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A legislative commission must act for the state, not the party, as health care reform rolls toward implementation of its major elements.
Wednesday, June 5, 2013
Conservative Republican governors who want to expand Medicaid in other states are at odds with their own party-controlled legislatures, where ideology threatens to override pragmatism. Virginia’s situation is a little different.
Our conservative Republican governor left a door open for the expansion to as many as 400,000 needy Virginians. But the House speaker sent hard-line opponents through, leaving its fate in doubt.
To ensure Democratic support for his signature transportation tax plan, Gov. Bob McDonnell agreed to a budget compromise that will expand eligibility — but only if a newly appointed legislative commission loaded on the House side with GOP hard-liners is satisfied the federal government will allow reforms designed to lower its cost.
And the commonwealth’s quirky law barring its governor from successive terms in office casts more uncertainty on the issue heading into 2014, when the Affordable Care Act is to be fully in effect — and a new Virginia governor inaugurated, who could end up having the final word.
In the face of all of these uncertainties, the process moves on. The legislative Medicaid Innovation and Reform Commission is scheduled to meet June 17, a week after McDonnell’s respected Virginia Health Reform Initiative Advisory Council meets to assess progress on Medicaid reforms.
It remains to be seen whether the commission, heavily weighted with Republicans, will be guided by partisan politics or budget pragmatism.
Hospitals and other health care providers clearly support expanding Medicaid to needy adults who will have no other way to get health care coverage. Treating illnesses, often far advanced, in emergency rooms is an expensive, not to mention cruel, inefficiency.
Adhering stubbornly to a system of charity care that works so poorly for patients and shifts the cost onto others, including businesses that offer health care benefits, should not be an option.
Especially when Virginia’s taxpayers will be helping to pay for the federal government’s offer to pick up the entire tab for states that agree to participate in Medicaid expansion its first three years, and 90 percent thereafter.
The philosophical fight is being played out in red states like Arizona, where Gov. Jan Brewer switched from opposition to acceptance of expanding Medicaid when she read the bottom line. Fellow conservative Gov. John Kasich of Ohio found his guidance in the Bible.
In increasingly purple Virginia, McDonnell was motivated by the urgent business need to update the transportation system. He was not similarly inspired on health care reform, but lawmakers who can work with reform or against it should take care of business, and needy Virginians.
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