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Local lawmakers: Split budget, Medicaid issues

Sunday, March 9, 2014

By DEBBIE HALL - Bulletin Staff Writer

Local lawmakers say the General Assembly session which ended Saturday was productive, even if there was no approval of a state budget or resolution to the impasse on Medicaid expansion.

Gov. Terry McAuliffe immediately called for a special session March 24, saying he’s hopeful that lawmakers will return ready to pass a budget that includes expanding Medicaid eligibility to about 400,000 residents, The Associated Press reported.

But this area’s legislators maintain the issues should be separated.

Del. Charles Poindexter

Poindexter, R-Glade Hill, said there is no money in the budget to expand Medicaid, even if the true cost could be predicted.

The Medicaid expansion “is the main component of Obamacare,” Poindexter said of the Patient Protection and Affordable Care Act.

That is not working well he said. “What guarantee do we have” that expanding Medicaid would work any better, he asked.

Currently, about 23 percent of the state budget goes to Medicaid, and “40 percent of all new money this year” has been funneled to the program, Poindexter said. The federal government is offering funds to help implement an expansion, but Poindexter said the offer comes with strings and controls attached.

Also, “we have no idea if they (the federal government) will continue” to help with the funding, Poindexter said.

Lawmakers in the Democratic-controlled Senate included in their budget what Poindexter described as “no more than an outline” to expand Medicaid. “They insist that if the federal government pulls out, we can pull out” and undo the expansion. “That is naive,” he said.

If federal funds are lost, it will be “a bottomless pit,” Poindexter said.

The option he supports is putting more funds into the state budget for hospitals, free clinics, community health centers and the like, and taking the Medicaid expansion out of budget negotiations.

Last year, the Medicaid expansion question was removed from the budget and a Medicaid reform committee — which Poindexter is on — was created to look at the current system, identify fixes to it, and get federal permission to make those changes, Poindexter said. “When that was done, then we were going to look at expanding” the program, he added.

Sen. Bill Stanley

Stanley, R-Glade Hill, said if a budget is not adopted by the June 30 end of the current fiscal year, “it be a complete mess. I don’t anticipate that, but right now, we are so far apart on where we believe the spending priorities are.”

Conferees in both houses have closed “a lot of the budget gaps that we have had. However, I know the conferees” on either side have differing views, Stanley said. “As dug in as they are either side,” it will be difficult for either side to budge.

Stanley said he thinks the answer to the Medicaid issue is “to come back next year with legislation that would provide a solution to a complex problem. There is, I think, a way that we can look to revolutionize how rural health care is delivered. ... It’s our obligation to make sure that we reform the industry to bring down health care costs,” he said.

But Stanley said he does not think there is any way to guarantee that the federal government would keep its end of the bargain if Medicaid is expanded.

Each year, the cost of Medicaid increases, he said. If the program is expanded and “when the federal government pulls back” its funding, Stanley asked where Virginia would find the money to make up for the loss. “Are we going to find it by reducing our funding to public schools or public safety,” or pass it on to taxpayers?

A Senate proposal to expand the program and then cut it if federal funding dries up is not realistic or fair, Stanley said. “You need to make sure it is a permanent entitlement if your are going to give it.”

Also, a decision to do away with the expansion could be appealed under the Administrative Procedures Act, which Stanley said could create a huge class action suits against state of Virginia.

Besides, “why do we have to rush into Medicaid expansion when Obamacare is being delayed for another two years? Why now,” Stanley asked.

Aside from the Medicaid issue, “I think we’ve got some great starts (in the General Assembly session). We’ve accomplished a lot — ethics reform, reform of the mental health system, workforce development — I think we did a very good job in moving in the right direction,” Stanley said.

He said he is most proud of the “work share” bill and the I-73 study which was approved.

Del. Danny Marshall

Marshall, R-Danville, said that overall, “I think we had a productive session. We passed three different bills on mental health this afternoon (Saturday). They added funds to mental health.”

One of the changes will lengthen “the amount of time someone has to stay in the system. It will make that better,” Marshall said. Also, an online system will be created to list open beds for those who need immediate help.

“Ethics reform is another positive, and we passed it in relation, I guess, to what happened last year” with Gov. Bob McDonnell and his wife, Maureen, Marshall said. They were indicted on federal corruption charges.

The reform measure was created and approved with bipartisan support. While it may not go as far as some may think it should, Marshall said that hopefully residents “will feel it’s a good idea” and that it does “move the ball forward.”

Also positive is the additional funding approved for the New College Institute to help maintain its new building, Marshall said.

“But, we’ve got to pass a budget first. ... We are not like” the federal government, which operated for five years without a budget, he said.

If lawmakers in Virginia can’t agree on a budget, “then the school systems will not get their money, the state police will not get their money, and on and on. The government will come to a halt,” Marshall said.

“We have asked Gov. McAuliffe to take Medicaid expansion” out of the budget, and have a special session devoted to discussing how to fix Medicaid, Marshall said.

“There are ideas being floated on how to fix it, but right now it’s in the budget” and lawmakers must decide whether to “take or leave it. I hope the governor hears from people at home. We are 99.9 percent together” on the budget proposals, he said. “If you pull Medicaid expansion out of it,” the budget likely would be passed in a couple of days.

Marshall said he does not know if the state government has ever stopped due to a budget impasse.

“The problem is when the state government stops, the governments in Martinsville and Henry stop, too,” Marshall said. Allowing that to happen “is not the right thing to do.”

Del. Les Adams

Adams, R-Chatham, said that between now and the special session, lawmakers will have an opportunity to hear about the issue from their constituents.

Medicaid expansion can be debated but not as part of the budget, he said.

“We should not wrongly try to include it in the budget debate. We should pass a clean budget so that localities” will know their state funds for education, public safety and other sectors and can finalize their budgets, he said.

If no state budget is passed, the government will shut down.

“Republicans are strongly against any shutdown as a negotiation tool. We need to uncouple these issues” and pass a budget, he said. “Then, we are happy to continue the debate as to whether to expand Medicaid under Obamacare.”

With the end of his first session in the General Assembly, Adams said, “it has been a real privilege for me to serve and represent the folks back home.”

Accomplishments this session include making good on one of his campaign issues of funding and reforming K-12 education, especially in regards to “ways to reform SOLs and assessment in particular,” Adams said.

Legislators passed a bill that limits the number of SOL tests in elementary and middle school up to the eighth grade, and also created an oversight review system “to make sure that folks at the local level and parents are able to have input and make adjustments as needed,” Adams said.

Two other accomplishments are mental health reform and ethics reform, he said. “I think both have broad bipartisan support,” Adams said.

Also, Adams said he was fortunate to be among a minority of freshmen legislators to gain approval on more than one bill that he either sponsored or co-sponsored. Those measures include extending the state scenic river designation of the Banister River in Pittsylvania County and authorizing a study directing the Commission on Youth “to look at federal, state and local funding for students with disabilities,” Adams said. A part of the study will include Medicaid funding.

“Overall ... this had been a very good session with a lot getting done,” aside from the budget impasse, Adams said.


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