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Virginia set to expand Medicaid as Senate and House back budget deal

Virginia set to expand Medicaid as Senate and House back budget deal

Posted by on May 31, 2018 in News | 0 comments

BY MICHAEL MARTZ Richmond Times Dispatch May 30, 2018

Six years after the U.S. Supreme Court left the decision to states on whether to expand their Medicaid programs under the Affordable Care Act, Virginia is about to extend health care coverage to hundreds of thousands of Virginians without it.

Gov. Ralph Northam has left no doubt he will sign a pair of budget bills that will begin a two-phased process of receiving federal approval to expand Medicaid in Virginia on Jan. 1, relying on billions of dollars in long-available federal funds and a pair of taxes on hospital revenues to pay for it.

The decisive vote came in the Senate just after 7 p.m. on Wednesday, when a bitterly divided chamber voted 23-17 to adopt a two-year budget that includes Medicaid expansion. Earlier in a grueling six-hour debate, the Senate adopted a revised budget for the current fiscal year that ends June 30, by the same margin, that directs the state to move forward on expansion.

A little more than an hour later, the House of Delegates adopted identical budget bills embodying a compromise negotiated by House Appropriations Chairman Chris Jones, R-Suffolk, and Senate Finance Co-Chairman Emmett Hanger, R-Augusta, to resolve an impasse that had left Virginia without a budget for the next biennium when the General Assembly adjourned its regular session on March 10.

“It’s not about the House. It’s not about the Senate. It’s about Virginia,” Jones said on the House floor. “And the 8.3 million people we represent.”

The victory was especially hard-fought for Hanger, a moderate Republican from the Shenandoah Valley who had been thwarted by fellow Republicans from expanding health coverage in 2014. This year, he had to overcome fierce opposition from Senate Republicans led by Majority Leader Tommy Norment, R-James City, who bitterly denounced the outcome and the backdoor negotiations with the House that produced it as “a degradation of the customs, usage and traditions of the Senate.”

Norment issued a statement saying the legislature had approved a budget “that abandons Virginia’s long-standing reputation for fiscal responsibility” and “marks a stark departure, both from the conservative fiscal policies observed by the commonwealth for generations and in the manner in which it was approved by the General Assembly.”

Hanger called Norment’s remarks “unfounded,” and Sen. Janet Howell, D-Fairfax, said the budget deal was necessary after the legislature failed to adopt a budget in March and the Senate Finance Committee didn’t propose its own amendments until seven weeks after the assembly convened in special session.

“Something had to happen,” Howell said. “You can’t just stand around and wait until we go over the cliff.”

In the end, three other Republican senators — Frank Wagner of Virginia Beach, Ben Chafin of Russell County and Jill Vogel of Fauquier County — joined Hanger and the Senate’s 19 Democrats in adopting the pair of budget bills to end a standoff that has been watched closely by national bond-rating agencies and institutional investors who hold the state’s AAA-rated bonds.

“We should be in much better position with our bond-rating agencies now,” Hanger said after the vote.

While Norment and other Republican opponents denounced the budget bills as anything but conservative, Wagner defended his decision to vote for them as a way to gain concessions that would allow the state to seek federal waivers that would impose work and other requirements on Medicaid recipients and fashion ways to lower commercial insurance premiums for middle-class Virginians.

“It’s a helluva lot more conservative than it was initially,” Wagner said after the vote.

House Speaker Kirk Cox, R-Colonial Heights, also defended his decision to support Medicaid expansion after almost five years of opposing it and after House elections last fall that almost cost the GOP its majority.

Cox said the budget “includes what I consider the most conservative set of reforms to Medicaid in the nation as part of a plan to expand health care coverage to working Virginians,” but Senate Republican opponents scoffed at the proposed work requirement and other reforms, while predicting future tax increases to pay for the expanded health care entitlement.

“In the 17 years I’ve been here, this is the one budget that scares me to death,” said Sen. Bill Carrico, R-Grayson.

His seatmate, Sen. Bill Stanley, R-Franklin County, denounced the budget as “a ticking time bomb” and a “$1.2 billion bailout to our hospitals.” Private hospitals would receive an estimated net benefit of about $880 million over the next two years from a pair of provider assessments that raise money for the state’s share of expansion and an increase in reimbursement rates for treating Medicaid patients.

Stanley also contended the state would not be able to reverse course and take back benefits for new recipients if the federal government reduces its share of the funding. “Once you ring this bell, you cannot unring this bell,” he said.

But Chafin and Vogel defended their decisions as necessary to invest in core public services, while expanding health coverage to people who need it and the hospitals that provide it.

“I came to the conclusion that ‘no’ just wasn’t an answer anymore,” he said.

Like Chafin, Vogel said she has opposed Medicaid expansion in the past, but supports the budget proposal because of the reforms it includes, as well as funding for her priorities.

