There's widespread confusion surrounding Virginia's decision to create a panel to oversee Medicaid reforms in the state, with both parties divided on what it will mean for 400,000 poor residents.
The General Assembly last month agreed to create a commission of 10 lawmakers to monitor progress on a set of Medicaid reforms that the state insists must be in place before it will consider expansion of the state-federal health care program under the Patient Protection and Affordable Care Act. Democrats won approval of the commission after threatening to block Gov. Bob McDonnell's historic transportation package.
McDonnell, who doesn't support a Medicaid expansion, noted that the commission is authorized to block it if conditions aren't met. He wrote to Health and Human Services Secretary Kathleen Sebelius last week, saying that "the language of the budget actually places a firewall against expansion consideration."
But conservatives accuse McDonnell of caving to Democrats and joining other Republican governors who are opening their states to President Obama's health care reforms.
"It can now come to fruition without taking a vote in the General Assembly," said Del. Ben Cline, R-Amherst, co-chairman of the Virginia Joint Legislative Conservative Caucus.
While some liberal activists say lawmakers didn't go far enough to provide health care coverage for more uninsured residents, Democrats are claiming victory for forcing McDonnell's hand.
"He took a hard-line position against any Medicaid expansion, and through the legislative process we were able to accomplish something else," said Sen. Don McEachin, D-Henrico.
So who is right? Nobody, says Michael Cassidy, president of the Commonwealth Institute, a Virginia think tank that has advocated for Medicaid expansion.
"It's neither a slam-dunk like some are claiming, nor is it a firewall," Cassidy said. "It's a process with some major speed bumps."
The money for expansion has been allocated, and the reforms sought under the budget bill are significant but within reach, he said. Flexibility to make Medicaid coverage more like private health insurance through co-payments and aligning benefits packages are two changes lawmakers laid out.
But McDonnell could amend the bill and require much tougher, loftier reforms, Cassidy warned. And the politics of the panel, which will have a Republican majority, could block an expansion even if it appears milestones are reached.
There's the race for governor looming as well. The Republican candidate, Attorney General Ken Cuccinelli, said the commission is unconstitutional. And Cline suggested that the Democratic candidate, Terry McAuliffe, could also dismiss the Republican-dominated panel if he felt it was an obstacle to his plans to expand Medicaid.
"If Terry McAuliffe is governor and he views a subcommittee as standing in his way," Cline said, "I would surmise that he would look to the courts."