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Virginia lawmakers advance Medicaid expansion, with strings attached

AP file Virginia Gov. Bob McDonnell wants the Medicaid expansion conditional on allowing reforms to the program.

RICHMOND -- Lawmakers on Thursday pushed Virginia toward a widespread Medicaid expansion created by President Obama that would put thousands of low-income residents on a government-funded health care program.

But while the House and Senate approved amendments to Gov. Bob McDonnell's budget that would include Virginia in the expansion of Medicaid under the Patient Protection and Affordable Care Act, it's conditional on the Obama administration allowing the state to reform the program.

Support to expand Virginia's relatively meager Medicaid program has grown among some Republicans after new cost projections showed the state would save $585 million during the next five years when the federal government is expected to pay a bulk of the expenses. By 2020, however, states will have to pick up 10 percent of the bill.

Many conservative lawmakers still doubted the federal government will be able to pay states 90 cents for every dollar spent on Medicaid after the initial expansion.

"I have no confidence in those promises and we will find ourselves in just a couple budget cycles with a huge problem we cannot fund," said Sen. Steve Martin, R-Chesterfield. "I don't think we should put ourselves in that position. I can't imagine the federal government is going to be able to sustain this."

McDonnell has not joined other Republican governors who have embraced the program in recent days and remains pessimistic that the Obama administration will approve his reforms, which include pilot programs and altering the benefits package to drive down the cost of the program. Allowing those reforms would automatically trigger the Medicaid expansion in the Senate version of the budget while the House wants the General Assembly to decide if it's worth it.

If it passes, about 300,000 Virginians would become eligible for benefits.

House Democrats called for the expansion to take place immediately while McDonnell and the Obama administration negotiated and implemented reforms, but Republicans rejected that.

"The reform piece never comes whenever we do that," said House Majority Leader Kirk Cox, R-Colonial Heights.

The budget amendments also included a 2 percent raise for teachers and support staff like janitors, while the Senate version threw in a 1 percent raise for all state employees.

The House voted to put $95 million into a rainy-day fund, $45 million more than McDonnell asked for, and $31 million for more school security in the wake of the mass shooting at a Connecticut elementary school. Representatives from the House and Senate will meet in coming weeks to hammer out the differences and present a final budget to be voted on by the end of the session.