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- Virginia legislators have a chance to protect patients, protect taxpayers, and protect their state’s health care system by resisting an ObamaCare takeover. They should take it.
- Virginia legislators have a chance to protect patients, protect taxpayers, and protect their state’s health care system by resisting an ObamaCare takeover. They should take it.
By Nic Horton and Josh Archambault— Mr. Horton is Policy Impact Specialist, and Mr. Archambault is a Senior Fellow at the Foundation for Government Accountability.
This week, Virginia lawmakers will convene in a special session to consider adopting ObamaCare's Medicaid expansion. But Democrat Governor Terry McAuliffe will be rebuffed once again due to waning public and legislative support for the program.
Earlier this year, during Virginia’s regular legislative session, Governor Terry McAuliffe (D) tried to strong-arm a divided legislature into accepting ObamaCare’s Medicaid expansion. House Speaker Bill Howell (R) held strong, calling instead for comprehensive Medicaid reform to make the program work better for the truly needy and taxpayers alike. Despite a Democrat-controlled Senate, ObamaCare expansion was D.O.A. in the Virginia House.
But like a good Clintonite, McAuliffe didn’t give up without a fight: he tried to tie ObamaCare expansion funding to the state budget — threatening a government shutdown and risking Virginia’s sterling AAA bond rating. This, of course, after he falsely accused his opponent of advocating for a government shutdown during his campaign, while consistently denouncing the federal shutdown, calling threats of a shutdown “dangerous and wrong.” McAuliffe dared Republicans to take the bait. They didn’t.
After weeks of standoff, Democrats announced in June that they would accept a state budget that did not include expansion funding. (The budget also included the Stanley Amendment that precluded expansion without direct approval by the legislature. McAuliffe vetoed this amendment, but the House Speaker ruled the veto unconstitutional.)
For months afterwards, McAuliffe signaled repeatedly that he may attempt to subvert the will of the legislature and expand ObamaCare unilaterally, much like Governor John Kasich did in Ohio. Of course, legal observers — including A.E. Dick Howard, who led the commission that wrote Virginia's modern constitution — have opined that expanding Medicaid via executive order would be illegal.
Perhaps finally recognizing that he does not have the authority to expand unilaterally, McAullife announced his “plan” for the special session last week. It essentially amounts to a concession on ObamaCare expansion, focusing instead on expanded outreach efforts to enroll individuals who are already eligible for Medicaid and additional coverage for those with “severe mental illness.” This coverage expansion will not come with ObamaCare taxpayer-funded "enhanced" federal Medicaid dollars, so it will be costly to the state.
But if McAuliffe changes course and decides to pursue legislative action on ObamaCare expansion, he’ll have a big challenge ahead of him as lawmakers prepare to convene this week: he must convince the Republican-controlled House to expand the unpopular law — and this time, he’ll have to deal with a Republican-controlled Senate as well.
How Virginia Got Here and Where They’re Headed
In August, a special election was held to replace Democrat Senator Phil Puckett. Puckett resigned in June. His replacement is Ben Chafin, a Republican who was elected by a margin of nearly 2-to-1 — perhaps due in part to McAuliffe’s stubbornness and repeated threats of executive action on Medicaid expansion. (Similarly, in Arkansas, now-Senator John Cooper defeated an ardently pro-ObamaCare candidate in a January special election in a district that hadn’t elected a Republican since Reconstruction.) But even as Chafin enters the legislature and ushers in a Republican majority in the Senate (albeit a slim one), there are still a few wildcards to watch.
The Gang of Three — Republican Senators John Watkins, Walter Stosch, and Emmett
While this Gang of Three is generally pro-expansion, they’ve shown a willingness to apply the brakes. (Interestingly, Senator Hanger has already garnered a primary opponent.)
On the House side, Speaker Bill Howell has been a champion of conservative principles and has held strong against an onslaught of special interest outcries. Thanks to his leadership, only one Republican voted for the ObamaCare expansion in the House last session. Howell even managed to bring over a Democrat vote against the expansion, Del. Johnny Joannou.
(Unfortunately, Joannou has paid a political price for his stand against ObamaCare: according to the Senate minority leader, Joannou’s benign red-light bill was vetoed by McAuliffe because “[Joannou] voted in a way that his excellency didn’t like on this whole Medicaid expansion.”)
It’s tough to see how expansion could ever make it through the lower chamber with Speaker Howell at the helm. And that’s a good thing for Virginia patients and taxpayers. Here’s why.
No Matter What You Name It, Medicaid Expansion Is Medicaid Expansion
There are only a few potential policy paths forward for the Virginia expansion, should it gain any traction. One is “Marketplace Virginia,” a virtual carbon copy of Arkansas’ failed ObamaCare expansion plan. Notably, the Arkansas program has been over budget every single month since it launched, failing to meet any of its lofty promises and leading to the exit of the state’s Medicaid director and several of its legislative architects. It’s a policy and political hot potato that’s bad for patients, bad for taxpayers and bad for the state budget.
