For three years we have had the opportunity to expand Medicaid and provide insurance coverage for up to 400,000 Virginians, 75 percent of whom either work full-time or live with someone who does. Expansion of Medicaid was included in the Governor's budget this year, but both the House and Senate stripped it out, in large part because of opposition to the President and his policies. Many have argued however that Medicaid has grown too fast and we need to get that growth under control before expanding the program. They are correct in that Medicaid spending has grown.

 

Medicaid spending has increased rapidly in the past ten years. Our expenditures have grown from about $4.4 billion in 2005 to almost $8 billion in 2016.  However, a couple of things explain the bulk of this increase. First, we have just gone through one of the worst recessions since the Great Depression in the 1930s. Incomes were slashed and jobs were lost, resulting in an increase of the number of children and low income parents who were eligible for Virginia's bare bones Medicaid program. The economic loss due to the recession has been exacerbated in Virginia by sequestration. For the past sixty years, Virginia has had a buffer against recessions because of the increased federal spending we could rely on to boost our economy. For many years, we all have been screaming about out of control federal spending. However, the other side of that is that a whole lot of that spending has been in Virginia, creating jobs and economic activity in the Commonwealth. Sequestration and its promised future effects mean that our economy is changing in ways bigger than most of us have experienced in our lifetime. Those changes will require us to continue to focus on economic diversification.

 

The second big factor in the growth of Medicaid spending is the aging baby boomer population. About 30 percent of recipients of Medicaid in Virginia are aged, blind, or disabled and account for about 67 percent of Medicaid spending. Many of those are in nursing homes or receiving personal care services to avoid nursing home placement. Medicaid was initially envisioned to be a program for the poor and was not anticipated to be required to provide long term care to so many individuals. Does that mean we need to throw those people out of nursing homes? Is that the policy decision we make to control Medicaid spending? Of course not. People who need care deserve to get it. But we have to be honest about discussing the growth of Medicaid spending. It is not growing because there are a lot of slackers who are getting Medicaid. 

 

The General Assembly has also worked hard in recent years to increase the number of waiver slots available to those individuals with intellectual and developmental disabilities.  In fact, our spending on ID waivers has increased 34 percent since 2010. The budget this year continues to expand waiver slots given the unconscionable number of people who have been waiting years and even decades for services. Should we keep these individuals and their families desperate for assistance on waiting lists for another decade? Of course not.

 

In other words, the rapid growth in Medicaid spending has to be addressed but cannot serve as an excuse for our failure to provide healthcare to the working poor.

 

Other issues of major import are still up in the air but close to resolution:

• The budget remains in negotiation. While there aren't major differences between the two proposals, there are some. Each side takes pride in its authorship. One issue of particular importance to me is state park spending. We are close to a deal to allow Natural Bridge to become a state park. The Governor included funding for two park rangers, and the plan is to boost advertising so we can increase visitors. The land acquisition of a state park in Highland County also remains under discussion, although it appeared dead just a few weeks ago.