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GOP-led push for Medicaid expansion faces roadblocks

February 23, 2018

Virginia state Sen. Emmet Hanger, R-Augusta, addresses the Senate over Medicaid expansion during the session at the Capitol in Richmond, Va., Thursday, Feb. 22, 2018. (AP Photo/Steve Helber)

RICHMOND, Va. (AP) — Even with new support from key GOP leaders, Medicaid expansion in Virginia still faces serious roadblocks.

That includes a fierce intraparty squabble among Republicans and strong disagreement among expansion supporters on how to pay for it — divisions that were on full display Thursday. The GOP-controlled House voted with a bipartisan majority for a budget that includes Medicaid expansion with work requirements, copays and new hospital taxes. The Republican-controlled Senate voted along party lines against including Medicaid expansion in its budget.

House Republicans had for years stood steadfastly against Medicaid expansion efforts — a key part of former President Barack Obama’s health care law — saying its long-term costs were unsustainable. But after a Democratic wave election last year reduced the GOP majority in the House from a near super majority to a 51-49 lead, many Republicans have switched positions. New GOP supporters of Medicaid expansion say President Donald Trump’s embrace of work requirements for certain Medicaid recipients has helped change their mind.

But there could be a steep political cost for the change of heart that makes it difficult for Medicaid expansion supporters, including Democratic Gov. Ralph Northam, to get the needed votes in the Senate.

Two GOP House members who are currently running for Congress — Dels. Ben Cline and Nick Freitas — urged their fellow Republicans to hold the line.

“I see us consigning future generations to a diminished America so we can bribe the voters today with a program that isn’t sustainable,” Freitas said on the House floor.

And Republican Corey Stewart, a former Trump state campaign chairman now running for the U.S. Senate, held a Capitol news conference where he repeatedly mocked Republican lawmakers who had switched positions on Medicaid expansion. Stewart compared the lawmakers to toilet paper while also calling them “weak” and “flaccid.”

“I feel sorry for their wives,” Stewart said. He also predicted that the pro-expansion Republicans would face serious primary opponents in the next election.

If Medicaid expansion is passed, the state estimates about 300,000 low-income adults would be eligible for Medicaid. Under Obama’s health law, states had the option of expanding Medicaid with the federal government picking up at least 90 percent of the costs. Most states did, and pro-expansion Republicans in Virginia have tried to draw parallels with other conservatives who have embraced Medicaid expansion.

“Our plan is similar to the plan enacted by Vice President Mike Pence when he was governor of Indiana, and includes some of the same key reforms that the Trump administration has already approved for other states,” said House Speaker Kirk Cox.

With the state Senate split 21-19 and one Republican senator already supporting Medicaid expansion, a single reversal by a GOP senator could provide the necessary majority to approve a budget with Medicaid expansion.

But the issue is complicated by the House’s support for new taxes on hospitals to help pay the state’s share of expansion costs. The taxes help boost anticipated revenues in the House’s proposed budget, which allows it to pay for things the Senate’s budget can’t like raises for teachers and state worker.

The state’s hospitals, which have previously said they were reluctantly open to the idea of new taxes if it helped get Medicaid expansion passed, have expressed concerns about the House’s plan to include the tax in the budget. They’ve also noted that the state would see an overall savings by expanding Medicaid, even without the tax.

Sen. Emmett Hanger, the lone Senate Republican openly in support of expansion, said Thursday that tax was a key reason why he doesn’t support the House’s budget proposal.

“I cannot support that today. I cannot support it two and half weeks from now. I cannot support it two months from now,” Hanger said.

The General Assembly is set to adjourn next month. But if there’s no agreement on the budget and whether to include Medicaid expansion in it, there could be a protracted stalemate.

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