HARRISONBURG — While Sen. Emmett Hanger delivered one of the key votes that paved the way for expanding Medicaid in Virginia, most of the rest of the Shenandoah Valley’s lawmakers opposed the measure.
On Wednesday, the state Senate voted 23-17 to approve a $116 billion biennium budget that expands Medicaid, a jointly run state and federal program that provides health coverage largely to low-income people, to up to 400,000 Virginians. Shortly thereafter, the House of Delegates approved the budget 67-31.
Democratic Gov. Ralph Northam is expected to sign off on the plan. Doing so would mean Virginia would receive about $2 billion more a year in federal funds.
Democrats have called for expansion the last several years. Proponents argued that Virginians are paying into the federal system without reaping the benefits.
On the other side of the aisle, the GOP has raised concerns that federal funding will not always be available, leaving the state with a program it cannot support.
On Wednesday, Hanger, R-Mount Solon, who co-chairs the Senate Finance Committee, and three other Senate Republicans voted for expansion: Frank Wagner, R-Virginia Beach; Ben Chafin, R-Russell County; and Jill Vogel, R-Upperville.
Local legislators Sen. Mark Obenshain and Dels. Steve Landes, Tony Wilt, Rob Bell and Todd Gilbert voted against expansion.
Hanger, who played a key role in negotiating the budget, said Thursday he was “pretty pleased,” especially since a few more of his colleagues had signed on.
“The budget bill turned out pretty good, I think,” Hanger said. “I think it was a good package. Medicaid, of course, was the controversial part of it, but beyond that I think we also included a lot of other good initiatives, which made it a pretty solid budget.”
Hanger had opposed the “provider assessment” — or tax — on hospitals initially to help pay for the program. He said he relented in negotiations with the House and governor’s office in exchange for more funding for mental health and substance abuse programs. He also stipulated that more money be put into the reserve fund, he said, which should improve Virginia’s bond rating.
With the assessment, hospitals will pay the state’s 10 percent share of expansion, with the federal government contributing at least 90 percent under the ACA, which phased in state funding over a period of several years.
Northam said in a statement Wednesday evening that it was “a victory for all Virginians.”
“This budget doesn’t just expand healthcare access to those who need it most,” he said in the statement, “it also invests in core economic priorities like education and workforce training and significantly increases the cash reserves that insulate our state finances from economic disruption.”
Four Republican Valley lawmakers disagreed.
Bell, R-Albemarle, and Wilt, R-Broadway, both said they were concerned the state could not support an even larger Medicaid program.
Bell said the program has grown significantly the last few years, and called expansion “unsustainable.”
“I am worried that this will simply make it grow even faster,” he said.
Landes, R-Weyers Cave, vice chairman of the House Appropriations Committee, said the decision will increase taxes and leave a “bill in the drawer” for future generations.
“It sets Virginia on the course now for the potential for higher taxes in the future,” he said.
Though the budget bills include language that would allow the commonwealth to disenroll people from the program should the federal government roll back its funding, Landes said he doesn’t believe Northam and Democrats would actually do that.
To sustain the program, he said, Virginia would need to cut its budget or raise taxes.
“The folks on the other side got what they wanted, and we will see,” Landes said. “Hopefully, they will remember when things don’t work out that [this] maybe wasn’t the right decision. Time will tell.”
Obenshain, R-Rockingham, who serves on the Senate Finance Committee, said it’s “a big mistake to double-down on Obamacare.”
“This expansion is being undertaken notwithstanding the fact that it’s not going to help anybody who’s struggling to pay health insurance premiums or deductibles,” he said. “It is expanding a broken system. I just think it’s a wrong turn for Virginia.”
There’s little opponents can do for now, Obenshain said, but wait and see.
“We don’t come back until January,” he said. “So, we will just have to monitor it and weigh our options and see what happens in Congress as well.”
If the federal government changes the program, “it will necessitate revisiting what we have just done,” he said.
Hanger said there are existing and new means to oversee expansion.
The legislature had already established the Joint Commission on Health Care, he said, and the budget bill requires the legislature to set up a “work group” to review and monitor the program’s implementation alongside Northam’s administration.
The legislation also proposes to establish a new unit within the Joint Legislative Audit and Review Commission to deal specifically with health care, he said.
Addressing concerns about funding at the federal level, Hanger said the federal government had “done some things that are basically undermining the insurance market.”
“We couldn’t fix that in our budget,” he said. “The experience of other states has been that when you do expand, it does cause a reduction, just by merely expanding, a reduction in the cost of insurance overall.”