“There’s a lot more in this budget than just Medicaid expansion,” she said.

For Democrats, victory was sweet after years of disappointments. “I can’t say enough good things about Emmett Hanger,” Minority Leader Dick Saslaw, D-Fairfax, said at a news conference of Democrats who applauded and replied, “Yes!”

“And also, Frank Wagner. It took a lot of guts,” Saslaw said.

Before the Senate could act on the budget bills that Hanger negotiated with Jones and Northam, the Senate first had to reject a package of amendments proposed by Norment and adopted in a tense Finance Committee meeting on Tuesday. The package embodied the budgets the Senate had adopted in February without Medicaid expansion or hospital assessments, with additional money from higher tax collections and spending on pay increases for public employees.

The Senate voted 22-18 to reject the committee amendments, with Vogel supporting them.

Hanger then fought off a series of amendments proposed to his substitute bills, including two by Sen. Steve Newman, R-Bedford, to the budget for the current fiscal year in an attempt to require approval of the federal waiver before the program could expand and to make the proposed work requirement more stringent.

The Senate then considered and rejected 18 amendments proposed to the biennial budget, including three Newman offered to put in further safeguards in case the federal government reduces state Medicaid funding or the state’s program takes up too much of the state general fund budget.

Hanger blocked each amendment in order to preserve his agreement with the House and governor and avoid amendments that could require a conference committee to reconcile the House and Senate budgets.

“We’ve got a responsibility in this chamber to get this right,” Newman complained, adding, “I don’t care about the agreement with the House. I don’t care about the agreement with the governor.”

In the end, however, the adoption of the budgets without amendments in both chambers cleared the way for quick action by Northam, who told reporters the legislature’s action was “a proud day for Virginia.”

“This is a budget that I really am proud of,” the governor said. “I think it’s good for all Virginians. It’s structurally sound. It expands health care in the commonwealth of Virginia and it protects our triple A bond rating.”

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Staff writers Graham Moomaw and Patrick Wilson contributed to this report

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Virginia school safety panel sets broad mandate for work

Virginia school safety panel sets broad mandate for work

Posted by on Apr 26, 2018 in News | 0 comments

By DAVE RESS Daily Press

April 26, 2018

The House of Delegates’ first Select Committee in 155 years got down to business with a briefing on Virginia’s extensive efforts to boost school safety — and a promise to look at school safety in the broadest possible way.

That includes looking at ways of preventing violence and addressing behavioral issues, as well as thinking about security measures — such as the unexpected new safety curtains installed in the glassed-in office that Speaker Kirk Cox found when he stopped by at the place where he used to teach.

“There’s more to school safety than higher walls and stronger locks,” Cox said, convening the Select Committee’s first meeting Thursday.

Cox said it was heartening to hear nearly 90 minutes of briefing on steps the state has taken in recent years.

They range from one of the nation’s most robust School Resource Officer programs and being the only state to require threat assessment teams in K-12 schools and colleges, to the longest-lived clearing house for school safety concerns and training at the Department of Criminal Justice Services.

But there’s more to do, he said.

Cox said addressing concerns expressed Thursday by, among others, Del. Mike Mullin, D-Newport News, about bullying and the violence it can foreshadow will be part of the group’s task in the months ahead.

Del. Chris Jones, R-Suffolk, said enhancing safety means building trust.

During a recent tour of schools in South Hampton Roads — when he heard a lot about physical safety measures — Jones said he also heard about a social media post that promised something big was going to happen at a high school cafeteria.

It turned out to be an invitation to a prom. But it meant hours of anxiety for parents and school officials, he said. Making sure everybody feels safe and secure in school will be a big job, he added.

“We have a strong foundation we’ll be able to add to,” said vice chairman Danny Marshall, R-Pittsylvania County. “I was a little surprised at all that’s been done.”

And, he said, the public has lots of ideas and lots of worries. Marshall said he received more than 100 emails with suggestions about safety measures since the Select Committee’s formation last month.

The committee’s goal is to review state and local policies on school safety and make recommendations to the General Assembly for the 2019 session.

The committee will not discuss issues related to guns or broader behavioral health policy, Cox has said, because other General Assembly committees and commissions are looking at those issues.

Instead it will look at providing additional mental health resources for students and developing protocols for prevention of mental health crises at schools.

In addition, the committee will explore ways to harden school security systems.

It will also consider best practices for school security and at deploying additional security personnel.

Ress can be reached by telephone at 757-247-4535


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House committee adopts new budget, with changes for Medicaid work requirement, insurance and cash reserve

House committee adopts new budget, with changes for Medicaid work requirement, insurance and cash reserve

Posted by on Apr 16, 2018 in News | 0 comments

By MICHAEL MARTZ Richmond Times Dispatch

Apr 13, 2018

There are few surprises in the new state budget the House Appropriations Committee adopted Friday, but concern about protecting Virginia’s triple-A bond rating will loom over the coming battle with the Senate over whether the final spending plan will expand the state’s Medicaid program.

