Gov. Terry McAuliffe will try again to pass an expensive Medicaid expansion in Virginia, following two defeats in previous efforts.
McAuliffe's first biennial budget includes a version of the Medicaid expansion under the Affordable Care Act that has proved impossible to move on prior attempts.
"I have come at this issue from every angle," McAuliffe noted in reference to his administration's previous attempts to expand the health insurance program for people who claim to be indigent.
In his third attempt, McAuliffe, along with Virginia's hospital association, proposes a plan under which the state's private hospitals would, in the governor's words, "provide the matching contributions needed to draw down federal funds" to support expanded Medicaid service.
Statewide Medicaid expansions have been among the thorniest of the troubles brought about by the 2010 Affordable Care Act, which continues to decline in popularity amid losses of full-time jobs, rising health insurance premiums and a punitive tax on Americans who are not able or willing to purchase insurance.
Although 31 states -- including some with Republican governors who verbally oppose Obamacare -- have expanded Medicaid, many states are reluctant to take on this new responsibility. The stalemate in Virginia has proved embarrassing for McAuliffe, a Democrat and close associate of the Clintons who has repeatedly made the case for committing Old Dominion taxpayers to President Obama's signature program.
The colorful governor showed his customary flair Thursday when he unveiled his budget request before the budget committees of the Virginia Senate and House of Delegates.
"Ladies and gentlemen, you are looking today at the Commonwealth’s first $100 billion budget," McAuliffe said.
McAuliffe's quip earned a quick rebuttal from likely 2017 Republican gubernatorial candidate Ed Gillespie.
"I guess we disagree on what we should celebrate in Virginia. I believe we should celebrate job creation and a stronger economy, not growth in government,"
Gillespie wrote on his Facebook page.
McAuliffe's two-year, $109 billion budget proposal includes something for just about everyone, including an additional $1 billion in education spending, targeted tax cuts for corporations and individuals, and increased economic development spending.
But Medicaid expansion is likely to prove contentious with Republicans who dominate the state House and hold a slim majority in the Senate.
The Virginia Hospital and Healthcare Association issued a statement on the drawdown plan after McAuliffe's presentation.
"The concept is flexible enough that it could be used within the existing Medicaid program to increase reimbursements, or to cover the state costs associated with helping more uninsured Virginians obtain health care coverage," said Julian Walker, the association's vice president of communications.
The association said it will insist any savings that might result in the state budget from their contributions "should be set aside for struggling rural hospitals."
McAuliffe has other plans for the money.
He told the House and Senate budget committees his version of the plan "can save $157 million in state funds over the next two years." The governor intends to use a portion of those savings "to provide Virginia businesses and families with $105.7 million in personal and corporate income tax relief and boost the Commonwealth’s economy."
House Republican leaders were unimpressed by McAuliffe's plans.
“The Governor has raised expectations and over promised," GOP leaders announced in a joint statement from House Speaker William J. Howell (R-Stafford), Majority Leader Kirk Cox (R-Colonial Heights), Caucus Chairman Timothy D. Hugo (R-Fairfax), Majority Whip Jackson H. Miller (R-Manassas) and House Appropriations Committee Chairman S. Chris Jones (R-Suffolk).
They were particularly critical of the new Medicaid gambit.
"It is unfortunate to see Governor McAuliffe include Medicaid expansion in his budget again, which he knows the General Assembly does not support," the House leaders said.
"Predicating economic development priorities and tax cuts on assumptions related to [Medicaid] expansion is counterproductive and only makes it more difficult to produce a budget on time."
Delegate Richard "Dickie" Bell (R-Staunton) offered a more colorful assessment of the upcoming budget scrum on his Facebook page.
"I will say this about the budget - it's BIG! and will receive a deep tissue massage in the House," Bell wrote.