General Assembly backs budget, Medicaid expansion

The Virginia General Assembly adopted a budget with Medicaid expansion, after roughly six hours of debate in a narrowly divided state Senate and a quick affirmation by a House of Delegates that had reversed its longstanding opposition earlier this year.

The budget — which also includes 3 percent raises for teachers and 2 percent raises for state employees — would pave the way for expanding Medicaid coverage to about 300,000 low-income Virginians, while requiring those who are eligible to show they’re working, moving toward a job or learning job skills.

“This is not about the House, this is not about the Senate, this is about Virginia and the 8.3 million people we represent,” said House Appropriations Committee chairman Chris Jones, R-Suffolk, who worked with state Sen. Emmett Hanger, R-Mount Solon, to write the compromise measure the two bodies approved Wednesday.

The vote marked a huge change in the state legislature’s stance on accepting federal Affordable Care Act dollars to expand Medicaid, as Republican legislators’ once-almost unanimous opposition crumbled, first in the House, during the regular session, then on Wednesday in the state Senate.

“Last November, voters spoke loudly and clearly for the values that are embodied in this budget,” said House Minority Leader David Toscano, D-Charlottesville, thinking of the Democratic gain of 15 seats in the November election.

In the House, 18 Republican delegates joined their 49 Democratic colleagues to vote for expansion. The vote for the fiscal year 2019-2020 budget was 67-31.

In the state Senate, four Republican senators joined the 19 Democrats to vote for the budget compromise and Medicaid expansion. The vote there was 23-17.

Later, Gov. Ralph Northam told reporters that it took five years for the General Assembly — including his old colleagues in the Senate — to come around to the idea of Medicaid expansion. He also attributed this to the November 2017 elections. Expanding Medicaid is a major priority that Northam and House Democrats campaigned on last year.

“I think finally, you know, people realized — when I say people, our leaders — have realized, there are close to 400,000 working Virginians that don’t have access to health care,” Northam said. “They end up in our emergency rooms and our ICUs, and so I think people felt the moral thing to do was to expand coverage.”

Northam also lauded the budget’s commitment to placing all surplus cash into reserves, and the raises for teachers and state employees.

Speaker of the House Kirk Cox also touted the reserve cash — and argued that’s why the budget is a conservative one — as well as how teacher raises will help curb teacher shortages.

“The Medicaid piece was a tough piece but having said that, the reforms that we really wanted, we had a good negotiation with Gov. Northam, I thought, and some of the senators,” Cox said. “We ended getting up a very good work requirement that was even strengthened over this conference process, and it really provides essential health care to people who need it.”

Speaking to the criticisms of how the budget deal came about, Cox said the process “wasn’t ideal,” but that it was available for a week and was largely similar to the House of Delegates’ budget.

“The process wasn’t ideal, but I will say from the House perspective, you know, we really tried passing a budget in special session very early,” Cox said. “I thought we were very patient, waited five or six weeks to get a budget back from the Senate.”

The General Assembly failed to pass a budget by its original March deadline because the House wanted a version of Medicaid expansion, while the Senate opposed that. A special session to hammer out a budget convened in April, but the Senate only recently began moving toward a budget draft.

In sharp remarks during a six-hour Senate debate, Senate Majority Leader Thomas K. “Tommy” Norment, R-James City County, said the process to decide on the budget was “degraded” this year because it left out finance staffers.

At one point during the Senate’s hours-long debate, he pressed backers of the budget about a $2.2 million appropriation for Hampton University’s Proton Therapy Institute, linked to an effort to secure land for the widening of the Hampton Roads Bridge Tunnel.

After grilling Hanger and state Sen. Frank Wagner, R-Virginia Beach — two of the four GOP senators who voted for the budget compromise — about Hampton University money, Norment asked if they had “any other sneaky little amendments.”

One of the supporting Republican votes was expected, from Wagner, who announced in April that he supports certain forms of expansion.

However, Sen. Ben Chafin, R-Lebanon, unexpectedly switched his stance and supported the package on Wednesday, as did Sen. Jill Vogel, R-Upperville, who said she was supporting the budget because of funding for the treatment of autism, as well as conservation efforts.

“For me, I came to the conclusion that no just wasn’t the answer,” Chafin said during discussion on the Senate floor. “That doing nothing about the medical conditions and the state of health care in my district just wasn’t the answer any longer … when I see the kind of monies this budget would deliver, tens of millions of dollars to rural hospitals. … I think it is absolutely imperative we look at this budget and look at it favorably.”

But a colleague from southwest Virginia, state Sen. Bill Stanley, R-Moneta, fired back, calling the proposal “a $1.2 billion bailout for our hospitals,” adding: “We’re spending money like a drunk in New Orleans.”

In February, the Senate on party lines voted down a plan with Medicaid expansion, with opposition on how it would be carried out and concerns over whether the federal government would actually follow through. Hanger had supported the idea of expansion, but did not like a hospital tax.

Then last week, Hanger reached a compromise with Jones that expands Medicaid with a hospital tax, but pumps savings from expansion into behavioral health programs — an important issue for Hanger, he has said.

In April, Wagner publicly said he would support expansion with some caveats.

“The dynamic here in the General Assembly has changed,” Hanger during the debate. “We find ourselves in a moment where we have … a bill that has been fashioned by consensus. We have other members of this body, the body at the end of the hall and input from the administration in terms of where we needed to go, thought it appropriate to go, to serve our constituents of our commonwealth.”

Norment aired strong opposition to how the budget was decided. He also said he faced a lot of “disrespect” from pro-Medicaid expansion advocates, sharing examples of people staging die-ins outside his office, honking outside his law office and “verbal abuse” from people after a Senate Finance Committee meeting Tuesday.

“These advocates, I appreciate their passion, but do they really think they are moving one vote by that misbehavior and disrepect, telling me that I’m not working? Really? Everybody in the body is working very hard regardless of where you fall on the issue, and none of us deserve disrespect.”

Nearly two dozen floor amendments were proposed from opponents of expansion and narrowly defeated. One was aimed at strengthening oversight of the work requirements tied to getting coverage. Another was aimed at banning the use of public funds for abortions.

Lt. Gov. Justin Fairfax broke four tie votes on amendments.

Both Stanley and Norment pressed Hanger on how they would verify that Medicaid recipients were following the work requirement. Hanger said there are existing agencies to focus on this, but both Norment and Stanley sounded unconvinced.

Sen. Mark Obenshain, R-Harrisonburg, who characterized Hanger’s package as non-transparent and exclusive, said the budget was “literally spraying money” everywhere.

“This budget substitute embodies all the worst that we expect usually to see out of Washington,” Obenshain said.

The House debate was much shorter, and the vote was pretty much in line with its vote for a budget with Medicaid expansion back in February.

“We either did Medicaid expansion or we wouldn’t have pay increases for teachers, for deputies, for state employees,” said Del. Gordon Helsel, R-Poquoson, one of the House Republicans who changed his longstanding opposition to Medicaid expansion to vote for the budget.

“I think I heard from everyone in my district, and I think this is what they want,” he said.