Laura Vozzella’s Washington Post story on how far Terry McAuliffe would go to expand Medicaid, and how the Republicans confusedly yet successfully stopped him (for now), has implications both for the nation and the Commonwealth. To recap Vozzella’s story, the Governor had decided to pull and end run around the House of Delegates and use the McDonnell tax increase as justification to expand Medicaid (even “the language was ripped out” of surrounding context that made clear there were unmet conditions to the expansion – as Vozzella notes), but the plan hit a landmine when State Senator Phil Puckett resigned, handing Republicans control of the State Senate – which then tweaked the FY15-16 budget, in response to blogger Steve Albertson, to make it abundantly clear that Medicaid expansion was a no-no. The Democrats were so desperate to keep Puckett in place that even Mark Warner himself joined in, “discussing the possibility of corporate work and a federal judgeship” for Puckett’s daughter, to no avail. Now, it should be noted that Puckett officially resigned from the State Senate on the 8th of June, while Albertson’s blog post that highlighted McAuliffe’s scheme was slapped up two days later. This leads us to our first takeaway from all of this.
Bloggers still matter: Facebook and Twitter may be fun, and useful for spreading a message, but blogs are still the place to go for detailed policy issues like this. Albertson’s post caught the attention of the powers that be in no small part because he spelled out exactly what was happening with a granularity thoroughly discouraged by Facebook and Twitter.
However, once Albertson explained the situation – and how to fix it – there was no guarantee his advice would prevail in Richmond. After all, three Republican Senators had voted for Medicaid expansion in explicit terms. Why would they suddenly reverse themselves to the point of stripping out a loophole for the Governor? Well, the primary victory of David Brat (which happened the very day Albertson posted) sent a message everyone in Richmond heard, which leads us to Lesson #2.
Federal and state politics are deeply interdependent in Virginia: Those of us who remember Bob Marshall’s near miss in 2008 – and how it spooked Richmond Republicans away from a tax increase – knew this already, but the “Brat effect” reminded the rest of Virginia. The Senate vote itself came less than a week after Brat’s win, and no one was willing to challenge the prevailing mood. To be fair, there was also concern that McAuliffe’s budget game playing would seriously damage Virginia’s reputation – which was already reeling thanks to the Bob McDonnell trial. Speaking of the former governor, his final-year stumbles bring us to Lesson #3.
“When you violate principles, invariably, it leaps up and bites you”: The actual quote comes from Bill Parcells, but it’s appropriate here. Bob McDonnell went back on his 2009 promise not to raise taxes, assuming that such a concession would be enough to get transportation funding. As it turned out, the Democrats saw weakness and asked for more: Medicaid expansion. Contrary to the assertion of Mr. McDonnell, they nearly got it with the very tax increase McDonnell first sought. Had McDonnell sought to use existing revenues (i.e., cutting the budget elsewhere) to get the money he wanted for roads, he could have at least sidestepped this problem.
That said, McDonnell was out of office when it became clear what was going on. Speaker Bill Howell, by contrast, spent months in 2014 insisting he was stopping Medicaid expansion while leaving a gaping hole in the defense. Those of us who would prefer to see Howell replaced as Delegate now have a new argument: incumbent incompetence (I’ll leave it to his defenders – and he has many who blog here – to present his side of the story).
Of course, this is all about how Medicaid expansion was defeated as a policy in 2014. It will almost certainly come back as an issue in 2015, one which the Republicans must address. This brings us to the last lesson.
If the Democrats are willing to these lengths to ram Medicaid expansion through (and they are), Republicans need an alternative to Medicaid, period. We can talk about constitutional issues and matters of state affordability until we run out of breath, but so long as the Democrats can equate opposition to Medicaid expansion with denial of health services to poor Virginians, we will be at a disadvantage. We can begin to address this by making it clear Medicaid does not help the poor nearly as much as claimed (and may not at all), but we also must examine market-based alternatives. Fixing the broken health pricing market is a good start, and combined with Ed Gillespie’s health tax credit idea it could bring poor Virginians into the health care market as equals, rather than second-class citizens trapped in a single-payer cul-de-sac.
As 2014 draws to a close, Virginia has been spared the problems of Medicaid expansion, but that doesn’t mean the battle is over. If Republicans want to prevail, they need to show that Medicaid is not just unaffordable, but suboptimal. Otherwise, we’ll be on the defensive for 2015 and beyond.
The post What the Virginia Medicaid Battle Told Us appeared first on Bearing Drift.
