On Sunday, the Senate Finance Committee and House Appropriations Committee released their respective budgets (see them here). Each chamber will debate the details of those budgets this week, with votes coming on Thursday. Perhaps the most glaring difference between the two budgets is just what was expected — the Senate budget includes an expansion of Obamacare — Medicaid expansion — and the House budget does not.
While supporters of expansion in the Senate claim their program isn't really expansion, the consequences of its proposal are the same. Couching it as a "private market" plan, advocates of the Senate budget hope to gain support. But regardless of the rhetoric, the plan expands Obamacare.
The glaring failures of Obamacare, including the millions who have lost health care coverage or are having to pay substantially higher premiums, the loss of work hours, the loss of jobs, the constant implementation delays because the law is unworkable, and the growing fears the federal government will not be able to hold up its financial commitment in future years, are just some of the reasons Virginia should avoid expanding the program.
Beyond that, the arguments for expansion of Medicaid are disingenuous at best and dangerous at worst. For example, some argue that Virginia will "lose money to other states" if we don't expand. That is fundamentally false. Medicaid money is based on a federal formula. If we don't receive the money, it doesn't go to other states because other states just get what the formula prescribes for those states and no more.
Proponents also argue that hospitals will lose millions of dollars in funding for indigent care without expansion because the money the federal government has been sending to hospitals was to be cut off in exchange for Medicaid dollars. But that cut in funding has been delayed a year (big surprise), and most hospitals are running well in the black. It is up to the federal government, which botched this entire program, to fix the problem and not simply dump it on the states to figure out.
Even worse, perhaps, than the failures of the Obamacare rollout are the failures of Medicaid itself. Studies have shown that care within Medicaid sometimes leaves a lot to be desired (see Avik Roy at Forbes). It is a fundamentally flawed program that bleeds fraud and provides inadequate care for those who desperately need it. Nearly doubling the program's size in Virginia without massive changes is foolish.
Frankly, one of the main problems with the battle over Obamacare is that we no longer are having a serious conversation about how to fix our health care system, deliver high quality care to all Americans (especially those who are in need of assistance) and do so in a financially responsible way. We are fighting over failed programs and a failed law, instead of figuring out real, 21st century solutions to our health care needs.
For all of these reasons, we strongly oppose expanding Obamacare in Virginia, and urge you to contact your legislators to urge them to oppose a budget that includes Medicaid/Obamacare expansion. This battle likely will force the General Assembly into overtime, but for what's at stake, the battle is worth the time.