In a letter to Senate and House leaders Thursday Lieutenant Governor Bill Bolling parted ways with Governor McDonnell. In contrast to the governor Bolling recommended expanding Medicaid under the Affordable Care Act (ACA). He compared it to legislation he proposed in 2000.
FAMIS, the Families Access to Medical Insurance Security has been improved through four administrations led by both political parties. During those years Bolling said that today FAMIS “provides basic health care coverage to over 115,000 children in our state.”
He said after reflecting on the Medicaid reform debate he reversed his opposition to the program. “I see many parallels between this decision and our work on children’s health insurance.”
Bolling in the reversal of his decision said he sees a return on the investment. He stressed that he had not changed his mind about making the state’s Medicaid program more effective and efficient.
The federal funds offered to the state to implement the expansion would cover working families. Some of the funds could be used to control costs and ensure quality care. This convinced Bolling to support the Medicaid expansion program.
“I believe the mounting evidence supports moving forward with the expansion, subject to our ability to obtain acceptable waivers from the federal government to implement critical Medicaid reforms.”
Bolling estimated that there would be a savings to the Commonwealth of $300 million from 2014 to 2018. He thought that the negotiation of waivers would be able to refine and reform the Medicaid program in the early years. The federal government will cover 100 percent of the cost until 2018 and 90 percent thereafter.
He said after extensive study the estimated cost to the state was not the $2 billion first thought but is much more manageable at about $137 million. Bolling told Senate and House leaders that by reinvesting federal funds in cost controls in the early years it would mitigate costs in out years.
Over 300,000 uninsured Virginians would receive health coverage under the Medicaid expansion program. It would benefit health care providers who ordinarily would be absorbing the cost of the uninsured. Hospitals would be shed the burden of charity care for the indigent.
Another benefit would be felt in Virginia as 30,000 jobs are projected to be created. “As the Commonwealth’s Chief Job Creation Officer I am particularly mindful of these economic benefits,” said Bolling.
With a more complete picture of the business case Bolling pushed legislators to move forward with plans to obtain authority from the federal government to implement the Medicaid expansion program with the caveat that it will produce acceptable Medicaid reforms.
Bolling stressed three milestones to be met as the Commonwealth moves forward: the ability to back out if federal funds fall through, achievement of reforms and evaluation of the quality of care and cost savings.
“I am confident that there is no state better prepared to move forward on both reform and coverage expansion than the Commonwealth … To Me the decision is straightforward. We should move forward just as we did 13 years ago [with FAMIS].”