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Medicaid Expansion Deal Struck Between Governor and House Leadership

Today’s announcement — healthcare expansion on the basis of strong conservative reform that include work requirements — is the definition of strong conservative leadership.

After years of steadfast conservative opposition to Medicaid expansion, it became clear last week that the fight over whether to expand Medicaid had been lost. Put simply, there were no longer 51 votes in the Virginia House of Delegates — the traditional conservative firewall — to stop expansion.

So the question real leaders had to ask is simply this: do we allow the Democrats to get a straightforward Bernie-style expansion which would bankrupt the state in a matter of years? Or do conservatives negotiate as good a plan as possible under the circumstances.

the politically expedient path would have been to sit back and let the Democrats have everything they want — and then let our children pay for it.

It would have been easy to vote no and head towards a principled and budgetary catastrophe. Yet Republican leadership under newly minted Speaker Kirk Cox decided to lead instead, successfully insisting upon a series of reform that reach well beyond the expansion itself, all of which should cheer conservatives.

First and foremost, the budget language includes a firm requirement that Virginia begin working with the Trump administration to use federal Medicaid funds to provide private health insurance to low-income Virginians, while ensuring that key conservative reforms like a work requirement are included.

The plan is very similar to the conservative approach Vice President Mike Pence enacted into law while Governor of Indiana, while including the tough workfare requirements demanded by Kentucky Governor Matt Bevin — in short, a legislative coup that puts Virginia’s Speaker Cox’s solution forward as the most robust and conservative of the three.

Perhaps most importantly to conservatives, the plan requires the waivers from the Trump Administration to come first. This guarantees that the conservative reforms in the plan — workfare specifically — must be implemented within the Medicaid system before it can be expanded.

Finally the plan includes a Taxpayer Safety Switch which ensures that should at any point in time the federal government cut its funding, the plan ends.

Many of us in the conservative movement fought against Medicaid expansion successfully for years, and hoped maintain the firewall with a 51-seat majority to win again this year.

However, given such slim majorities, it is clear now that Republicans simply do not have the votes.

Thomas More — former chancellor of England and now famous Man For All Seasons — once counselled that one must not abandon the ship in a storm because one cannot control the winds. What we cannot turn to good, one must at least make as little bad as we can.

Given the situation, we commend and applaud Speaker Kirk Cox for working so diligently to ensure that rigid conservative reforms became part of the deal, reforms Governor Northam proved reluctant to adopt.

True, the politically expedient path would have been to sit back and let the Democrats have everything they want — and let our children pay for it. Yet behind our principles are values, and such values often mean mitigating the worst effects to achieve salutary reform.

For the workfare requirement across Medicaid alone, we salute Speaker Cox for having the courage to do the right thing. For including private health care plans and a dead man switch in the event the federal government walks back on its funding commitments, we applaud House conservatives for hammering out a path forward. It’s not the best deal… but it’s well beyond what any conservative expected from a Democratic governor.

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