RICHMOND – Democrats delivered an ominous sign about the prospects of passing a Senate budget this week when the party’s five senators on the Finance Committee voted against the bill Sunday.
Their stated beef was the Medicaid expansion amendment in SB 800 that Democrats saw as foot-dragging rather than forward-looking to move Virginia toward implementing a key component of Obamacare.
Three days and some discussions later, Democrats are expressing cautious optimism that at least some of their 20 members will support the budget bill and deliver enough votes to get it out of the Senate.
Both General Assembly chambers – the House of Delegates and the Senate, each controlled by the GOP – are scheduled to vote today on their respective budget bills.
But the suspense is in the Senate because Republicans and Democrats have the same number of members seats in the 40-seat chamber where 20 votes is enough to kill a fiscal bill such as the budget.
Amendments in the House and Senate budgets include language to conditionally expand Medicaid, a government-backed health insurance program for low-income people, under provisions of the federal health care law.
States have an option on Medicaid because of a U.S. Supreme Court decision that left that choice to states, striking a provision of the law that sought to compel state program growth under a threat of lost funding.
McDonnell and some fellow Republicans have resisted expansion even though the feds are offering to cover the majority of expansion costs, at least in the initial years after the program starts in 2014.
They want federal waiver allowing the state can pursue cost-controlling measures before expansion, a concept embodied in the House of Delegates’ budget bill.
Addressing the Finance Committee Wednesday, Virginia Health and Human Services Secretary Dr. Bill Hazel said the governor remains skeptical such allowances will be made to his satisfaction.
Other Republicans are warming to the idea of expansion, particularly if the state sets aside savings it realizes in the early years of expansion.
Sen. Emmett Hanger said a floor amendment to the budget now under consideration would authorize the administration to move forward on expansion even as the state pursues federal flexibility.
“I believe very sincerely this is the most important decision on our table this session,” said Hanger, R-Augusta County.
Medicaid expansion would bring an estimated 275,000 uninsured Virginians, many of them childless adults, into a program that now covers medical care for nearly 1 million needy citizens.
People now covered under the program funded 50-50 between federal and state governments include children, pregnant women, and elderly and disabled adults who meet income guidelines.
The expansion population would have 100 percent of their coverage costs paid by the feds initially; that figure would later drop to 90 percent.
Costs to Virginia through 2022 under that scenario would be $137 million, though Hazel said Virginia’s expenses under expansion would balloon to $1 billion a year if the cost-sharing formula ever dropped to 50-50.
Inaction is also expensive, according to an analysis out Wednesday by the Commonwealth Institute for Fiscal Analysis, which estimated Virginia would lose $5 million daily in federal tax dollars that won’t return to the state starting in 2014.
Looking ahead Wednesday, Sen. Janet Howell said Democrats are prepared to support the Senate budget if it includes “affirmative acceptance of Medicaid expansion going forward immediately” but also calls for program reforms.
Howell, D-Fairfax County, said members of her party won’t support a budget that conditions expansion to federal decisions beyond Virginia’s control.
Even if the Senate budget is amended to appease Democrats, that bill still has to be reconciled with the House spending plan.
-Julian Walker, The (Norfolk) Virginian-Pilot