Friday, August 22, 2014

Virginia is having an insane fight over Medicaid expansion

Drew Angerer / Getty News Images

There is a tense and increasingly unbelievable fight over Medicaid expansion happening in Virginia. It now involves a huge political fight, a potential government shutdown and one apparent bribe to get a legislator out of office — and that's only the beginning.

To back up: Virginia is among the 24 states that have not committed to participating in the health law's expansion of the public program. Tens of thousands of Virginians would be eligible for Medicaid coverage under expansion although there are some discrepancies in estimates of how many: the Virginia governor's office estimates 4000,000 could benefit while Kaiser Family Foundation ballparks the number at 98,000 Virginia residents.


Democratic Gov. Terry McAuliffe has been an ardent supporter of Medicaid expansion since he came into office this past January. He even drew up plans for how the Medicaid expansion would work in the state, down to the technical upgrades that computers would need.

This all happened as the Republican-controlled Virginia House was dead-set against expansion and passed a budget that didn't fund the program. The Senate, meanwhile, passed a budget that did fund the Medicaid expansion. That body is evenly split between 20 Republicans and 20 Democrats but in Democrat-control because the state's lieutenant governor, who is the tiebreaker, is a Democrat.

The whole fight is coming to a head right now because by the end of the month the Virginia government needs to pass a new budget. Because the House  budget doesn't fund the Medicaid expansion and the Senate budget does, negotiations are gridlocked.

McAuliffe appears unwilling to budge and pass a budget that doesn't expand Medicaid. Instead, his staff is exploring two options: whether they could use an executive order to expand Medicaid or, if they can't, how they could manage the first government shutdown in Virginia history. Here's how the Washington Post's Laura Vozzella (who is doing the best reporting on this story) describes it:

McAuliffe (D), who ran for office as a bipartisan dealmaker, continues to say publicly that he wants to find a legislative solution to the Medicaid standoff. But with the start of the new fiscal year less than a month away, the governor appears to be mulling over the extraordinary use of executive power, both to keep the lights on in state government and to muscle Medicaid expansion past the legislature.

Either move would be a brazen challenge to the General Assembly, which under the state constitution has sole authority to appropriate money, including $2 billion a year in federal pass-through funds that would bankroll the Medicaid expansion.

The latest twist in the story is arguably the craziest: Republicans appear to have persuaded a Democratic Senator to resign his seat in return for "awarding his daughter a state judgeship and himself a job as deputy director of the state tobacco commission" Vozzella reported Sunday night.

This would give Republicans at least temporary 20-19 control of the Virginia Senate, which may be all they need to pass a budget that excludes Medicaid expansion. And it gives the Democratic Senator a pretty nice state government job to boot.

How exactly this ends isn't clear at this point. But it does point to the rest of the month being all out political war in Richmond over whether the state expands Medicaid. And it is arguably the most tense Obamacare fight happening anywhere in the country right now.

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