
Richmond – The
2018 budget drama finally
was put to bed late last
week. Governor Ralph
Northam put pen to the
massive amounts of
paper that comprise
Virginia’s 2018-2020 biennium
spending, the commonwealth’s
so-called
priorities.
It’s now law —
not only the spending
mandated in it, but any
language amendments
that were included. These
lines of verbiage may
have nothing to do with
spending money and
everything to do with
policy. They have the
effect of any law, even
though they get less
scrutiny than stand alone
bills that go through the
normal legislative
process. In fact, any policies
adopted in the budget
takes precedent over
current law although
they expire at the end of
the budget.
Despite the headline
grabbing hoopla of
Obamacare Medicaid
expansion, the budget, as
with all budgets, is about
the details, especially
since it includes more
than $100 billion in
spending. One such
detail is LARCs — Long
Acting Reversible
Contraceptives. A surprise
to people who don’t
realize contraception is a
core function of government,
Virginia now will
spend in the neighborhood
of 10 million new
dollars (so much for the
budget crunch and the
need to provide health
care for the truly needy)
for women to receive
these implants that last
for years but can be
removed when conception
is planned.
It’s a pilot program,
but as with any
entitlement it’s not likely
to expire without a clear
and committed majority
to fiscal discipline and
sound health care policy.
That is less likely because
Virginia’s new big time
contraceptive enterprise
funds abortion providers
such as Planned
Parenthood which, in
turn, donates large portions
of its millions in
profits to Democrat candidates.
Republican lawmakers
couldn’t grasp
that scheme. Not only did
they include it in the
budget, but flat out rejected
an opportunity to
keep the policy but
restrict the type of
providers who would be
paid to carry it out.
Details.
Another detail is
the $600 million in new
taxes to partially fund
Medicaid expansion. The
largest chunk comes from
a hospital tax that will
raise the cost of care for
both individuals not on
Medicaid and for the
government that must
fund it back to the hospitals.
There’s also confusion
as to who will benefit.
Supporters think it’s
going to the working
poor but lawmakers
made it clear most of it is
going to indigent and
assisted living patients.
Either way, the second
largest detail not considered
is that, by and large,
specialists, whom the
patients generally need
the coverage for, don’t
accept Medicaid.
Hospitals are the biggest
beneficiary of the expansion,
and not always the
hospitals that truly need
it. Further boomeranging
is that the influx of government
spending
inevitably will drive up
costs that will drive some
out of private insurance
into Medicaid.
But the biggest
detail left unscrutinized,
despite much warning, is
that Obamacare itself will
be dismantled in the near
future. First, there is a
federal court case likely
to succeed because the
individual mandate, the
portion of the law the
Supreme Court cited in
its justification for its
approval, was eliminated
in the tax reform bill. The
Justice Department will
not challenge this lawsuit
brought by 21 states.
Additionally, a new
repeal and replace bill
gaining the support of all
GOP U.S. Senators, and
Trump Administration
action, may see
Obamacare off once and
for all.
Stephen J. (Steve)
Rossie is a Richmond-based
public and government relations
consultant. He has
been a General Assembly
lobbyist since 2006 and has
written about Virginia government
since 2007.