medicaid expansion

After four years of resisting Medicaid expansion in Virginia, 20 Republican lawmakers in the House of Delegates relented and helped to push a limited, bipartisan expansion across the finish line, a vote one conservative member believes the GOP will live to regret.

“I think this is going to prove to have been a very, very bad decision,” said Republican Del. Nick Freitas, who is also a candidate for U.S. Senate this year.

Former Democratic Virginia Gov. Terry McAuliffe pressed for full Medicaid expansion for four years.  He failed each year, given the GOP’s roughly 2-1 majority in the House of Delegates.  However, in November, Democrats picked up 15 seats, leaving the Republicans with a slim 51-49 majority.

Earlier this week, Virginia House Speaker William Howell announced a bipartisan agreement to expand Medicaid in Virginia, but with certain conditions, including work requirements and the ability to reverse the expansion if the federal government fails to deliver the funding it has promised.

On Thursday, the plan cleared the House of Delegates, 69-31, with all Democrats and 20 Republicans voting for it.  There is still an uncertain future, however, since the Virginia Senate did not include Medicaid expansion in it’s budget, meaning the issue will be resolved in a House-Senate conference.

Freitas says Howell and other Republicans have reasons for what they did but he says it was still a big mistake.

“It’s frustrating.  I certainly understand where the speaker and other members are coming from with respect to being concerned that a full expansion is in the works.  So their attitude is that we’ve got to do something first in order to make sure that we get certain provisions in there that Republicans have asked for in other states,” said Freitas.

“We just voted on it on the House floor today and unfortunately it did pass with 31 Republicans voting against it.  So it was actually a minority of Republicans in the House of Delegates that voted for the Medicaid expansion within the budget,” said Freitas.

Freitas says this is a terrible idea both fiscally and in terms of health policy.

“This is bad not only from a fiscal standpoint, which we tend to focus on a great deal but I think it’s bad also when you look at the underlying problems with respect to Medicaid.

“This is a program that is failing people not only from a fiscal standpoint, but it’s actually failing people with respect to the quality of health care that it’s supposed to be able to provide.  I don’t think any of us should be shocked by that.  That’s what happens when a government tries to micromanage a program,” said Freitas.

But were Republicans wise to head off a much worse program that could have passed instead of this one or should the GOP have avoided this path altogether?

“You can make a reasoned argument that something worse could come.  The question is how complicit do you want to be in the end product.  I don’t think there’s a good way to expand Medicaid, period,” said Freitas.

He also says the provision to reverse the expansion in certain circumstances may sound reassuring but believes that would never happen.

“If we don’t have the will to prevent a bad program from expanding, I don’t see how we’re suddenly going to have the will to kick off hundreds of thousands of people that we’ve made dependent upon that program once it’s gone into play,” said Freitas.

The argument that the bipartisan bill had to be pursued to avoid a more liberal version begs the question, since Republicans still control both parts of the legislature.  Were some Republicans prepared to vote for full expansion without the GOP conditions?

“I think that’s a fair assessment.  I do believe that there were some Republicans that were willing to vote for a full expansion,” he said.