Virginia is one of a handful of states deciding whether or not to expand Medicaid coverage to hundreds of thousands of uninsured people. A decision isn't likely any time soon, but experts say the commonwealth has some options.
Lawmakers on Virginia's Medicaid Innovation and Reform Commission heard a variety of perspectives Monday afternoon. Some said move forward with expansion, some said stop, and others said try something completely different.
Under the Affordable Care Act, the federal government says it would help states expand health coverage to people making just above 133 percent of the federal poverty line. It would cover all expansion costs for three years and drop down to 90 percent after that.
The Commonwealth Institute for Fiscal Analysis says the decision is a no-brainer.
"Expanding Medicaid is the most cost-effective way to cover nearly 400,000 hard-working Virginians," said Massey Whorley, senior policy analyst at the Commonwealth Institute.
The group says expansion would also bring down $22 billion in federal funds, and could support up to 30,000 jobs - but not everyone likes the idea.
"Medicaid is a program that is failing, it fails patients on the program, it fails taxpayers, and to make that program bigger is just not right," said Christie Herrera, Foundation for Government Accountability senior fellow.
Herrera says expansion could cost those already in the program access. Others like Virginia's Medicaid Innovation and Reform Commission Vice-Chair Delegate Steve Landes worry the federal government can't afford to pay for expansion.
"We've got to look at whether the money is going to be there or not," Landes said. "More importantly, they're not guaranteeing if the money is not there that you can opt out."
But there are alternatives to expansion, and state lawmakers expressed interest Monday in exploring what else is out there.
"Virginia has options," said Dr. Devon Herrick, National Center for Policy Analysis senior fellow. He says Virginia should seek the middle ground, and find a method of expansion tailored for Virginia.
"Experimentation is good, and I think it would not make sense just to do a one-size-fits-all solution in Virginia," said Herrick.
Some states have found different ways to use expansion funds; Arkansas recently received approval to use expansion funds to purchase private insurance plans in the state's healthcare exchange, rather than expanding the Medicaid program. But any change in the guidelines requires a waiver of approval from the U.S. Department of Health and Human Services.
"We have to get approval for everything we do through the federal government," Landes said.
Medicaid expansion will likely remain a hot topic heading into the 2014 General Assembly session, when lawmakers will have to work together with a newly elected governor to craft the state's biennial budget. Democratic gubernatorial candidate Terry McAuliffe fully supports expansion, while Republican candidate Ken Cuccinelli is staunchly opposed.