RICHMOND, Va. – Virginia Governor Bob McDonnell said in his State of the Commonwealth Address this week that he will not support the Medicaid expansion in Virginia, which is part of the federal health care reform law.
The governor’s new budget reflects this decision.

Jill Hanken, an attorney with the Virginia Poverty Law Center, says the governor has stripped $1.1 billion from the budget – an amount she says is approaching what would come from the federal government to pay for Virginia's Medicaid expansion beginning January 2014.


"The federal government pays the entire cost of the expansion for the first three years, and this is bringing $2 billion a year into Virginia – which would be used not just for health services for low-income people, but it would support hospitals, businesses and overall economic activity."

According to a recent study by Chmura (Cha-MOORE-uh) Economics and Analytics in Richmond, the Medicaid expansion in Virginia would produce about 30,000 jobs, mostly in the medical field. After 2019, the state would be required to cover 10 percent of the costs for the expansion.

Hanken says the state's share is dwarfed by the amount of federal dollars that will be rolling into the state.

According to the Virginia Senate Finance Committee, the state spent more than $1 billion over the course of a 10-year period to subsidize indigent care at the University of Virginia and Commonwealth University Health Care Systems.

Hanken says federal funds for the expansion of Medicaid would offset these state costs.

"Also when hospitals do provide indigent care services, it affects all of us, our own health care insurance premiums go up by about a thousand dollars a year."

Hanken adds that Virginia has one of the most restrictive Medicaid programs in the entire country, but the expansion would alter this and about 400,000 Virginians could qualify for Medicaid health insurance.

The Virginia General Assembly will decide during its 2013 session whether to adopt the Medicaid expansion.





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While cuts to food support programs and Medicaid gained attention as the debate over the budget bill went on, there is also a long-term likelihood it will result in automatic spending cuts to Medicare.

According to the Congressional Budget Office, the reconciliation bill is projected to add more than $3 trillion to the deficit over 10 years. If the estimate is accurate, the Statutory Pay-As-You-Go Act would require the executive branch to enact automatic spending cuts, including 4% annual cuts to Medicare starting in January, translating to around $500 billion in cuts over 10 years.

John Geer, professor of political science at Vanderbilt University and co-director of the Vanderbilt Poll, said a spring survey found Tennesseans were broadly opposed to cuts.

"We ask about Tennesseans' willingness to support cuts to Medicaid, Medicare, Social Security, veterans, etc.," Geer outlined. "And the truth of the matter is that Tennesseans are opposed to cuts in any of these programs. And it doesn't matter your partisan stripe, whether you're a liberal Democrat or a conservative MAGA-ite, you don't want to see these programs cut."

More than 1.5 million Tennesseans depend on Medicare. Congressional action would be needed to avoid automatic cuts, likely requiring a 60-vote majority in the Senate.

While funding to research under the National Institutes of Health would not be subjected to automatic cuts, the Department of Government Efficiency has already fired 2,500 researchers at the NIH and canceled more than 800 research grants. Geer's polling found more than 70% of Tennesseans oppose cutting funding for basic research.

"We asked a battery of questions about cutting research at universities, at hospitals, for drug discovery, etc., and again, there's partisan differences," Geer reported. "The MAGA folks, so to speak, are happy to do the cutting but the rest of the state has concerns."

The poll found 73% of Tennesseans support research at teaching hospitals and 66% supported research at universities.


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As the U.S. Senate has approved President Donald Trump's tax cut and spending bill, health care advocates are hoping to get California's Republican members of Congress on board to reject huge potential cuts to Medicaid, known as Medi-Cal in the Golden State.

The House approved the massive budget bill once before but now must reconsider the changes made in the Senate.

Matthew Herdman, California state director for the nonprofit Protect Our Care, hopes three California House members in particular will "flip" their votes.

"We believe that it's possible to stop this," Herdman explained. "When it initially came through the House, it only passed by one single vote, which means any one -- of David Valadao, Young Kim or Ken Calvert -- could vote against this in order to stop it."

The Congressional Budget Office estimated the Senate version of the bill would slash about $1 trillion from Medicaid and other health programs and it is forecast to cause almost 12 million people to lose health coverage by increasing work requirements and requiring people to verify their eligibility more often. Backers said the savings are necessary to partially cover the cost of extending Trump's 2017 tax cuts.

Rep. David Min, D-Calif., who represents parts of Orange County, said the bill would still increase the national debt by trillions of dollars.

"It's all because of this completely evil and immoral agenda to give more money to people in the world who don't need it," Min asserted. "This is so wrong, and we need to fight back."

Naida Tushnet, a member of the Long Beach Gray Panthers, said she is worried about low-income older people who rely on both Medicaid and Medicare, particularly for long-term care.

"If they have to keep filing, even if they're capable of doing it all, they're going to fall into the cracks, because the system -- that's all online -- has been stripped of humans, because they fired all those other people who could take it on the phone and talk them through it," Tushnet outlined.

President Trump has set a deadline of July 4 for final passage of the bill, so the Republican leadership in the House is furiously negotiating and will try to hold a vote in the next few days.


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An Illinois professor cautions against premature celebrations of victory or defeat after the U.S. Senate passed President Donald Trump's budget reconciliation bill Tuesday.

The Senate narrowly passed an amended version of the bill after Vice President JD Vance's vote broke the 50-50 deadlock. The bill now goes back to the House because of the changes made to it in the Senate.

Brian Gaines, professor of political science at the University of Illinois, said the narrow margin in both chambers still makes the bill's future uncertain.

"We've seen the House being pretty unruly lately and it's a very small margin for the Republican majority, so I think there's a lot of suspense about what the House is going to do next," Gaines explained. "This is not yet the time for a victory lap for Donald Trump or the '(One) Big Beautiful Bill (Act).'"

Gaines noted Rep. Mike Johnson, R-La., the Speaker of the House, has already faced difficulties in uniting the Republican Party on key issues like Medicaid, Social Security and local and state taxes. He added the changes made in the Senate to address the issues could further complicate its fate in the House.

The House will now work to pass the bill by Friday. Gaines views the President's July 4 deadline as potentially flexible, yet strategically important, since most folks in Congress would like to go home for the holiday weekend.

"The danger, of course, of people going back home is that they're more likely to hear opposition than support," Gaines observed. "You might end up with a caucus that's even harder to get on board after they've had the chance to hang around barbecues and have people complain to them."

Gaines emphasized the difficulty of passing legislation with small majorities and praised Johnson's skill in navigating the challenges. He noted the unpredictable nature of large legislative outcomes and the uncertainty about exactly what's in the massive bill make it hard to hone in on any implications.

"Surprisingly often, when there's a very big bill like this, 'We have to pass it to know what's in it,' turns out to be true in some respects," Gaines added. "Some of the consequences you see months later are not the ones that we were talking about in advance."