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Pragmatism needed on health care reform
Virginia has been a leader in Medicaid reform, but it will fall behind if it resists a proposed expansion of the insurance program.
Monday, March 4, 2013
In pursuing a transportation deal this winter, Gov. Bob McDonnell dispensed partisan sound bites but planted his feet in the commonwealth’s center, where most of his constituents reside. The result is a pragmatic road and rail package that may not please everyone in his party, but it rewards him with the legacy he sought.
McDonnell now faces a decision with consequences that could overshadow that achievement. A federal plan to expand the Medicaid insurance program to cover low-income workers remains alive in Virginia but its future is murky. The commonwealth is all but certain to delay implementation for six months after other participating states have gotten started next January. There is a danger that Virginia could fall much further behind in providing medical care for the uninsured and pursuing reforms to ensure Medicaid is financially sustainable.
McDonnell must set the tone for pragmatic policymaking by preserving a compromise adopted by the General Assembly last month. Budget leaders established a commission of 10 legislators charged with approving the expansion once they are satisfied that reforms are under way. The deal calls for testing innovations through pilot projects that would be funded from cost savings the state would realize as part of its participation in the federal expansion.
Virginia has been a leader in Medicaid reform. All pregnant women and children in the program are enrolled in a managed care system, for example.
Other states are adopting similar models and pursuing new ideas that could be beneficial to the commonwealth. For example, Arkansas has gotten a verbal agreement to purchase private insurance for new enrollees through a health care exchange, a concept attractive to conservatives.
Republican governors in Florida, Ohio, Michigan and Arizona, among others, have already fully embraced the expansion, acknowledging that it makes sense financially and will benefit thousands of low-income families. The federal government will pay the full cost for new enrollees for three years and no less than 90 percent in future years.
McDonnell has continued to negotiate with federal officials on changes he’d like to see to the current and new Medicaid programs. The Centers for Medicare & Medicaid Services issued a letter last month giving preliminary approval to many of those ideas and promising to work with Virginia on others.
McDonnell was generally supportive of the Medicaid deal laid out in the state budget, but some Republican legislators want him to renege and block the expansion. They insist that the existing insurance program must be fully reformed before it is allowed to grow. But Virginia needs the cooperation and financial support of the federal government for those reforms to take place.
Once again, McDonnell must decide whether he will be an obstructionist or a problem-solver. He should remember that political ambitions mean little without tangible accomplishments. His legacy is still a work in progress.
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