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Capitol Square Diary - Details
By Stephen J. Rossie

Square2017 imageRichmond – 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.


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