The putative purpose of the special session of the General Assembly that begins on September 18 is to consider and debate alternatives to Medicaid expansion under the Affordable Care Act. The economic and public policy facts so overwhelmingly support accepting the incremental $2.1 billion that would flow to the Commonwealth under the ACA that opposing views are at least as counter to the facts as the views of those who deny evolution or climate change, and far more tangibly harmful to Virginians!
If you believe this statement is hyperbole, please consult a study just released by the Robert Wood Johnson Foundation and the Urban Institute. The study compares the economic and health care results of accepting Medicaid expansion under to the ACA to those of rejecting these federal funds. The study covers 24 states that, to-date, have decided to exercise the “freedom” of opting out of Medicaid expansion that the Supreme Court so obligingly offered them. The study is a mere nine pages, but it is heavily laden with hard data and systematically takes up and demolishes all of the seemingly credible arguments that have been made in the states that have opted out of participation.
Today, the nationwide, state-level opposition to the acceptance of federal funds under the ACA richly deserves the label “political cant.” Unfortunately for the residents of the 24 ACA “secessionist” states, their Republican governors and/or legislators set forth hardline positions against participation in Medicaid expansion at a time when some element of doubt remained regarding the likelihood of full rollout of the program. They were making political arguments based on serious questions about the long term macroeconomic and health care impact of the ACA. I do not underestimate the ongoing importance and validity of these concerns. Massive new government programs have unanticipated consequences. That said, I recognize that congress and the states will be analyzing, assessing and passing legislation that refines the ACA program as far as the eye can see into the future.
We should remember that the ACA was intended to raise access to health care in the United States to the status of the “basic right” that it has become in virtually every developed country in the world. While the ACA approach for achieving this goal is imperfect, think for a moment about what 24 states are saying by their actions. They are saying that poor people in their states should not be offered this access, even though every comprehensive study has shown negative impacts on the state budget of rejecting federal funds.
A consortium of foundations in Pennsylvania commissioned a comprehensive study to consider all state budget costs and benefits. It concluded that Medicaid expansion would produce $5.8 billion in benefits over 10 years. This study caused Republicans to rethink their opposition and to move forward seeking a waiver in order to participate. Virginia has performed a similar study and, despite the loud protests among Republicans, the study reaches a similar conclusion. But, even if the impact on the Virginia budget over 10 years is zero, an additional 400,000 low-income Virginians would have received insurance at no additional cost to taxpayers.
I’m sure some of my colleagues across the aisle feel that opposition to Medicaid expansion is a matter of principle. But to me this act of withdrawal, of secession, from the nation’s commitment to what is universally recognized as a basic human right, seems economically absurd and morally repugnant.
Speaker of the House of Delegates William Howell is currently establishing the rules for the upcoming session to consider legislation that would enable some form of insurance expansion for low income families. The Speaker dislikes the Medicaid expansion option, because “Medicaid is broken.” He dislikes accepting federal funding (which consists entirely of taxes Virginians have already paid) because he thinks it’s not a reliable funding source. We Democrats disagree. But I hope the Speaker is open to a full and honest hearing for alternatives, as I and my fellow Democrats are, in order to help restore fiscal responsibility and ethical governance to the Commonwealth. Feel free to let him know what you think!
Delegate Kory represents the 38th District in the Virginia House of Delegates. She may be emailed at DelKKory@house.virginia.gov.