emmett-hangerBy Peter Galuszka

Could some seemingly small technical changes in legislative tactics and voting powers on an obscure commission clear the way for passing a state budget and expanding Medicaid in some form?

Sen. Emmett Hanger, a Republican senator from Augusta, thinks so. If he’s right, there could be a way out for both Republican House Speaker Bill Howell and Democratic Gov. Terry McAuliffe who are taking the stubborn impasse right up to the wire of June 30.

Hanger is proposing technically separating Medicaid expansion to 400,000 lower income Virginians from the budget debate, but with a twist.

There would be legislation linked to the budget requiring changes in the voting of a legislative commission known as the Medicaid Innovation and Reform Commission (MIRC) which was formed in 2013 and must agree that enough positive change in the Medicaid program is taking place to allow expansion. It would most likely occur through private insurance exchanges of some type.

“By October of this year we might be able to begin some limited enrollments,” Hanger told me in an interview.

I called him because, frankly, I didn’t understand media accounts of what he was proposing although the reports indicated that there could be some kind of breakthrough involved. My undergraduate degree is in international relations and I used to study diplomacy. I realize that such types of granular give and take can bring tremendous progress. I am intrigued.

Of course, I could be dead wrong and Virginia will not pass a $96 billion, two-year budget, the state will lose its good bond rating, government will shut down at least in part, teachers won’t get paid and those caught in health care limbo between Medicaid and Obamacare will remain there.

Talking with Hanger gave me some perspective that I didn’t have and haven’t read in the Mainstream media.

First, he said that the General Assembly has already approved Medicaid expansion. It did so last year with former Gov. Bob McDonnell in office. But it also created the 10 member legislative Medicaid Innovation and Reform Commission to identify problems and offer improvement suggestions for the state’s Medicaid program. No expansion can occur unless the commission approves. Hanger is chairman of MIRC.

By law, any expansion of Medicaid must be approved by a supermajority vote of the commission. That means that a majority of the five Senate members of the commission would have to say yes. Ditto a majority of the five House members.

Hanger’s proposal would make it a straight majority vote of six out of 10 members from both Senate and House sides. Plus, they won’t vote to approve expansion, only to disapprove it. In the meantime, MIRC would set clear metrics to benchmark what reforms are truly wanted.

Medicaid expansion would involve some kind of private health exchange (now dubbed “Marketplace Virginia”), and there would be added safeguards that there would be adequate copays by participants and ways to make sure that emergency rooms aren’t suddenly flooded with newly insured patients. He also wants a workable data system to keep track of patients and payments and other safeguards to prevent abuse. There are at least 17 categories of improvement areas.

The Senate would concede and use the House’s budget bill. The House would drop “Marketplace Virginia” from its bill and would concede that addressing additional Medicaid reforms would be required.

“Technically, it delinks Medicaid expansion from the budget bills,” says Hanger. But he adds that many seem to have forgotten that the General Assembly actually approved of Medicaid expansion last year “if a series of reforms were taken.” He says his plan would insure that just that happens and he believes it could happen quickly while the budget impasse is resolved separately.

He says that Howell, who has stubbornly resisted any Medicaid expansion this legislative session, seems amenable. So does McAuliffe.

The danger, of course, is that decoupling Medicaid from the budget bills takes away leverage points from both sides. Democratic Senator Dick Saslaw fears some kind of trick as do some Republicans.

My view is that sure there’s that risk, but it’s getting really late to keep playing chicken. My view also is that McAuliffe has done a hell of a lot more to compromise than Howell has.

Also, in my view, a private exchange is not the best way to go to expand Medicaid but the reality is that Virginia has a highly conservative legislature. Other conservative states such as Indiana have managed health care expansion through private exchanges, so I guess half a loaf is better than no loaf.

It seems that Hanger’s proposed deal might just get that, and not too late, either. It’s worth a look since the financial and health alternatives are truly terrible to contemplate.

