Virginia will be expanding Medicaid shortly. If I am reading the budget correctly, the state will modify their State Plan Amendment within 45 days of the governor’s signature for a straight up no strings attached expansion while a 1115 waiver with work requirements and other restrictions is prepared. Even if CMS rejects or modifies the waiver, the expansion happens via the SPA.
400,000 people will get coverage.
I want to highlight a few things I’ve written over the past eighteen months:
I’ve been quiet for the past week as I wanted to avoid seventeen hundred words of straight profanity. I think I have had enough time to at least go through a couple of stages of coping so this is a post to outline some of my assumptions for the next four years. I’ll get to health policy in another post.
TLDR: We’re fucked hard and good
Now from May 2017 during the ACHA fight
We aren’t going to win often but we get to choose how to lose. We can roll over without trying to defend our values and our morals or we can fight as hard as we can to either get a policy win or inflict significant political costs on Republicans to increase the probability of future policy wins by either putting the fear of losing their seats into them which constrains future opportunity space or flipping those seats in 2018.
More subtly, we tell stories to ourselves. I want those stories that I tell to myself about me to be true. Defending and improving the ACA is one of those stories that I tell myself. The ACA benefits 2009 me far more than it benefits the 2017 me. It is a gut check. Am I full of shit or do I actually believe in what I think I believe in?
I expected to lose, but I expected to fight a good fight.
Now today from a good friend:
Some paths to coverage are being impeded, others open. If we knew where we'd be now in Jan 2017 we'd be (conditionally) happy. https://t.co/bHWFjRHuPW
— xpostfactoid (@xpostfactoid) May 30, 2018
I can’t say I am inherently optimistic but compared to November of 2016, at least on healthcare, the worse case scenarios are, in my mind, effectively precluded and there are possibilities of improvement. States are taking the lead on taking advantage of inefficient sabotage by using 1332 waivers. Voters in Maine expanded Medicaid while enough signatures will likely put Medicaid expansion on the ballot in three more states this fall. Virginia expanded Medicaid. Yes, there are significant whacks being taken on the notion of social insurance in health care but compared to what could have been, the reality is far better than I feared.
And that is due to everyone who has stepped up. It is due to everyone who has made a phone call. It is due to everyone who was a shoulder to support their fellows. It is due to everyone who said that we need to do better and worked towards that.
Let’s celebrate a bit tonight, as our country is getting a little bit better tonight because of collective, political action because people decided to give a damn and do something about it.
Jeffro
Damn straight it’s time to celebrate! This is a new “third rail” of American politics that appears to only be dangerous to tea party numbnuts… and you are right David, it took the efforts of millions to get us to this point
Omnes Omnibus
Seconded. And thank you and the other front pagers for helping to keep us focus(Squirrel!!)ed on the important things.
JPL
I’m curious how the law compares to the Kentucky expansion. In Kentucky if you miss the 20 hour mark, you can’t reapply for a year. (at least that’s my understanding) It’s good news anyways and I hope the GA will follow suit.
Duane
David, if you find time could you discuss Missouri’s Medicaid spend down program. The only thing its done for me thus far is cause me to lose my primary care and prescription program. Do other states do this? Oh, they want 400 a month, too.
David Anderson
@Duane: let me find out something before I respond
Duane
@David Anderson: Thanks.
Elizabelle
Glad to see this. It actually is fiscally responsible.
JPL
@Elizabelle: Yes.. In the olden days we had a news media that would cover that.
Another Scott
Yes, indeed, it’s a good day in Virginia.
Don’t minimize your part in our success in this effort. You, and Gaba, and all of your colleagues who dug into the weeds to tell us what was going on “behind the headlines” gave us essential information and told us about the real-world impact.
Thank you.
But we have to keep fighting. They’re not going to give up in trying to gut Obamacare and the rest of the safety net.
160 days to go…
Cheers,
Scott.
cthulhu
At base, the more people covered by Medicaid, the harder it is to go after it in the future.
Fake Irishman
Well said.
I’ve got a two-month old. I want to be able to look her in the face in 25 years. Fighting for what’s right is important, even though sometimes you lose and you often have to compromise to make forward progress.
Now we have to stop the bad guys this summer if they decide to try again. And then we have win some more elections.
planetjanet
As a Virginian, I am enormously happy tonight. I hold no delusions that the annual free health fair by RAM in the far southwest of the state will no longer have patients to serve. But maybe the lines will be shorter. I am proud of my Governor and all of the great Democrats we elected last fall. I am rejoicing that the work knocking on doors all summer worked. Elections matter. We missed taking control of the House by 1 seat. But the election put fear in the hearts of Republicans who still have them. This is big. It puts a major win on the resume for all those newly elected Delegates and Senators who can show real results for working people. That is huge! Thank you to all who worked on this.
Matt McIrvin
They were talking about repealing the ACA entirely in a special session of Congress on Inauguration Day, 2017. I thought they were gonna pull that lever.
Jean
@planetjanet: As a Virginian, I too am happy tonight. Teachers will get a 3% raise starting July 2019, which is too little, too late, but better than nothing, which is what it has been. Schools will get more funding.