At least some Virginians with incomes too low to get Medicaid — for instance, people with disabilities whose income exceeds $9,650 a year — might get coverage even if the state Senate and House of Delegates are billions of dollars apart on expanding Medicaid.
So far, nobody in Capitol Square is blinking. But nobody is really betting on a take-it-or-leave-it confrontation — that either the House approach or the Senate’s will be the ultimate result. Fingers crossed, legislators are hoping for a compromise.
There’s a long way to go. The House plan would use $2.9 billion in federal funds and a $307 million tax on hospitals over the next two years 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 Senate plan does not include any of that federal or hospital tax money.
Since covering more low-income Virginians generates some $371 million in savings in medical and mental health programs that now fall entirely on Virginia taxpayers, the House plan can fund some potentially popular programs, from teacher salary increases to port dredging.
The Senate can’t.
“I’m confident that when we get to the end there will be more people covered,” said House Appropriations Committee chairman Chris Jones, R-Suffolk. He noted that he’s seen the House and Senate be much further apart and still reach a compromise by the early March deadline set by the state constitution.
“I’ve already asked [Senate Finance Committee] staff to see if there’s some way of finding a middle ground,” said Senate Majority Leader Thomas K. “Tommy” Norment Jr., R-James City.
But it will be a challenge, Norment said. If there is a middle ground, it would probably involve finding a source of money other than the hospital tax, he said. It could mean looking for savings by shifting some low-income Virginians whose care now falls entirely on the state, to Medicaid plans that don’t draw as much federal support as full Medicaid expansion does.
Incentives to compromise
There are some spurs to action.
“We can’t get out of here until we have a budget, after all,” said Del. Mike Mullin, D-Newport News, pausing for minute as he tried to corral his three young sons who were up for an end-of-the-work-week visit to the Capitol before enjoying a family weekend.
Stark disagreement over Medicaid expansion almost led to a government shutdown in 2014. That year, a Republican-led House stood strong against expansion under Obamacare, while the evenly split Senate approved a plan to make thousands of people eligible for Medicaid.
A budget deal, with no Medicaid expansion, emerged in June only after the surprise resignation of Democratic Sen. Phil Puckett gave Senate Republicans a one-vote majority. The budget was passed just days before a July 1 deadline for a government shutdown — and only after then Speaker of the House William Howell ruled vetoes of budget items by then-Gov. Terry McAuliffe were unconstitutional.
Still, the power of the governor, working with the lieutenant governor, to change the budget worries senators. While the lieutenant governor can’t break a Senate tie vote on a budget, he can do so on the governor’s amendments to the budget. That opens the possibility of a deal outside the control of Senate GOP leaders in a 21-19 body, with one key actor, state Sen. Emmett Hanger, R-Mount Solon, eager to expand access to Medicaid but strongly opposed to a hospital tax.
Politics will matter.
Twenty House Republicans, stunned by the loss of 15 seats last November, changed their stance on Medicaid expansion. They joined 49 Democrats to vote for a version requiring adult recipients who are not disabled to work or sign up for training programs. But that requires federal approval that senators worry might not come for months, if at all, as Obamacare remains a political football in Washington.
So far, Senate Republicans aren’t acting worried about their next races, in 2019, even though six represent districts that voted for Gov. Ralph Northam as he campaigned forcefully for Medicaid expansion. In two Richmond suburban districts, represented by state Sens. Glen Sturtevant, R-Richmond, and Siobhan Dunnavant, R-Henrico, Northam won by margins of 16.7 and 4.3 percentage points. The district represented by state Sen. Frank Wagner, R-Virginia Beach, went for Northam by 8.5 points.
“Make no mistake about it — Medicaid expansion is closer to happening in Virginia in the first four months of Northam’s governorship than during the four years of McAuliffe’s time as governor,” said Stephen Farnsworth, professor of political science at the University of Mary Washington. “It shows that elections have consequences. Republicans lost a lot of seats last November, and Medicaid expansion has become viable for many of the Republicans who remain in the legislature.
Some form of Medicaid expansion appears to be on the horizon, according to Farnsworth and John McGlennon, professor of political science at the College of William and Mary. McGlennon believes it will happen because the House’s plan has a trigger switch — that if the federal government does not pony up the money it has promised for this program, the state could de-enroll people. Farnsworth pointed to the Senate’s willingness in the past to do something about Medicaid, and that there are a couple of “gettable” Republican senators who are open to the idea.
The key decisions will come down in a couple of weeks, when lawmakers chosen by each chamber — called conferees — will meet and try to hash out a deal to make one budget.
“It’s important to remember that these House and Senate bills are sort of like the opening bid in a game of cards,” Farnsworth said. “Things are going to go around the table a few times before there is an agreement between the chambers.”
That House’s willingness to move on Medicaid expansion could give the Senate a big bargaining chip, McGlennon said.
“The question is whether this really has to do with the Medicaid expansion or whether there’s something else that the Senate is looking for legislatively,” McGlennon said, noting that the Senate at one time was more willing to do something about Medicaid than the House.
What could that bargaining chip be? “I don’t know that,” McGlennon said with a laugh.
Ress can be reached at 757-247-4535. Amin can be reached by phone at 757-247-4890.