Sunday, January 29Hampton Roads Weekly


Media reporting on this year’s Virginia General Assembly session focused on the primary disagreement that resulted in an extended budget impasse: Obamacare’s optional program to expand the entitlement state by extending Medicaid benefits to able-bodied adults.

This disagreement has been part of each of the last five General Assembly sessions, but advocates for the full implementation of Obamacare in Virginia took a different approach this year.  Having watched Governor McAuliffe repeatedly try and fail to extend this entitlement to those not currently eligible, Obamacare supporters attempted to rebrand Medicaid expansion as “conservative.”

Expanding Obamacare in

Virginia will cost the state over $300 million, accelerate the rate of growth of the fastest increasing portion of the state budget, and grow state government by more in a single year than at any time in at least a generation.  There is nothing even remotely conservative about it because there is no conservative way to expand Obamacare.

Originally designed to help those most in need, Medicaid represented a tiny percentage of Virginia’s budget when first enacted over fifty years ago.  Now, even before expansion, it accounts for 23% of General Fund expenditures.  According to a December 2016 report by the Joint Legislative Audit and Review Commission, Medicaid grew at a rate of 8.9% annually over the last decade.  With the enactment of Obamacare’s expansion of the program, the number of those receiving benefits will immediately increase by more than 30%.

The dramatic and unprecedented growth in this social safety program comes with other less-than-desirable features.  In order to pay for the Commonwealth’s current share of the expense of expansion, a brand new $600 million tax has been imposed on Virginia’s hospitals.

What, then, would cause those who voted for this plan to claim it is somehow “conservative?”  Proponents have most frequently cited provisions for a work requirement and what they call a “taxpayer safety switch.”

States that have already expanded Obamacare have been proposing work requirements as a way to curtail the program’s growth.  But, those proposals have reporting requirements,

administrative expenditures to monitor and enforce compliance, and penalties for those who fail to comply.

Delegate Jason Miyares (R-Virginia Beach) sponsored legislation this session that would have given Virginia a real work requirement for Medicaid.  The legislation he introduced was structured similarly to those being enacted in states that have already expanded Obamacare.  In order to win the approval of Governor Northam and General Assembly Democrats, the House gutted the sensible, conservative features of Delegate Miyares’s bill.

I sponsored a budget amendment which would have given Virginia a stringent work requirement with a kill switch if the Federal Government would not reimburse the state of Virginia at the 90% level.  It was defeated 21 to 19 in the Senate. With 19 Democrats and 2 Republicans who did not want a real work requirement.

What was passed as a work requirement has no reporting requirements, no penalties for failing to work, no implementation standards, and, most concerning, insufficient funding for implementation.  But to ensure Medicaid expansion will not be delayed, the Northam Administration will only be required to apply to Washington for a waiver to enact its work suggestion.

Under the terms of the budget approved by the General Assembly, Medicaid will be expanded even if the work suggestion plan is rejected by the federal government or tied up in federal court (as Kentucky’s plan currently is).  And as has been evidenced by the recent federal court cases halting work requirement plans, these reforms are likely to be on hold for years and may never be enacted.

The second way proponents claim Obamacare expansion became conservative is with the addition of a “taxpayer safety switch.”  Advocates claimed this provision would allow Virginia to end the program in the event the federal government fails to cover its share of the expense.

This provision is an unenforceable farce.  The “safety switch” was a scheme originally concocted by Governor McAuliffe, not House Republicans.

And, it was a feature of all of McAuliffe’s proposals to expand Obamacare during his term.

In a speech to the House of Delegates on February 11, 2014, then-Delegate (now Speaker) M. Kirkland “Kirk” Cox (R-Colonial Heights) derided the idea that Virginia could rescind Obamacare expansion as McAuliffe claimed, stating, “The idea that somehow Virginia can back out of Medicaid expansion is a pipe dream.  It is like a bad warranty from a used car salesman.”

Saying something is conservative doesn’t make it conservative.  There is simply no way to characterize the massive expansion of state government, the ballooning of the state budget, and a reliance upon an uncertain revenue stream (the Trump Administration’s budget phases out Medicaid expansion funding) as conservative.

Exacerbating this situation, Virginia’s working families are dealing with dramatically increasing health insurance premiums, skyrocketing deductibles and out-of-pocket expenses, and higher medical costs.  Obamacare’s Medicaid expansion does nothing to address any of these problems.  It will not reduce a single monthly premium, lower any family’s deductible, or decrease the cost of healthcare.

Adopting Obamacare’s optional Medicaid expansion scheme was a mistake for Virginia.  And, there is nothing that can be done to Obamacare to ever make it conservative or affordable.

William R. “Bill” DeSteph, Jr. represents the 8th District in the Senate of Virginia.  The 8th District is comprised of portions of the City of Virginia Beach.