Virginia is THISCLOSE to Medicaid expansion for 400K, except for one thing...

What the heck, I'll make this Medicaid Expansion News Day:

Virginia’s Republican-led legislature is on the verge of doing something that would’ve been almost unthinkable just a year ago: approving legislation that would use money from the Affordable Care Act to expand Medicaid to as many as 400,000 people.

That coverage expansion would come at a price for Democratic legislators, progressive activists and low-income Virginians, however. Any Medicaid expansion bill that makes it out of the General Assembly will carry with it new work requirements for Medicaid enrollees, a priority for the GOP at large and for President Donald Trump’s administration.

Democrats in the Virginia legislature have tried in vain for six years to persuade their GOP counterparts that accepting federal dollars to extend Medicaid coverage to poor adults is the right thing to do. Accepting a work-requirements policy that would create bureaucratic obstacles to eligible Virginians appears to be the compromise needed to win the bigger fight.

“Most of the Democrats in the Senate are prepared to accept the work requirement in order to get expansion passed,” said state Sen. Janet Howell (D), who represents parts of Fairfax and Arlington counties in Northern Virginia. “We have hundreds of thousands of Virginians who have no health insurance, largely because we in Virginia have a very stingy Medicaid program,” she said.

(sigh) I'm torn on this. Here in Michigan is that we've had ACA Medicaid expansion for nearly five years without any problems to speak of. It works pretty damned well and falls into the classic "if it ain't broke" category. Ironically, we were somehow able to get it passed with minimal strings attached even under a rabidly right-wing GOP state legislature (although it was pushed hard by a less-rabid GOP governor).

The difference in Virginia is that Democrats there have been desperately trying to get Medicaid expansion through for years without success, even under a Democratic governor. So, while I'm strongly opposed to work requirements for Medicaid on principle, in the case of Virginia I can understand if that's what it takes to get it done.

In addition, not all work requirements are created equal: 

Virginia lawmakers are still working out the final form of the work requirement. The latest version, based on the policy enacted in Arkansas last month, would make a person’s Medicaid coverage contingent on them working at least 20 hours a month for the first three months. The minimum number of hours gradually increases, eventually reaching 80 hours a month after a year on the program. There are other means of meeting this requirement, including being enrolled in school or a job-training training program, or volunteering.

Anyone who fails to meet one of these standards for more than three months during a year losses their health coverage and has to wait until the following year to reapply.

There are numerous exceptions in the most recent version of the legislation, including for children, people over 55 years old, people with disabilities, people with “serious mental illness,” women who or are pregnant or have just given birth, those determined to be “medically frail” and people who are the primary caregivers for children or adults with disabilities.

Again: Not happy about it, but this may be the best shot they have at putting it through. If so, hopefully future Democratic gains will allow them to cut back or even eliminate the work requirements down the road.