RICHMOND, VA - A new legislative commission on overhauling Virginia's Medicaid program elected as its leaders two Republicans from Augusta County leaning in different directions on possible expansion of the health care program for hundreds of thousands of uninsured Virginians.
Sen. Emmett W. Hanger Jr. was named chairman of the Medicaid Innovation and Reform Commission, and Del. R. Steven Landes its vice chairman in the first meeting of the panel since the General Assembly created it as a gatekeeper for expanding Virginia's Medicaid program under the Affordable Care Act.
In a meeting interrupted by raucous protests from citizens opposed to the federal health care law, Hanger said he supports state action to reform and possibly expand the Medicaid program as early as the middle of next year.
"We cannot do nothing in Virginia," said Hanger, chairman of the Senate Finance Committee's subcommittee on health and human resources.
Landes represented a different view from the House of Delegates, where Speaker William J. Howell, R-Stafford, publicly stated that he appointed five members to the commission who would oppose expanding Medicaid.
"Our federal government is broke," Landes said in opening remarks. "They say they're giving us new funds (to pay for expansion), but some of us are concerned about where the dollars are going to come from and whether they're going to be there."
Ultimately, the debate comes down to money -- up to $31 billion in federal funds to pay for expansion in Virginia over the next 10 years, including 100 percent of the cost of extending coverage in 2014 through 2016. Beginning in 2017, the federal share would scale back gradually to no less than 90 percent of the cost.
For lawmakers, the prospect of losing federal funding competes with the fear of taking on bigger bills in the long run for a program that already accounts for 21 percent of the state budget.
The longer the state waits before expanding the program, the less federal help it will get to pay the bill, Hanger said in an interview after the two-hour inaugural meeting. "When you get beyond Jan. 1, that's when the clock ticks and you begin losing federal dollars."
On the other hand, Landes said he does not foresee the new panel approving Medicaid expansion this year or without the support of the full General Assembly, even those it is empowered to do so.
"The General Assembly is going to have to take action, one way or another," Landes said after the meeting.
The new commission will meet again in August and October to review progress in reforms the state must undertake before expansion could proceed. No vote is expected before December, after the election of a new governor, lieutenant governor, attorney general, and members of the House of Delegates.
Two veteran Republican delegates lost primary elections last week. One of them, Del. Beverly J. Sherwood, R-Winchester, appeared Monday as a member of the new commission for the remainder of her term.
The politics of the issue reflects the larger national shouting match that has raged since Congress narrowly approved the Patient Protection and Affordable Care Act in 2010. The U.S. Supreme Court ruled the law constitutional a year ago, although it made Medicaid expansion optional instead of mandatory for states, and the law's principal champion, President Barack Obama, was re-elected in November.
"The issue of the Affordable Care Act was decided in the election," Senate Finance Committee Chairman Walter A. Stosch, R-Henrico, told an audience filled with green-shirted opponents of the law who just had come from a Capitol rally organized by Americans for Prosperity. "We're not here to decide that particular matter."
Some of the protesters voiced their opposition loudly during the meeting, demanding repeal of the law, which was adopted by Congress, not the Virginia General Assembly.
But most of the meeting was devoted to the hard facts of reforming a complex program that Virginia shares with the federal government to provide health coverage to almost 1 million Virginians.
More than half of the program's recipients are children, but they account for just 21 percent of its cost in Virginia. Similarly, pregnant women and parents with extremely low incomes represent an additional 10 percent of the cost.
In contrast, elderly and disabled Virginians requiring long-term care services in nursing homes and elsewhere account for 7 percent of the program's recipients but 35 percent of its cost.
Expansion would extend coverage for the first time to childless adults, as well as to disabled Virginians and parents earning up to 133 percent of the federal poverty level, which is $31,322 for a family of four.
About 70 percent of Virginians who would become eligible for Medicaid under the expansion live in households where at least one person works full or part time -- an issue for lawmakers concerned about helping those who don't help themselves.
"Most of these folks are working or making an effort to work," said Secretary of Health and Human Resources Bill Hazel. "Some of them are not, but the majority are."
Hazel and the state's Medicaid agency have been working since last year on major changes to the program that the state wants to accomplish to reduce costs while coordinating and improving care for people who too often go to hospital emergency rooms for basic medical care.
They outlined a series of 19 initiatives that must be addressed to reform the program before expansion can occur under language adopted as part of the state budget this year.
While Gov. Bob McDonnell opposes expansion without significant reform, his administration has worked closely with the Obama administration on initiatives that will give the state more flexibility in how it administers the program -- most notably a newly approved pilot project for elderly and disabled Virginians who are eligible for both Medicaid and Medicare, the federally run health care program primarily for the aged.
State officials see the approval of the "dual eligible" project and other long-sought reforms as the result of federal desire for Virginia to expand its Medicaid program, as well as support from Marilyn Tavenner, Hazel's predecessor who now runs the federal Centers for Medicare and Medicaid Services in Washington.
"The feds are willing to discussion things that have not been on the table," Hazel said.
mmartz@timesdispatch.com
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