Virginia Governor Bob McDonnell is insisting, despite reports to the contrary, that he has not officially signed off on an expansion of Medicaid in the Commonwealth in a letter to HHS Secretary Kathleen Sebelius. The full text of the letter is here. It reads in part:
“The recently passed budget of Virginia contains language outlining a series of reforms that must be completed to the satisfaction of a new legislative commission prior to consideration of Medicaid expansion. Some media outlets and elected officials have labeled this as approving Medicaid expansion in Virginia. This is absolutely incorrect.
“The language of the budget actually places a firewall against expansion consideration, unless real, sustainable cost saving reforms are implemented at the state and federal level. Members of the commission have already been appointed by the House of Delegates, and several have already expressed deep concern about expansion. Additionally, my office is currently reviewing the budget language to see what changes may be necessary. Final legislative budget votes occur on April 3, 2013 during the reconvened session of the General Assembly.
“As Governor, while the decision currently rests with me on whether or not to expand, I am not going to do so given the vast reform required to make our program cost effective. We are just beginning the process of designing and implementing the real, long term, cost saving Medicaid system reforms necessary to ensure the citizens that our Medicaid program is well managed, entrepreneurial, and efficient. My view of necessary reform for our state and nation may be more comprehensive than what is currently contained in the budget. I attach for your review a summary of the kinds of reforms we contemplate being needed in Virginia before a governor or a legislative commission might even consider a program expansion. We have just one chance to actually fix the program so that it serves people well, but doesn’t contribute more to the national debt, or produce unsustainable future increases in state general fund expenditures. Thus, please do not include Virginia on any list of states that have acted to expand Medicaid, as that would be inaccurate.”
While McDonnell may insist this is still a matter to be decided, the Wall Street Journal recently editorialized that Virginians should have no such illusions:
Mr. McDonnell even cut an 11th-hour deal with Democrats over the expansion of Medicaid under ObamaCare. Last Wednesday Mr. McDonnell issued a press release declaring: “I cannot and will not support consideration of an expansion of Medicaid in Virginia until major reforms are authorized and completed, and until we receive guarantees that the federal government’s promises to the states can be kept without increasing the immoral national debt.”
Two days later, to secure Democratic votes on his tax increase, he agreed to let a bicameral commission decide if the state will expand Medicaid. He agreed even though his attorney general, Ken Cuccinelli, issued an opinion that this is an unconstitutional delegation of authority. Mr. McDonnell says the commission means Virginia won’t expand Medicaid as long as Republicans control the legislature, but wait until the hospital lobby gets done working the same Republicans who raised taxes.
Indeed, this looks more like an approach designed to cede control from McDonnell’s hands than to create any kind of “firewall against expansion” as the governor claims. If he must expand the program, it’s better to do so following the Arkansas approach than any other.