Peter’s Take: On Medicaid Expansion, What Is the Va. GOP’s Alternative?

Peter’s Take is a weekly opinion column. The views and opinions expressed in this column are those of the author and do not necessarily reflect the views of

Peter Rousselot

In two earlier columns, I urged Virginia’s political leaders to try to find bi-partisan common ground to improve access to healthcare for Virginia’s poor.  In the second of those columns, I explained that Republican leaders in many other states, even leaders who opposed the Affordable Care Act, have found ways to do this either by expanding Medicaid or by using a premium assistance model.

Regrettably, Virginia still seems gripped in partisan gridlock.

Virginia’s Democratic Governor, Terry McAuliffe, continues to insist that expanding Medicaid is the right solution. Virginia’s Republican leaders are just as adamant that expanding Medicaid is the wrong solution. Governor McAuliffe has asked his Secretary of Health to present a plan by September 1 under which the Governor would expand Medicaid without legislative approval. Virginia’s Republican leaders say that the Governor lacks the authority under the Virginia Constitution to proceed without legislative approval. If he tries to do it this way, the Republican leaders have promised to sue the Governor to block his plans.

For nine months, Governor McAullife and Virginia’s Democratic legislative leaders have made their proposal to expand Medicaid crystal clear, but they have failed to persuade Virginia’s Republican legislative leaders. These Republican leaders have just said no.

What is the Virginia Republican legislative leadership’s alternative to Medicaid expansion?

For some Republicans, that alternative may be the status quo.  The status quo shouldn’t be an option for Virginia — any more than it has been for many other states with Republican governors.

It is long past time for Virginia’s Republican legislative leaders to take a stand. If you don’t support Medicaid expansion, what do you support? Put your alternative out there for Virginians to compare side by side with Governor McAuliffe’s proposal.

How about supporting the Arkansas approach?

Arkansas did things a little differently than other states that expanded Medicaid. The Republican-dominated legislature wouldn’t pass a traditional expansion; instead, it mandated that federal money be used to pay premiums for private insurance plans through the state’s marketplace, an alternative proponents dubbed the “private option.” Other states have used federal money for premium support, but not to the extent Arkansas has.

The Arkansas approach has been remarkably successful:

No state has made progress faster than Arkansas….[T]he percentage of the state’s population without insurance dropped nearly in half, down from 22.5 percent in 2013 to 12.4 percent today.

Personally, I strongly favor a straightforward expansion of Medicaid in Virginia — as advocated by Governor McAuliffe.

What I don’t understand is why Virginia’s Republican legislative leaders can’t tell us what they support instead.

Peter Rousselot is a former member of the Central Committee of the Democratic Party of Virginia and former chair of the Arlington County Democratic Committee.

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