House Appropriations Committee Budget and Medicaid Expansion.

This past Sunday, the House and Senate money committees released their separate versions of our Commonwealth’s biennial budget. I serve on the House Appropriations Committee and chair the Health and Human Resources subcommittee of that body.  Many of you may have read the headlines that the House of Delegates is “expanding Medicaid.”  Let me address some of the confusion and misinformation on this.

I have consistently voted AGAINST Obamacare Medicaid expansion, due to the unsustainable costs of the current Medicaid program and my concerns about Washington’s commitment to pay for most of the expansion.  Those concerns are not going away, but with Congress’s inability thus far to repeal and replace Obamacare- and the new political reality in Richmond- the topic of Medicaid expansion has overwhelmed our budget conversations and priorities.  Virginia has to live within that reality as we try to address our own healthcare challenges.

If the House of Delegates does nothing with our Medicaid program, we could very well end up with Obamacare Medicaid expansion without any reforms, or end up in a Washington-style budget impasse that Virginia cannot afford.  Unfortunately, there are a few of my colleagues who have publicly stated they will support Medicaid expansion no matter the design.  This is simply unacceptable to me.  You elected me to represent you and your family- and that includes protecting your hard-earned tax dollars.  While I remain hesitant about expansion, I cannot ignore our duty to have a balanced budget and to fund the core essential functions of state government.

The House budget that was released on Sunday includes language to require Virginia to begin working with the Trump Administration to use federal Medicaid funds to provide health insurance to low-income Virginians, while ensuring that key conservative reforms- like a work requirement, cost-sharing, and personal responsibility incentives- are included. Our plan is very similar to the conservative approach Vice President Mike Pence enacted into law while he served as Governor of Indiana.

One of the most important reforms to the Medicaid program is a work requirement, which we call the “Training, Education and Employment Opportunity” program. Virginia led the way in the 1990s to help people get off public assistance and into good paying jobs. We need to replicate the success of “workfare” in Medicaid.  The details on this requirement for meaningful employment have yet to be worked out.

One of our biggest concerns is that Virginia will get stuck paying more. The House budget took steps to protect taxpayers by requiring hospitals to pay for the additional state cost.  The plan requires hospitals to pay for 100 percent of the state’s share of the cost, which is currently 6.5% and will increase to 10% by 2020. They will benefit immensely from increased federal healthcare funding. They can and should pay some of the cost to protect Virginia taxpayers.  We also created the “Taxpayer Safety Switch,” to make sure that if the federal government ever backs out of its commitment to pay its 90% share of the cost the new plan will end.

My longstanding concerns with the cost of Medicaid expansion aren’t going away, but unfortunately the Affordable Care Act is not going away and the Trump Administration is the best chance we have to secure conservative, responsible reforms to the Medicaid program. Each year I have represented you in Richmond, we have worked to transform our Medicaid program, in areas like mental health access, managed care design, and ways to address the opioid crisis.  This year is no different.

The budget is not final. The House and Senate versions of the budget are currently $600 million apart. I look forward to working with my colleagues in both chambers to secure the most fiscally responsible budget in the end.

Thank you for allowing me to share my thoughts on this important topic with you this week.  I look forward to coming back next week to provide even more detail about the good things being done in Virginia’s budget.  Until then, feel free to contact me at DelSGarrett@house.virginia.gov or (804) 698-1023.  Have a wonderful week!