Facing a GOP-dominated legislature averse to Medicaid expansion, Gov. Terry McAuliffe on Monday unveiled a more limited plan to expand health services, using his executive authority and available federal funding.
The plan would provide coverage to only about 20,000 of the estimated 400,000 who would be covered if Virginia expanded Medicaid under the Affordable Care Act.
Although he campaigned on expansion and barnstormed the state to hear tales of hardship from uninsured Virginians, McAuliffe could not get the General Assembly on board.
McAuliffe on Monday did not back away from the ongoing political fight with House Republicans over Medicaid expansion. He said the decision to not seek expansion puts the state at a competitive disadvantage with other states — some run by Republican governors — that expanded coverage.
He and health officials have come up with a 10-point plan that would provide additional coverage to 20,000 mental health patients and maximize participation in existing state and federal benefits that cover current Medicaid-enrolled children, veterans and pregnant women.
The administration says its approach requires no immediate assembly action. It would use about $40 million in carry-over funds for the last six months of the 2015 fiscal year, which ends next July 1. Going forward, however, the program would require approximately $80 million in state funding per year, which would be subject to assembly action.
In each year, the state contributions would be matched by federal dollars of at least equal or greater than state spending.
A large component of the program seeks to maximize enrollment in the existing ACA, with statistics showing an additional 160,000 Virginians could currently qualify for benefits but are not enrolled.
Next week, the assembly will return to Richmond for a special session to discuss the issue of Medicaid expansion. Earlier this year, House Republicans through budgetary maneuvers and superior numbers blocked McAuliffe from using his authority under the state budget to authorize acceptance of Medicaid expansion dollars.
Democrats have criticized Republicans for rejecting the expansion plan and not offering an alternative proposal to address the coverage gap.
Both Senate and House leaders spoke of an eventual need for legislative approval of McAuliffe’s proposal.
Speaker of the House William J. Howell, R-Stafford, said he’s still reviewing McAuliffe’s “proposed changes to Virginia’s Medicaid system.”
“The proposal will require General Assembly approval to be made permanent and will, of course, be given due consideration during the 2015 General Assembly session.”
He said he’s committed “to a full and fair debate on Medicaid expansion” during the upcoming special session.
Senate Majority Leader Thomas K. Norment Jr., R-James City, said, “By not attempting to enact major policy changes unilaterally by executive fiat, and without General Assembly approval, Governor McAuliffe has wisely averted an unwarranted constitutional crisis.”
Norment said the policies McAuliffe announced will be given “due consideration” during the 2015 session.
McAuliffe’s shop says its plan would impact 200,000 lives. Aside from the 160,000 people who could be enrolled through the federal health care exchange and the 20,000 people with mental health illnesses who would receive insurance, the plan includes outreach to about 35,000 children who are eligible for Medicaid and FAMIS, but are not enrolled.
Virginia fashioned the Family Access to Medical Insurance Security program more than a decade ago to expand health care for children outside of Medicaid.
Expanded dental care would be made available to about 45,000 pregnant women on Medicaid or FAMIS. McAuliffe is also proposing to allow state workers to enroll their children in FAMIS, accounting for about 5,000 children.
As part of the plan, the state would develop “health homes” for 13,000 current Medicaid enrollees. The homes are not physical homes but integrate other health care services to enrollees with severe mental illness or “substance use” disorders.
Virginia ranks last in the nation in the number of veterans facilities compared with the veteran population, McAuliffe said. His plan would improve access for 840,000 veterans by taking advantage of federal funding.
McAuliffe also said he would issue Executive Order 27 creating a task force to address prescription drug and heroin abuse, which officials say claims more lives each year than car accidents.
Finally, McAuliffe said the state, tapping federal funding, will improve the “Cover Virginia” website, which helps people determine their benefits and options for health care.
McAuliffe continued his drive for full expansion to draw down federal dollars and provide care to potentially hundreds of thousands of people in the so-called coverage gap. He acknowledged his initiatives do not “solve the larger problem.”
He cited the power the Republican leadership has in the General Assembly to prevent the expansion he sought, but said “what comes with that power also comes responsibility.” He called on the GOP to “start discussion and start acting for those Virginians who elected us.”
Following conversations with leaders in Washington at the Centers for Medicare and Medicaid Services, he said that if the assembly is willing to come to the table, he’s confident that the commonwealth could create a unique program to cover Virginia’s needs.
In a seemingly sarcastic nod to the upcoming special legislative session Republicans called to discuss expansion, the governor said he knows that Republicans “would not waste our taxpayer money in coming back to Richmond” without the intention of trying to come up with a solution.
“Senator McEachin, isn’t that right?” he asked Sen. A. Donald McEachin, D-Henrico, one of a number of Democratic lawmakers, administration officials, health care stakeholders and lobbyists who attended the event in the Patrick Henry Building.
“I’m not so sure, governor,” McEachin responded.
McAuliffe said if they want to come up with a creative idea, he’s all for that.
McAuliffe introduced James Martin, a young man who received life-saving open-heart surgery May 28 only to see his insurance expire on his birthday days later, leaving his grandmother to pay for medicine he needs to stay alive.
“We owe it to the citizens of the commonwealth to provide health care to citizens of the commonwealth,” he said. “This isn’t about politics — it’s about people.”