Crossover and Medicaid Expansion

This past week the General Assembly saw the crossover and lots of chest thumping. Both sides, Republicans in the House of Delegates and Democrats in the Senate, claimed to be the source of all things moderate and reasonable. The proof, however, is in the pudding, and people can make their own judgments. The big hang up at this point remains from the opening day of session: Medicaid expansion.

Paying for Medicaid Expansion

As explained in this space before, Medicaid expansion is an optional part of the Affordable Care Act. Payment for expansion, however, is not optional. Funding comes from federal taxes. People are already paying increases in taxes on insurance premiums and in other areas. Virginia taxpayers will continue to pay those taxes whether or not we expand Medicaid; however, if we don’t expand in Virginia, our taxpayer dollars will be spent to provide coverage to residents in other states. Virginia loses in excess of $5 million in federal funding every day that we don’t expand Medicaid.

Last week Senator John Watkins, a Republican from Powhatan, revealed a new approach to Medicaid expansion. His proposal, which would need to be approved by the federal government, would allow us to put our own brand on expansion and provide coverage to an estimated 285,000 people. The plan, Marketplace Virginia, requires recipients of the new coverage to pay a premium, just as they would if they had private insurance. The proposal also includes language we inserted into the budget last year that says if federal funding ever dips below 90 percent of the cost of expansion, Virginia will be allowed to withdraw. As explained before, under existing law, the federal government will pay 100 percent of the cost of expansion for three years, reduced to 90 percent in the sixth year of expansion. The premiums will be collected to apply against the state’s share of the cost.

Members of the House of Delegates argue that reforms to Medicaid must occur before expansion. Two of the primary concerns, however, are already written into the law. We already establish a minimum 90 percent funding level, and we require the payment of premiums. Requiring some form of financial responsibility on the part of the insured is a significant reform. What’s more is the unbelievable pressure that the cost of providing for the uninsured puts on our health care system. That pressure has shut down hospitals in Virginia and in other parts of rural America. Expansion of Medicaid will provide the necessary funding to keep rural hospitals open.

Impact of Medicaid Expansion on Treatment of Mental Illness

And, important to me, expansion of Medicaid requires equity between the treatment of mental illness and other illnesses. This will pump over $200 million a year into Virginia’s treatment for mental illness. Without question, this will raise the level of mental health care higher than we have ever had in Virginia. Expanding insurance coverage, passage of the omnibus mental health bill, and a comprehensive review of our system has the potential to bring much needed transformations in the delivery of mental health care in Virginia and put the Commonwealth in a leadership position among the fifty states in the treatment of those who suffer mental illness.

As Virginians we should not expect to be any less than leaders.

I continue to be overwhelmed by the kindness and the support I receive from constituents, people around Virginia, and people all over the country on a daily basis. It remains my distinct honor to represent you in the Senate of Virginia. If I can be of service, do not hesitate to contact me at PO Box 396, Richmond, VA 23218,, or (804) 698-7525.