Time to resolve debate over Medicaid expansion

Published 10:41 am Friday, May 30, 2014

by Bill Bolling

Enough is enough. The time has come to resolve the debate over Medicaid expansion — or coverage expansion, as supporters prefer to call it — adopt a new state budget and move on.

Unfortunately, resolving this issue will require compromise on every side, and compromise appears to be a four-letter word to too many of our political leaders these days.

In reality, compromise is an essential part of a working democracy. Without it, very little can get done. With it, nothing is impossible.

The debate over coverage expansion is complicated. First, the issues are very complex, and difficult for most people to fully understand. Read a primer on the intricacies of how coverage expansion would work and you’re likely to come away scratching your head.

Second, there are legitimate points that have been made by both sides in this debate. There is no right or wrong way to look at this issue. There are just differing ways, and both sides of the debate have offered reasonable arguments in support of their respective positions.

That’s why compromise will be required to resolve this issue. When no one is necessarily right or wrong, the only way to reach agreement is to meet somewhere in the middle — respecting the views of everyone concerned.

There’s another reason why compromise will be required to resolve this debate: The political realities in Richmond demand compromise.

Virginia’s governor is a Democrat and the state Senate is controlled by Democrats. However, there is a solid Republican majority in the House of Delegates. Clearly, no one has the ability to force anyone to accept their point of view. A divided government can only work when our leaders are willing to compromise.

By now we should have learned that reaching agreement on an acceptable Medicaid compromise will not be easy, but I still believe it is possible; and I would like to offer the following as a framework around which a compromise can be built.

First, the issue of coverage expansion should be resolved separate from the adoption of a new state budget. An issue of this magnitude should be addressed in legislation, not in budget language. However, to make certain that all sides honor a compromise, this legislation must be passed at the same time the budget is adopted. This will require some choreography from the legislature, but having spent 18 years in the General Assembly, I can assure you that our legislators are fully capable of orchestrating such choreography.

Second, the Senate’s approach to implementing coverage expansion should be embraced. I like the fact that the Senate has proposed the creation of Marketplace Virginia, which basically means that anyone eligible for insurance coverage through a legislative expansion would secure their coverage through the private insurance marketplace, not Medicaid. Although premium support would be provided by the state, this is exactly the approach Republicans have promoted for years. We now have a chance to put our money where our mouth has been.

Third, we need to find a way to scale back the magnitude of the plan proposed by the governor and the Senate. It is highly unlikely that the House of Delegates will ever support a plan that could impact as many as 400,000 Virginians. A more modest approach should be pursued right now. While this will require creativity, and the cooperation of federal authorities who must ultimately approve the plan, I believe we can find a way to make it happen. A scaled-back plan, perhaps one that would impact 150,000-200,000 Virginians, would be much more likely to survive House scrutiny.

Fourth, the approval of a coverage expansion plan must be accompanied by agreement on a few specific and achievable reforms to the state’s Medicaid program that we can reasonably implement over the next 12 months. I am confident Secretary Bill Hazel and his team will aggressively pursue any and all reasonable reforms the assembly may ask of them. To give them time to achieve these goals and develop guidelines for an expanded health insurance program for qualifying Virginia families, implementation of the coverage expansion should be delayed until July 1, 2015.

Finally, any coverage expansion compromise must include strict language that the program will cease if the federal government ever fails to fully fund the financial commitments it has made under the terms of the Affordable Care Act. Republican leaders in the House of Delegates have expressed reasonable concerns about the federal government’s ability to fund this program over time, and these concerns must be respected in any legislation that authorizes a limited coverage expansion program to move forward.

If our leaders can come to agreement on these five principles, I believe it is possible to resolve the prolonged debate over coverage expansion, finalize our work on the state budget, and move on.The time for making points and picking fights is over. The time for working together to find common ground and resolve an issue of great importance to many Virginians has arrived. It will require leadership and compromise. I believe our elected officials can provide both, and I stand ready to help them in any way I can.

BILL BOLLING is the former lieutenant governor of Virginia and a former member of the Virginia Senate. He serves as chairman of the Virginia Mainstream Project, an organization committed to promoting a more mainstream approach to politics and policy in Virginia. Contact him at www.billbolling.com. This column first appeared in The Richmond Times-Dispatch.