Virginia: Could it be? Medicaid expansion for 400,000 more people could be a reality within 48 hours!

2018 MIDTERM ELECTION

Time: D H M S

Several stories like this throughout Monday afternoon/evening (via Michael Martz of the Richmond Times-Dispatch:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

(The article goes into all the other non-Medicaid related stuff in the budget as well, of course, although some of it is obviously healthcare-related.)

...Hanger still must overcome a major hurdle in the Senate. Majority Leader Tommy Norment, R-James City, leads a Republican majority that opposes expanding Virginia’s Medicaid program with billions of dollars in federal money available to the state under the Affordable Care Act. It would provide health coverage for hundreds of thousands of uninsured Virginians.

Norment also serves as co-chairman of Senate Finance, which has yet to propose its own version of the state budget or schedule a time to meet on Tuesday afternoon. The full Senate convenes at 3:30 in a special session that began on April 11 but stalled while Republican senators waited for updated information on state revenues.

Hanger appears to have enough votes in the full Senate to approve Medicaid expansion, but not in the Finance Committee. Minority Leader Dick Saslaw, D-Fairfax, told reporters last week that he’s prepared to move to discharge the committee so the Senate could consider the proposals as a committee of the whole.

...The House Appropriations Committee will meet at 8:30 a.m. Wednesday, followed by the full House of Delegates at noon to consider whatever the Senate approves. Jones sent a letter to House members with proposed budget amendments.

...The budget proposal embodies both the House plan to expand Medicaid on Jan. 1, using a provider assessment on hospitals to pay the state’s share of up to 10 percent of the cost, and Senate priorities for health care spending, particularly in behavioral health.

...One assessment would raise about $306 million for the state’s share of Medicaid expansion costs, which would increase from 7 percent next year to 10 percent in 2020 and thereafter under the federal law. The other would raise about $284 million that would be used to increase Medicaid reimbursement rates for hospitals and their physician groups from 71 percent to 88 percent of their costs.

As an aside, if $306 million covers up to 10% of the cost of Medicaid expansion, that suggests that the total cost would be around $3.06 billion. If 400,000 Virginians are enrolled, that's around $7,650 per enrollee (federal + state funding combined). As it happens, traditional Medicaid cost around $6,900 per enrollee on average in Virginia in 2014, so that seems to be in the right ballpark.