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Republicans: Medicaid expansion should be separate from budget
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Del. Charles Poindexter
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Monday, March 31, 2014

By K.A. WAGONER - Staff Writer

While the Virginia Senate and House of Delegates are at an impasse over Medicaid expansion, the budgets proposed by each chamber are less one-tenth of 1 percent apart.

"The differences could be resolved and passed in a day or so," said Del. Charles Poindexter (R-Glade Hill), who is a member of the House Appropriations Committee that crafts the state budget. "Gov. (Terry) McAuliffe, however, has insisted he will not agree to a budget that does not contain Medicaid expansion, and the Senate Democrats have gone along with this, effectively holding the budget -- and funding to local governments, teachers, schools, and law enforcement -- hostage."

Poindexter and Sen. Bill Stanley (R-Glade Hill) held a press conference Friday afternoon in response to Gov. Terry McAuliffe's visit to Carilion Franklin Memorial Hospital to advocate for Medicaid expansion.

"The governor brought his Medicaid roadshow to town today," Stanley said. "Whether you support or oppose Medicaid expansion, Virginia cannot afford to have any single issue obstruct the passage of a biennial budget and threaten a shutdown of state government."

The Republican solution is to pass a budget and take up the Medicaid expansion issue as a separate legislative matter in a special session, Poindexter said.

"If Medicaid expansion is such a good proposal, let it stand on its own to be debated and voted on, rather than forcing it on Virginia, so teachers can get their paychecks and local governments can receive funding," Poindexter added.

"You can't endanger funding for state government responsibilities and risk a shutdown every time you fail to get one of your policy priorities through the General Assembly," Stanley said of the governor's push for Medicaid expansion. "It's time for the governor to end his roadshow and get down to the people's business."

Last year, both chambers of the General Assembly agreed to thoroughly review the Medicaid issue via the creation of the Medicaid Innovation & Reform Commission (MIRC) before taking any steps to expand the program, said Poindexter, who is also a member of MIRC.

MIRC was created to identify and implement reforms to the current Medicaid program prior to determining whether Virginia should implement the federal Affordable Care Act's (ACA) expansion of Medicaid, he said. The General Assembly agreed at that time the expansion should not be part of the budget process, "so critical state funding to schools, localities and public safety would not be impacted by a budget stalemate, which, unfortunately, is exactly what we're experiencing now under Gov. McAuliffe."

MIRC has worked to address necessary reforms to the current Medicaid program and research the flexibility, cost, and quality care components in various hypothetical expansion scenarios.

"What we have found is troubling," Poindexter said. "Only 25 states have decided to expand Medicaid, and in those states, ER visits remain high, doctors are refusing to accept new Medicaid patients due to low reimbursement rates, and the federal government will not grant permanent flexibility waivers to the states to make cost and quality of care reforms to the program."

Currently, 22 percent of Virginia's entire budget is devoted to Medicaid, and that number is steadily growing each year, Poindexter said. At a national level, it is estimated 30 percent of the program is lost to fraud, waste and abuse.

In 2012, former Attorney General Ken Cuccinelli recovered $200 million in Medicaid fraud through a detection program that has since served as the national model for Medicaid fraud investigation, he added.

"Every dollar of that 22 percent of the state budget that is wasted or abused is a dollar that is lost to K-12 and higher education, local governments, our law enforcement officers, and other health and human services," Poindexter said. " Therefore, I find it very irresponsible to not first reform the current program, focusing on cost-savings and health outcomes measures, and then evaluate whether it should be expanded."

McAuliffe's budget proposal includes a "pilot program" plan that the governor says will make Medicaid expansion temporary. However, Stanley said there is "no such thing as a Medicaid pilot program."

"Most of his (McAuliffe's) 101 budget amendments assures the expansion is permanent, not temporary," Stanley said. "If we expand the program, we can't come back two years later and drop those people. We would have one of the biggest class action lawsuits the state has ever seen."

Stanley also addressed the current backlog for Medicaid coverage, saying that 44,000 people are already waiting for coverage.

"If we add another 200,000 to the rolls, how can the government handle it?" he asked. "It would be a bureaucratic nightmare."

Another issue driving the Medicaid expansion debate is the ACA's cuts in Medicare that will have a significant negative impact on hospitals and healthcare providers, Poindexter said. One way the ACA is funded is through $700 billion in Medicare cuts, and just recently the Centers for Medicare & Medicaid Services (CMS) accelerated these cuts to Medicare and Medicare Advantage plans.

"Because Medicare is a large revenue source for hospitals (close to 50 percent in this region), many hospital administrations are pushing Virginia legislators to accept the ACA's expansion of Medicaid so federal dollars will flow in and offset the Medicare cuts," Poindexter said. "I do not accept the argument that Virginia must expand an already ballooning government program at serious financial risk to taxpayers to fix a federal problem President Obama and Senator Warner created with the Affordable Care Act." 

Stanley ended his remarks by publicly vowing to work with Democrats and the governor on Medicaid expansion during a special session to find solutions to help the working poor, as long as we "put everything on the table," he said. "We need to find a way to bring down costs and improve delivery of services. But we have to be deliberate in our approach."

As for Virginians, only 4 percent of voters think Medicaid expansion should be the state's top priority, according to a poll by the Quinnipiac University Polling Institute, Poindexter said. In the survey, voters listed the top priorities as jobs, education and the economy.

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