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14 responses to “Sen. Emmett Hanger’s Good Idea”

  1. larryg Avatar

    this is more obfuscation by the GOP in my view:

    here is what Howell tweeted:

    William J. Howell @SpeakerHowell ·
    “Senator Hanger has made an encouraging and productive offer.” — Full statement of @vahousegop leadership: http://www.vahousegop.com/2014/05/house-leadership-statement-on-senator-hangers-proposal/

    here’s what the link points to:

    ” “Senator Hanger has made a productive offer that leaves us encouraged about the prospects of reaching an agreement on the state budget. He acknowledges the need to separate Medicaid expansion from budget deliberations in order to facilitate the prompt passage of a state budget, recognizes the need for continued reforms before we consider expansion, and emphasizes that any attempt by the Governor to spend money from the state treasury absent a budget law or to expand Medicaid without the legislature’s approval would be totally unacceptable. We will take a very close look at the proposal and immediately begin talking with Senator Hanger.”

    tell me exactly what Howell is saying here…

    and who does Howell think is reading his words?

    you CAN HAVE “reform” AND have expansion.

    you CAN stipulate that you WILL have expansion and it WILL be implemented according to legislative directive…

    Mr. Howell is tap dancing – again… he’s got the trap door lifted and reading to disappear down it.. again…

  2. larryg Avatar

    we have 400,000 people who WORK in our state who do not have access to insurance.

    Forget the MedicAid Expansion – just tell me what Speaker Howells plan is to help those folks?

    We use MedicAid right now – to subsidize nursing homes for people who own homes – so they can give their assets to their kids instead of paying for their nursing home care.

    that is NOT required by the Feds. It’s totally optional and Virginia has chosen to provide that subsidy to those who have significant assets – at the very same time they turn their back on people who are working for a living.

    this is how the GOP does business. It’s disgusting.

  3. jhuenn Avatar

    Thanks Peter. Your explanation of Hanger’s proposal is far better than what I got out of the major metropolitan daily that was delivered to my doorstep this morning. Virginia politics sure are interesting. I just wish legislative districts were more diverse and forced their representatives to search more for a common ground that appealed to the center rather than the extreme.

  4. Thanks for the reporting, Peter. This definitely helps us better understand the significance of the Hanger proposal.

  5. DJRippert Avatar

    I give Hangar credit for trying. However, I suspect his plan is unconstitutional under the Virginia Constitution.

    While Attorney General, Ken Cuccinelli was twice asked to opine on the constitutionality of MIRC. In both opinions he found it would be unconstitutional for the General Assembly to delegate the enactment of legislation to a committee. As usual, The Imperial Clown Show in Richmond formed MIRC anyway (who can forget Tim Kaine’s transportation plan which was passed and then immediately found unconstitutional by unanimous vote of the Virginia Supreme Court?).

    Maybe Hangar’s new approach would somehow bypass the lingering constitutionality issues. Or maybe not. Either way, it’s a cop out for an obviously incompetent legislature which was voted into office to make decisions – not delegate decisions to committees and not to sit in stony stalemate.

    If they go forward with this how long can it before somebody who doesn’t like the outcome sues the state over the approach? No doubt they could hire Cuccinelli as their lawyer! The Virginia Supreme Court has already demonstrated that it has no qualms about throwing out laws it finds to be unconstitutional.

    The Imperial Clown Show in Richmond should do its damn job and make a decision.

    Here is Cuccinelli’s second opinion –


    1. larryg Avatar

      I too thank Peter for his excellent journalism.. and he shows up the lame stream media … over and over..

      but the GOP fully intended to deep six the expansion issue by shunting it off to a committee to die – .. let’s be honest…

      and now they’re saying what?

      what are they really proposing other than more fan dancing?

  6. Peter Galuszka Avatar
    Peter Galuszka

    Thanks for the kudos.

    DJR, Your point about constitutionality is a good one. When I spoke with Hanger something was tugging at the back of my mind — such as why an appointed committee of legislators gets to make such an important decision.

    1. It may well violate one-person, one vote.

      On another part of the question, how does the Virginia Plan reduce ER visits? I’ve asked Senator Favola who said each person covered has a PCP who must approve treatment. But that doesn’t make sense if the person bypasses the PCP and goes to the ER. Her answer was simply foolish and wrong. The logic fails. Alternatively, the Plan could limit the number of ER visits covered. But I’ve not heard that is part of the Plan. I’m still looking for an answer to this question. Both Oregon and Washington had big jumps in ER visits by Medicaid patients. How does the so-called “solution” work?

