After the Special Session began on the 24th of March, I started to write a column that never got published. The column began as follows:

I have always thought that it is important to maintain a sense of wonder, a sense of amazement at life’s twists and turns. That sense of wonder keeps you from taking for granted the people and places in your life that are important. So it is with some pride that I can report that on the 25th of March, the first daffodil bloomed in my yard. However, I can also report that bloom was soon covered with snow as winter is playing the part of Gilda Radner in that old Saturday Night Live skit about the guest who would not leave… speaking of guests that will not leave, the General Assembly is still in session.

The Governor called the Virginia General Assembly into Special Session for the purpose of passing the budget. The Constitution requires that we adopt a balanced budget every two years. For the most part, finalizing a budget compromise is not a significant problem. This year, the House and the Senate, Democrats and Republicans, are hung up on the notion of Medicaid expansion.

The real debate does not revolve around healthcare. After all, most people recognize that it makes sense for us to close the coverage gap and provide insurance for up to 400,000 people. After all, a healthier workforce makes for a smoother, more effective economy. Insurance coverage means more illnesses are prevented, and it is simply the right thing to do to help people stay well. The hang up is on the details of this particular plan. The column that I started a few weeks ago was shelved, at least in part, because it reflected my pessimism about the Special Session. I like to remain optimistic.

The real debate this year is about the way healthcare is provided. Those who argue against Medicaid expansion are concerned the federal government will not be able to meet its fiscal obligations and the burden will fall on Virginia’s taxpayers. It seems to me that this is an argument that can be made about any federal program. But unlike some federal programs, like Medicare Part D prescription coverage, Medicaid expansion has a funding source set out in the Affordable Care Act. In 2002-2003, Medicare was expanded to provide a prescription drug benefit. There is no question that this program was needed, but in passing it, Congress and the President failed to fund it. Every cent of Medicare Part D that has been spent over the last 12 years has been borrowed money. The Affordable Care Act on the other hand, is paid for through tax and fee increases at the federal level. In fact, Virginians are paying about $2.9 billion a year for Medicaid expansion. What sense does it make to pay for a program that Virginians cannot access?

For some, opposition to expansion is just a continuation of frustration over the passage of the Affordable Care Act. The appropriate place to have a debate over federal programs, how they are funded, and over the size and scope of the federal government is not in the state legislatures, but in Congress and in federal elections. That is precisely why Republican senators have joined Democratic senators to pass Marketplace Virginia. While we have rejected outright Medicaid expansion, we have adopted a Virginia approach that will allow us to provide insurance coverage to hundreds of thousands of people, and bring the federal dollars that Virginians pay in taxes for the Affordable Care Act back to Virginia. Who can argue that over $5 million a day in federal funds will not have a positive impact on Virginia’s economy?

In fact, expanding access to our healthcare system will require the addition of jobs to take care of those people. And, access to preventative health care, rather than relying on expensive treatment in emergency rooms for unmanaged illnesses, will save money. In part, the Affordable Care Act cuts some Medicare reimbursements. Those cuts will cost Virginia hospitals in excess of $300 million. Why should we not accept federal money to expand coverage, to make those hospitals whole, and to increase the healthcare workforce?

From where I sit, the hang up now is not over what is the right thing to do for Virginia. The hang up between the Senate and the House of Delegates is purely political. The House says no to Medicaid expansion, so the Senate offers Marketplace Virginia, a private insurance based program. The House continues to say no. Anything linked to the Affordable Care Act is anathema to some, whether or not it is beneficial to Virginians, to our hospitals, and to our overall healthcare system.

Anyone watching the recent episode of 60 Minutes that contained a story about healthcare in rural southwest Virginia recognizes that we have a huge gap in the number of people that are covered in Virginia. We need to address it now. The way to close the gap between the House and the Senate and get a budget passed in Virginia is to adopt Marketplace Virginia and do it now.