuliffe’s proposal to strip language from the budget that would have allowed more than two dozen private hospitals to receive additional federal Medicaid payments through a complex arrangement. State officials feared it could lead to federal disapproval and a financial liability later.

Birth-injury program

Legislators also agreed to a new payment structure for the Virginia Birth-Related Neurological Injury Program to address concerns that Medicaid has been billed improperly for services that should have been covered primarily by private insurance.

They also accepted McAuliffe’s proposal to direct the State Corporation Commission to study ways to ensure the program is able to meet its long-term financial obligations to beneficiaries, who are guaranteed lifetime care in return for not filing medical malpractice lawsuits against doctors and hospitals for birth-related neurological injuries.

However, the House rejected another provision the governor proposed that would have required use of Medicaid reimbursement rates to determine how much to pay for some services now provided under higher, negotiated prices.

Jones, the House Appropriations chairman, said the amendment would have “hurt the reimbursements given today if agreed to.”

The House rejected the provision by a 67-32 vote.

The House rejected 12 of the governor’s proposed amendments, including his attempts to restore money the legislature stripped from the budget for solar power development, cybersecurity education, and preparing to screen inmates for mental illness.

Democrats joined Republicans in voting 76-24 against McAuliffe’s latest attempt to cut $5 million from the commemoration in 2019 of the 400th anniversary of the founding of the House of Burgesses, the arrival of the first women and Africans in the Jamestown Colony, and celebration of the first Thanksgiving.

“It’s not a big party,” Cox said tartly after recounting the economic benefits of the commemoration.

The General Assembly also approved amendments by McAuliffe that restore a pause in permitting for the closure of Dominion Virginia Power’s coal ash ponds at four locations pending detailed assessments of existing contamination at the sites, alternatives to capping the ponds and closing them in place, and whether the ash that has been stored there for decades can be recycled.

The amendments to Senate Bill 1398 by Sens. Scott A. Surovell, D-Fairfax, and Amanda F. Chase, R-Chesterfield, restore provisions that were cut out of the bill during the session. Dominion told the governor in a letter this week that it agreed with the amendments and would conduct the assessments prior to pursuing permits even if the legislature voted down McAuliffe’s amendments.

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House rejects McAuliffe's effort to expand Medicaid –