Even the federal government may be souring on the Arkansas expansion plan, having recently rejected Pennsylvania’s request for a similar expansion, forcing the state to instead expand via managed care and denying all of the state’s unique waiver requests.
More than that, it’s clearly a headache that Virginia lawmakers don’t want to deal with. (Readers who are skeptical that Virginia is trying to copy Arkansas should read this document from the Virginia House Republican caucus.)
Another is a proposal being pushed forward by Delegate Tom Rust, the only Republican to support ObamaCare expansion in the House last session. His proposal, which borrows its Orwellian “Health Care Independence Act” title from Arkansas, is a near carbon-copy of the ObamaCare window dressing used to pass ObamaCare expansion in Iowa and New Hampshire. However, Rust takes this bad proposal one step further by providing extra subsidies to individuals above 138 percent FPL who are on the ObamaCare exchange.
Polling Update: Voters Still Don’t Like ObamaCare Expansion
Republicans in Virginia have a majority of voters on their side against the ObamaCare expansion. An April poll from Christopher Newport University found that 53 percent of Virginia voters oppose ObamaCare expansion in the state. And opposition isn’t just coming from “right-wingers” as some pundits have speculated — in fact, 55 percent of Virginia independents oppose the expansion as well.
A poll commissioned by the Foundation for Government Accountability in March found that 53 percent of Virginia voters were less likely to re-elect their legislator if their legislator supported the ObamaCare expansion.
A more recent poll, conducted by Roanoke College, also shows that a plurality of Virginians oppose expansion. Even more striking, 61 percent of those polled oppose the governor’s talk of cutting the legislature out of the debate and expanding via unilateral executive order.
These sames trends have made their way to the ballot box in Arkansas, a state that some Virginia lawmakers are hoping to emulate. In the May primaries, a key House architect of Arkansas’s ObamaCare expansion was defeated by a political newcomer, after out-fundraising him by nearly three-to-one. Another pro-ObamaCare Republican state lawmaker was soundly defeated by double-digits in his primary contest — an almost unheard of phenomenon in a state that was struggling to find Republican candidates just a few election cycles ago.
The question for Virginia lawmakers who are flirting with ObamaCare Medicaid expansion is, “Do you feel lucky?”
Politics Aside, ObamaCare Expansion is Bad Policy
We’ve written at length about the negative impact of Medicaid expansion from a policy standpoint, but a few points bear repeating once again.
While the state wrestles with a $2.4 billion budget shortfall, lawmakers should remember that expanding Medicaid will only make this problem worse. None of the expansion funding can be used to shore up existing shortfalls or to provide care for current enrollees. It is reserved to create a new entitlement for working-age adults. Nearly 80 percent of these adults have no dependent children, more than 40 percent do not work at all and more than a third have prior involvement with the criminal justice system, including having spent time in jail or prison.
Meanwhile, current Medicaid enrollees — the truly needy — will be first on the chopping block, should Virginia decide to accept the expansion. In Arkansas, the Gang of Three’s apparent inspiration, this isn’t just a talking point: truly needy children like Chloe Jones are already being harmed while hundreds of thousands of able-bodied adults receive care at no cost to them.
And it’s not just the truly needy who will suffer: ObamaCare expansion will steal millions of scarce public dollars from schools, roads, and law enforcement services. That’s a big reason why some Virginia school board members are speaking out in opposition to McAuliffe’s ObamaCare plan. And let’s not forget: the federal share is partially paid for with more than $700 billion in cuts to the Medicare program, which federal actuaries say could jeopardize access to care for seniors.
Finally, in a few very short years, expansion will make the Virginia’s budget problems much worse as the state is put on the hook for a larger and larger share of the cost. It’s a nightmare in the making, but one that Virginia lawmakers have the chance to avoid.
A Better Way Forward
Speaker Howell said it best in a recent interview:
[ObamaCare expansion is] such a big new entitlement at a time when we need to be looking hard at the cost of entitlements.
Instead of rushing headlong into ObamaCare expansion, Virginia should be working towards policies that will promote lower health care costs for everyone. Legislators could accomplish this by following Speaker Howell’s lead, working towards a plan that utilizes true market principles and doesn’t count on unreliable federal funding.
In this special session, Virginia legislators have a chance to protect patients, protect taxpayers, and protect their state’s health care system by resisting an ObamaCare takeover. They should take it.
TWITTER: @JoshArchambault, and @nhhorton, and follow The Apothecary on Facebook. Or, sign up to receive a weekly e-mail digest of articles from The Apothecary.
UPDATE: The chart of Census data was updated, as the original contained an error.
