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Bill Hazel echoed the governor’s concern: Can the federal budget afford the expansion?
Wednesday, February 6, 2013
As the General Assembly considers an expansion of Medicaid, Virginia’s top health official briefed a Roanoke audience this week on some of the challenges that lie ahead.
Secretary of Health and Human Resources Bill Hazel made no predictions on whether legislators will expand the government insurance program for the poor and disabled as part of the Patient Protection and Affordable Care Act.
But in a speech Monday at the Virginia Tech Carilion School of Medicine, Hazel said a key concern is whether the pledge of federal funding for much of the expansion will hold true over time.
“There is no free money from the federal government,” Hazel said. “We aren’t sure that will continue to be there, and if it isn’t the state will have to raise taxes.
“And the legislators do not like to raise taxes to pay for somebody else’s promises. That I can guarantee.”
Speaking to a crowd of more than 200, Hazel rattled off the numbers and details that are at the center of the debate.
It will cost the state at least $137 million — possibly as much as $280 million — over the next nine years to pay for the expansion, even with nearly all of the funding coming from the federal government, he said.
Expansion of Medicaid is a key goal of the Affordable Care Act, President Barack Obama’s overhaul of the health care system that was passed by Congress in 2010.
The U.S. Supreme Court upheld the law last year but ruled that the government can’t force states to expand Medicaid or withhold all funding from those that don’t.
In the coming weeks, the General Assembly will consider budget amendments to expand the program — the costs of which are normally shared equally between the state and federal government — to people with incomes of up to 133 percent of the federal poverty line.
The federal government is promising to pay 100 percent of the costs for those added to the program for three years, starting in 2014. The portion of federal funding would decrease to 90 percent by 2020.
All told, Virginia would receive about $23 billion in federal funds.
However, in echoing concerns raised by Gov. Bob McDonnell and some Republican lawmakers, Hazel questioned whether the debt-ridden federal government will be able to make good on that commitment.
“Have you all seen any signs of that problem being solved in Washington?” Hazel said of the federal budget deficit. “That’s what’s so worrisome about this.”
Many Republicans have criticized the act, with Attorney General Ken Cuccinelli challenging it in court. But Hazel, a McDonnell appointee, also acknowledged some arguments for expansion, including those made by Carilion Clinic President and CEO Nancy Agee in her introduction to his remarks.
Among other things, Agee pointed out that Virginia ranks 48th in the nation in per capita Medicaid spending.
While early estimates were that the expansion would cover an additional 430,000 of the state’s 1 million uninsured, Hazel said that number will likely be closer to 270,000.
Supporters of expansion say it would provide health care to needy Virginians while boosting the economy with the creation of about 30,000 new health care jobs.
Some legislators want to make Medicaid expansion contingent on changes, if allowed by the feds, that would give the state more flexibility and ensure more efficiency.
Details of those reforms likely will be hashed out in the coming weeks.
“While the train has been coming, we have not had a political conversation about what reform is,” Hazel said. Given the financial complexities and politics at play, some have wondered if there is any hope for expansion this year.
“I think there is hope for the system,” Hazel said. “It’s going to be a challenge for us to make it work.”
Weather JournalMidday update: More ice likely later