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.