      1. larryg Avatar

        How would you KNOW for ANY prospective law that intended change?

        you don’t not do the law because you don’t have 100% guarantees..

        you do the law and if it needs to be fixed – to get to the goal -you do that.

        the point is – do you want to continue to have ERs be primary care and make no effort at all to move away from it unless you have absolute guarantees.

        more import – we can argue about entitlements for folks that don’t work – but these folks work… and we currently subsidize employer provided insurance, Medicare and Medicaid for nursing homes and I see no “concern” about these things not working as we would like – either.

        you move forward a little at a time – you don’t freeze yourself in place because there are no guarantees.

        1. I’m still looking for an answer to a reasonable question: How will the Virginia plan prevent excess use of ERs in light of the Oregon and Washington experiences? Senator Favola’s answer is lacking.

          1. larryg Avatar

            re: ” I’m still looking for an answer to a reasonable question: How will the Virginia plan prevent excess use of ERs in light of the Oregon and Washington experiences? Senator Favola’s answer is lacking.”

            How do you know that about ANY law that purports to change behaviors?

            would you base your support on changes to the immigration laws – on “guarantees” that stricter laws would work?

            is your support or non-support of any new law – governed by guaranteed outcomes?

          2. larryg Avatar

            the real question is – does the Va legislature have an approach to providing access to health care – for people who work?

            what’s the answer?

      2. larryg Avatar

        Here’s the question.

        On what basis would one oppose working people getting the same kind of access to insurance that employer-provided folks get?

        In other words, employer-provided folks get tax-free insurance benefits and they pay the same price no matter their individual health status.

        on what basis would we oppose the working poor from getting the same deal?

        remember – this is not “free” insurance. they have to pay for it – on a means-tested basis but why would they not get to write it off on their taxes?

        the benefit they’d receive wold be

        1. – access with the same price no matter their individual status (just like employer-provided).

        2. – the price advantage of belonging to a huge pool of insured as opposed to being charged an individual rate.

        but here’s another question for those who oppose ObamaCare and the MedicAid expansion.

        Do you know why:

        1. employer-provided insurance is tax free – what’s the benefit to the govt?

        2. do you know why anyone who gets employer-provided pays the same price no matter their individual health status? how can govt require the free market to provide this?

        bonus question – on the answers to 1. and 2. above – do you suspect the answer is that they get those benefits through the unfettered free market or do they get those benefits through govt regulation?

        Hint – if the benefits of employer-provided insurance is due to the free market and not govt regulation – how come those same terms are not available to other folks who buy individual insurance on the open market?

        where oh where in the voluminous ObamaCare regulations is this explained?

        double bonus question:

        how hard would it be for the GOP – to offer as a REAL alternative to ObamaCare that said in very few words – that any individual could have access to insurance that provided the same benefits for employer-provided – at the same price regardless of their individual health status and would be allowed to write off their insurance costs from their taxes?

        what justifies employer-provided insurance offering large insurance pools at one price for all when the market-priced insurance does not offer similar policies to folks who don’t have employer-provided insurance?

        where in all that legislation that preceded ObamaCare does it say that the govt will insure that employer-provided insurance will be tax-free and will offer one price to all?

        How many of us that have access to employer-provided insurance – care about this when we talk about ObamaCare and the MedicAid expansion?

        how many of us are truly free of hypocrisy if we have access to employer-provided yet we oppose insurance to others – on the same basis that we have access?

  7. Breckinridge Avatar

    Now what was that line they gave Brian Keith/Theodore Roosevelt in that great film, “The Wind and the Lion?” I have this memory of TR saying to John Hay (played by John Huston) – “now why spoil the beauty of the thing with questions of legality!”

    They will find a way to a budget when they want to, and the path may wander. Unless a couple of Senate Democrats are ready to break with their governor and vote a bill out of Senate Finance by joining with the GOP members, all of this is just a hand puppet show. Show me the committee vote. (Once it is out of committee, only one Democrat needs to break and vote aye on the floor, which is what Colgan did the last time.)

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