Virginia Republicans are now beginning to discuss a big issue in this year’s General Assembly – Medicaid expansion. On Monday, Speaker of the House Kirk Cox (R-Colonial Heights) sent a letter to Democratic Governor Ralph Northam claiming his conservative caucus is agreeing to start a dialogue on the commonwealth’s healthcare policy.

Speaker Cox has adamantly stated that he and his Republican delegation will oppose any “straightforward” expansion terms for Medicaid, claiming that any proposed legislation must include work requirements and other terms favored by the Republican majority. Although increases Medicaid in states around the country was a crucial part of the Obama-era Affordable Healthcare Act (ACA), conservative-minded state lawmakers throughout the nation have prevented expansion. State legislatures are now also reworking their positions after the Trump Administration stated they will allow work requirements to be written into bills for low-income Medicaid recipients.

According to a report from the Daily Press, Cox’s letter to the governor stated, “The House is willing to begin a dialogue on health care that includes significant reforms and strong taxpayer safeguards.” Discussing work requirements with Democrats will be a key part to the progression of Medicaid expansion in the Virginia House. Since the beginning of the 2018 session, the speaker has forwarded at least eight separate bills referencing Medicaid or state involvement with ACA to the House Rules Committee, indicating an attempt at a compromise with Democrats for coverage for low-income citizens.

“If there is significant opposition to the common sense concept of requiring able-bodied adults to work before receiving entitlement benefits, I fear the window on healthcare reform will narrow. I genuinely hope this is not your position,” Cox wrote to Northam.

Under current law, able-bodied adults cannot sign up for Medicaid in Virginia. However, low-income pregnant women for pre-natal care and delivery or extremely impoverished parents can still receive Medicaid. The fiscal cut off for recipients is 30 percent of the federal poverty level, which equates to an income of no more than $4,872 a year in Virginia for a single parent of a single child.

In the report, spokeswoman for Governor Northam Ofirah Yheskel stated that the governor, “is encouraged that House Republicans are willing to begin the discussion about coverage expansion, though he believes the dialog should begin with connecting more Virginians with quality health care, not less.” Although he must wait for the House Rules Committee to decide, “He [Governor Northam] looks forward to working with the General Assembly on a plan that works for all Virginians,” Yheskel added.

The proposed work requirements would be set for adult Medicaid recipients to work for at least 20 hours a week. Waivers would be in order for those attending school, those of whom are the sole caregiver for a child under six years of age, or are barred from working due to a disability. The requirements would need permission from the federal government in order to impose them, but the White House has stated they will allow states to decide on work requirements to receive healthcare aid.

“If your position is to pass straightforward Medicaid expansion without work requirements or other reforms, then you will be responsible for the failure to provide healthcare coverage to more Virginians,” Cox wrote in the letter. On January 23, the speaker held a telephone town hall that discussed various issues with the General Assembly. According to the subsequent poll, 42 percent of respondents believed Medicaid should be expanded, but only with work requirements.