State budget battles and the fight over healthcare expansion are no closer to a resolution, with less than two months to strike a deal before a possible state government shutdown. Now Senate Democrats are asking House Republicans: if you don't like our plan to expand healthcare, where's your solution?
In a letter Monday, Senator Donald McEachin told Speaker of the House Bill Howell, "that House Republicans either engage with our proposal" or "put forward a proposal of their own..."
But that request will go unanswered, as the GOP continues to emphasize passing a budget first.
A House Republican spokesman said Tuesday, "the House has always said we are willing to discuss any proposal on Medicaid expansion after we pass a budget to keep government open."
Read the full letter below:
Dear Mr. Speaker:
In a January op-ed, you argued that it would be a mistake to expand Medicaid — but you also said that “Virginia should look at alternative ways to help those in the Obamacare coverage gap.” It is now May. Four months have passed, and I feel compelled to ask: what are the alternatives you’ve offered?
While we may disagree about Medicaid expansion — and the term “Obamacare coverage gap” — based on your op-ed, we have significant common ground on which to build. We clearly agree that a coverage gap exists. We agree that its existence is a problem for Virginians . And we agree that lawmakers have a responsibility to help those affected.
In light of that agreement, I am dismayed by our current impasse. Democrats have clearly and repeatedly signaled their desire to work constructively on this issue. Remember what has happened over the last year.
In a bipartisan compromise, the General Assembly created the Medicaid Innovation and Reform Commission — and we agreed to postpone expansion until that commission had overseen reforms. MIRC’s authorizing language statesthat “the Commission shall approve implementation” of expansion when specific requirements are met. As Secretary Hazel has explained, those requirements have been met. Unfortunately, commissioners from the House continue to oppose expansion for unrelated or unknown reasons.
Because of the intransigence of House MIRC members, my Senate colleagues and I planned to close the coverage gap in this year’s budget. Medicaid expansion remains our preferred outcome, but — in the interests of finding common ground — we have chosen to support a compromise alternative. Marketplace Virginia is a “private option” plan that enables Virginians to buy coverage through a private insurance network. Originally crafted by Republicans, the plan enjoys bipartisan support in the Senate — and it contains provisions designed to address concerns that you and other skeptics have voiced.
Your caucus has rejected our proposal out of hand.
At the start of our current special session, the governor proposed a budget. In response to your concerns, that budget did not contain Marketplace Virginia. Instead, it called for a no-risk, no-commitment pilot program that would allow Virginia to try Medicaid expansion for two years. Gov. McAuliffe promised, “I, and I alone, will take the responsibility” if the pilot program were to fail.
House Republicans immediately dismissed the governor’s budget, allowing no time for public comment or real deliberation.
As a result, a budget containing Marketplace Virginia is once again before you — and you have refused to act on that budget. You have offered no serious suggestions for improving upon the Senate’s approach, nor have you proposed a plan of your own.
I find that silence baffling. On January 13, Del. Steve Landes delivered the “Weekly Virginia GOP Address,” in which he said the following:
Democrats often accuse Republicans of being the party of no. But that’s not true. Instead of just saying no, we are working on an alternative to Medicaid expansion that would address the coverage gap created by ObamaCare with a conservative, market-based solution.
When Del. Landes made that comment, I took him at his word — and ever since, I have looked forward to working with your caucus to craft a strong compromise. Lately, though, I have grown concerned. Again, four months have passed. Where are the alternatives that you called for, and that your party has promised? When will you unveil the proposal that you are “working on”?
In your op-ed, you laid out three criteria for what an acceptable alternative to Medicaid expansion would look like — criteria that Del. Landes echoed almost word-for-word. I believe Marketplace Virginia meets all of these requirements.
· “First, [an alternative approach] shouldn’t rely on federal dollars. Any plan that relies on federal money not only leaves Virginia taxpayers on the hook once that money goes away, it also contributes to the national debt.”
Marketplace Virginia will terminate automatically if the federal government pays one cent less than what it has promised — meaning Virginia taxpayers are off the hook. The plan doesn’t contribute to the national debt, either. The non-partisan Congressional Budget Office found the Affordable Care Act to be deficit-neutral. In other words, the same law that cleared the way for Medicaid expansion (or a private-option alternative) also raised sufficient funds to pay for it.
· “Second, it should provide targeted coverage to those who truly need it without growing the size of government. Medicaid is meant to serve the truly needy—the working poor, single moms and children. An alternative plan should help those who need it the most.”
Those who find themselves in the coverage gap meet your criteria. Seventy percent of these men and women come from working families. They earn too much to qualify for Medicaid, but they earn too little to receive tax credits that help other Virginians buy insurance. Through no fault of their own, these people are denied access to quality, affordable care. They deserve our help.
· “Finally, it should be based on principles utilized in the private market. The plan should emphasize cost sharing, health and wellness, and competition. These principles keep costs down and improve the quality of care.”
As my Senate colleagues and I have said many times, Marketplace Virginia is a private option plan that enables Virginians to buy insurance through a private network — and it contains requirements of exactly the kind you describe. To quote the relevant amendment, Marketplace Virginia will mandate “cost-sharing of up to 5 percent of total household income”; it will use accountability requirements to “promote healthy behaviors”; and it will encourage “competitive, value-based purchasing of health care” to ensure that coverage is “fiscally sustainable and cost effective.”
I understand there may be disagreement or concerns about the merits of Marketplace Virginia — or, for that matter, any specific policy proposal. However, I cannot understand why, having identified a problem and promised a solution, House Republicans refuse to engage with legislators seeking to address that problem in a bipartisan, constructive way — a way that is entirely compatible with the approach you yourself have outlined.
I urge you to remember what is at stake. You have heard the statistics many times; I pause to repeat just a few of them here. Closing the coverage gap will save hundreds of lives — experts believe we could prevent anywhere from 266 to 987 needless deaths each and every year. Closing the coverage gap will also bring an estimated 248,000 Virginians the security, peace of mind, and health improvements that come with insurance. Closing the coverage gap will save our statemore than $500 million, and — in the first year alone — Marketplace Virginia will return $1.7 billion in federal taxes to the Virginians who paid them.
Conversely, inaction means financial waste, human suffering and needless loss of life. Whatever our disagreements, we can all agree that those things should not be allowed to happen.
In your op-ed, you wrote that “Virginia is known for its judicious, responsible approach to governing. We must continue to apply that approach when looking at all issues, including health care.” I couldn’t agree more — and so I renew my request: that House Republicans either engage with our proposal, put forward a proposal of their own, or explain to all of us exactly what has changed in the past four months.
A. Donald McEachin