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I am Still a NO On Medicaid Expansion!

I have been split on this Medicaid Expansion matter and I have to thank Del. Chris Peace for this explanation of part of this House of Delegates budget proposal when Del. Peace said on the Peace Progress that the expansion would not cost Virginia taxpayers any new tax dollars:

The cost of the expanded coverage would be offset by revenue from the Health Care Fund that is generated from a provider assessment on hospitals. The proposed hospital provider assessment (authorized on Part 3 of the introduced budget) would apply to only private acute care hospitals (excludes public, freestanding psychiatric and rehabilitation, children’s, long stay, long-term acute care and critical access hospitals). The assessment will be calculated annually by May 1. Each hospital’s assessment will be based on the assessment percentage times net patient service revenue. The assessment percentage for each hospital is calculated by taking 1.08 times the non-federal share of the full cost of expanded Medicaid coverage divided by hospital net patient service revenue. The estimated cost of the coverage expansion for which the provider assessment would be based is $80.8 million in FY 2019 and $226.1 million FY 2020. The estimated general fund costs and savings are illustrated in the table below. (Table omitted)

I think this means the private hospitals will be taxed and that tax will be the source of the state portion of the expansion.

I have one huge problem with this:  The hospitals will if necessary pass that tax on to the patients in higher costs.  A second issue is this IS a tax – called whatever it is – it is a tax and private hospitals are taxpayers as well.

There’s more:  The expansion cost in FY 2019 is $62,365,125 and the expansion cost in FY 2020 well, expands to, $198,156,098.  I wonder why.  I fear Medicaid expansion is a budget buster.

I was told in my email that I, and five million others, got from Speaker Cox that this is a conservative plan with work requirements and that if the ACA (Obamacare) gets abolished the expansion is ended.  Some of those ideas sounded good to me.

I also am encouraged that both John Fredericks and Del. Glenn Davis, both of whom I admire and respect very much, support the House bill.

But a close examination revealed something I find disturbing – the assumption of how many will be affected by this expansion:

Proposes to reduce funding by $120.4 million GF in FY 2019 and $221.4 m
illion GF in FY 2020 and increases funding of $926.1 million NGF in FY 2019 and $2.2 billion NGF in FY 2020 to reflect the net impact of expanding Medicaid to individuals with income up to 138 percent of the federal poverty level pursuant to the Patient Protection and Affordable Care Act (ACA) by October 1, 2018. The proposal assumes that 300,000
individuals would be enrolled.
Now I have heard from every Democrat involved in this issue that the number is 400,000.  So I am always concerned that the fiscal impact will be understated again and the bill will be more than expected.
With all due respect, I realize this might be seen as best of a bad situation, but with all due respect, I would vote NO.  I have serious issues with expansion coming from a budget amendment from the Governor but since the legislature does touch it, it is probably constitutional.  Let the Dems pass this and then let them own this issue down the road.  I think it will blow up in their faces.  If they pass it it might cause nominal Hillary voters to stay home and the Republicans might win back a few seats lost in 2017.
Still I am still a NO.


About Elwood Sanders

Elwood "Sandy" Sanders is a Hanover attorney who is an Appellate Procedure Consultant for Lantagne Legal Printing and has written ten scholarly legal articles. Sandy was also Virginia's first Appellate Defender and also helped bring curling in VA! (None of these titles imply any endorsement of Sanders’ views)

4 Responses to “I am Still a NO On Medicaid Expansion!”

  1. GeneTheRealist says:

    You would be singing an entirely different tune if you were one of those with no healthcare. I cannot see any path for you to one day make it to the bench. None what so ever.

    • Gannon says:


      Once and for all…. ObamaCare, Medicaid, or HEALTH INSURANCE does not equate to HEALTH CARE.

      Good luck finding a doctor in any private practice setting who accepts MEDICAID. Medicaid does not PAY. MEDICAID patients are non compliant and often require EXTENSIVE TIME in the Doctor’s office for a reimbursement of $20. That is why doctors do not accept MEDICAID PATIENTS who are a legal liability.

      VCU exists to treat the poor and uninsured. So the medical students and interns and residents and fellows in training can practice on them. VCU is a state funded medical institution. Provides medicaid services.

      Also- these medicaid patients are going to suck the local cities and counties of millions of dollars in social services. YOUR TAXES are going up in King William if this passes to pay for it. Once they qualify for MEDICAID the demands for a ride to the doctor or 5 thousand other destinations becomes a requirement of the local social services boards……..

  2. Bob Shannon

    Much is exposed in this discussion about the lack of any real world business experience in those discussing the topic.

    Of course the hospitals will pass on the costs of the tax, like any other expense to the private pay patients, that is how business deals with any expense , taxes or others.

    The solution is to stop electing people who are slaves to the lobby interest who fund their re-election campaigns with publically financed political campaigns.

    Until the money is removed from the process good solid people who might otherwise make excellent elected representatives will continue to stand on the sidelines , ultimately resulting in men like Peace who are much more a part of the problem than they will ever be the ones finding solutions. For Del Peace to call himself a conservative is with his record laughable.

    Reform of Medicaid is now beyond a possibility. This legislation assures that. We now will have a state wide, state run Universal health care system . The hospitals, the drug industry and the assorted medical providers that have tapped into the trough of public money will never walk away from it. They won.

    Bob Shannon King William


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Tom White Says:

Nothing is more conservative than a republican wanting to get their majority back. And nothing is more liberal than a republican WITH a majority.

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