(AP) Virginia lawmakers are coming back to the Capitol today seeking to pass a budget after failing to do so earlier this year.
The hang-up: An intraparty feud between Republicans in the GOP-led General Assembly over whether to expand Medicaid. After five years of a near-unified opposition to expanding the healthcare program for the poor, Republicans are now split on the issue.
Those in favor say the inability of President Donald Trump and a GOP-controlled Congress to repeal the Affordable Care Act last year make continued opposition to Medicaid expansion politically untenable. Most Republican lawmakers still oppose expansion though, saying its long-term costs are unsustainable.
The pro-expansion faction appears to have the momentum after a key Republican senator announced he was switching positions last week, a move that gives lawmakers who favor Medicaid expansion a majority in both chambers.
But its passage is not a done deal. Here’s a look at the stakes and possible sticking points awaiting lawmakers upon their return Wednesday:
Most states opted to expand Medicaid under former President Barack Obama’s health care law. If Virginia joins them, it’ll mean about 400,000 uninsured low-income adults will be eligible for publicly funded health care coverage. The state expects about 300,000 of those eligible to sign up.
With the federal government promising to pay no less than 90 percent of the new costs, Virginia will get an additional $2 billion in federal funds each year.
Proponents of Medicaid expansion say Virginia can’t afford to pass that up. By including Medicaid expansion in the budget, lawmakers can afford to spend more on education, give raises to state employee and make other investments.
“This comes down to an economic decision: we just cannot from a business perspective leave money on the table,” Democratic Gov. Ralph Northam said Tuesday on the John Fredericks Radio Show.
Opponents of Medicaid expansion say it’s unwise to count on continued federal funding under Trump. White House officials have urged Virginia Republicans not to expand Medicaid.
There’s also a political calculus at work. Democrats believe their advocacy for Medicaid expansion helped make historic gains in the state House last year and some Republicans are eager to take Medicaid expansion off the table ahead of the 2019 legislative elections.
But Republicans who support expansion may pay with a primary opponent. At least one Republican challenger has announced his intention to challenge a pro-expansion incumbent House member.
A key potential sticking point among pro-expansion lawmakers is whether the state budget should include a new hospital tax to cover the state’s share of expansion costs.
Northam and pro-expansion House Republicans support such a tax while Sen. Emmett Hanger, one of two Republican senators who support Medicaid expansion, has voiced opposition. The state’s politically powerful hospitals have concerns as well.
Virginia Hospital and Healthcare Association spokesman Julian Walker said hospitals are “willing to consider” a new tax but insist that the money raised be used solely for healthcare related costs.
There are also potential disagreements to how any extra money related to Medicaid expansion should be spent.
Northam wants to put more money into the state’s rainy day fund, the House wants to fund an ambitious cyber security training program and GOP Sen. Frank Wagner, the senator who announced his support for expansion last week, wants a tax cut for Virginians making between $30,000 to $50,000 a year.
Passage of a state budget —either with Medicaid expansion or without — is expected to take weeks or longer. Lawmakers are set to return Wednesday to open up the special session, but aren’t expected to do anything beyond procedural moves.
The process will continue Friday, when the House Appropriations Committee meets to take up its version of the budget. The full House is expected to pass its version of the budget April 17. The Senate will then take up the proposed budget.
Lawmakers have until July 1 to pass a spending plan, or else state government will shut down.
-ALAN SUDERMAN, Associated Press