Jeff McWaters: The conservative case for expanding health coverage in Virginia

As advocates go, I am about as unlikely as it gets for Medicaid expansion.

“Outspoken opponent” is a fair characterization of my position regarding expansion under the Affordable Care Act during my time representing Virginia Beach in the state Senate.

Even now, I’m no cheerleader for the idea. I am, however, a realist.

And the plain truth is that at the federal level our Republican Party has abdicated the mantle of leadership on health-care reform. That’s left conservative legislators in Virginia in an awkward position.

For years, Virginia Republicans faithfully rejected the siren call of Medicaid expansion based on assurances that the courts would dismantle the ACA. Or that congressional Republicans would provide a conservative replacement plan that would cost less, provide better coverage, and reduce government involvement.

Those empty assurances were exposed last summer when the U.S. Senate failed to muster a simple majority of 51 votes, not the 60 normally required, to repeal and replace ACA.

To add insult to injury, the alternatives offered by Congress would have rewarded states that expanded Medicaid eligibility while shortchanging those that stood firm in opposition. That’s hardly a way to reward loyalty and commitment to conservative principles.

Realizing this, Republicans in the Virginia General Assembly have regrouped.

***

The House of Delegates’ Republican majority has made the best of a difficult situation by developing a plan that helps people with the expectation they will take ownership of their lives and their health. Able-bodied people who enroll in the health benefit program will be working or in a work-training program.

Participants will pay a portion of their health-care costs just as other families do, and people will be incentivized to be healthy. Having skin in the game is a critical aspect of health care, and I believe this plan makes sense for hard-working Virginians.

Like it or not, the ACA is the law. Alternatives congressional Republicans offered last summer confirm they don’t have a better plan to repeal and replace. Given that, Virginia’s legislative Republicans have seized on the opportunity to work with President Trump to enact conservative reforms on a program that is here to stay.

While we might wish for a different outcome, the available options aren’t appealing. Virginia can continue to watch billions of our tax dollars leave the commonwealth, never to return. That’s harmful to the economy. Truth be told, it’s also risky for Republicans at the polls at a time when voters are highly focused on health care.

Virginia Democrats are already within striking distance of passing outright Medicaid expansion, without any conservative reforms attached.

The plan Virginia House Republicans have developed presents an opportunity to accomplish real conservative entitlement reform, just as Virginia did in the mid-1990s with welfare reform. Delaying action could result in an outcome that isn’t as much of a bipartisan compromise as the deal we can make now.

***

For years, many in our party resisted Obamacare as an article of faith. What we must now reckon with is the fact that Obama is gone from office, that the public mood has shifted, and that our health-care system operates on the idea that even the uninsured aren’t turned away when they need care.

I hope what has been proposed in Virginia is a stepping stone to better, more comprehensive health-care system reforms that deliver on the twin goals of lowering costs and improving patient outcomes.

Just as Virginia led the way on welfare reform, we can also lead the way on health-care reform by setting an example that all people who use health-care services should have skin in the game so they help pay for their own care if they get sick or hurt.

We can encourage more doctors to treat patients on the lower end of the economic scale so that people receive preventative care in the proper setting. This keeps patients out of emergency rooms when that isn’t the right place for their needs to be met.

We successfully persuaded more family doctors to see Medicaid patients during my time as an executive with Amerigroup, a managed care health insurance provider.

We can create a primary care system that allows people to get care when they need it in a cost-effective way, while also encouraging patients to take greater control of their own lives and invest in their personal health.

These objectives are hallmarks of conservatism — individual liberty, personal responsibility, and fiscal prudence. The House of Delegates has offered a path forward on conservative health care reform that is worthy of serious consideration.