The committee made a number of important changes to the pair of budgets — one for the fiscal year that will end June 30 and the other for the biennium, and then adopted both by 16-5 votes that reflect a continued division among Republicans over Medicaid expansion.

The committee’s action paves the way for the full House to vote on its version of the budget Tuesday afternoon, when lawmakers return to continue the special session in an effort to resolve the impasse.

The amended House budget bills would tighten the requirement that able-bodied Medicaid recipients work or look for employment, seek a new federal waiver to allow Virginia to bolster its individual market for health insurance, and require all higher-than-predicted revenues at the end of this year go into the state’s new cash reserve.

However, Senate Republicans made clear that the proposed changes wouldn’t change their opposition to Medicaid expansion in the budget.

“The few changes to the House’s original proposal approved by the committee today do not narrow the chasm between our respective proposals,” Senate Majority Leader Tommy Norment, R-James City, said in a statement Friday afternoon.

Gauging revenues

Norment, who is co-chairman of the Senate Finance Committee, called again for “an up-to-date and comprehensive re-forecast” to help the assembly “in its efforts to reach an agreement on a fiscally responsible budget based on sustainable revenues.”

State Finance Secretary Aubrey Layne told the committee Friday that the governor and other assembly budget leaders were right in deciding to not revise revenues in order to reflect higher income tax collections from affluent taxpayers who don’t have taxes withheld from their paychecks, but instead submit estimated payments in response to capital gains or other income gains.

Revenue growth fell by 1 percentage point last month, to 5.2 percent, compared with the previous March, primarily because of the state had one fewer deposit day for payroll income taxes.

Total revenues still are tracking ahead of the forecast of 3.4 percent annual growth with three months left in the fiscal year, but Layne said most of the increase came from nonwithholding tax collections in December, after President Donald Trump signed a tax reform bill that will eliminate the ability to write off state income taxes on federal tax returns next year.

Those gains could be offset by a big surge in refunds beginning in May and declines in other revenues, such as sales tax, Layne said. “It looks like the numbers are not telling us as of right now that a [revised] forecast … based on economic data is warranted.”

Bond rating

The cash reserve requirement, proposed by Gov. Ralph Northam and Appropriations Chairman Chris Jones, R-Suffolk, is aimed at quieting concerns among national bond-rating agencies, particularly S&P Global Ratings, which placed a negative outlook on Virginia’s financial condition just shy of a year ago.

“Triple-A bond rating is what we’ll be paying very close attention … and we will do what is necessary in the cash reserve arena to be sure we satisfy the requirements of the rating agencies in that context,” Jones told the committee.

Layne told the committee that S&P continues to ask questions about Virginia’s level of reserves, which was a primary reason the agency downgraded the state financial outlook from stable to negative on April 21 last year.

“They really didn’t like it that we pulled money out [of the rainy day fund] again in 2018,” Layne said, referring to a decision in 2016 to withdraw from the constitutionally established Revenue Stabilization Fund to help fill a projected gap in state revenues over the current biennium.

The finance secretary said earlier this month that he believes expanding Medicaid to accept billions of dollars in federal money under the Affordable Care Act is crucial to generating the resources for Virginia to bolster its financial reserves.

Norment called Layne’s concern “a toothless tiger,” since only four of the 12 states with the highest credit ratings by all three national agencies have expanded their Medicaid programs.

The Senate addressed concerns over state financial reserves in its version of the budget last month by proposing a deposit of about $180 million into the state’s new cash reserve — about $90 million more than the House and about $90 million less than then-Gov. Terry McAuliffe proposed in his parting budget in December.

“It isn’t a toothless tiger,” Quentin Kidd, director of the Wason Center for Public Policy at Christopher Newport University, said earlier this week. “We could be paying more for the money we borrow.”

Cash reserve

The new House proposal would require that if revenues exceeded the forecast by 1 percent or more in this budget — or almost $200 million — all of the money would be deposited in the new cash reserve, the rainy day fund or a state water quality plan.

Anne Oman, legislative fiscal analyst for the committee, estimated 1 percent in additional revenues would generate an additional $136 million for the new cash reserve, boosting it to about $382 million, as well as $38 million for the rainy day fund.

The amendments eliminate a previous House proposal to dedicate any additional revenues at the end of this fiscal year to a one-time bonus for state employees.

Work requirement

The committee also amended the budget to bolster the House’s proposed work requirement for Medicaid recipients, primarily the childless adults who would be covered by expanded eligibility. They would be dropped from benefits until the next annual open enrollment if they failed to look for work in some fashion in three months of the year.

Jones said the new provision is based on the same requirement in the Medicaid work requirement federal regulators approved for Arkansas this month. The previous House budget included money to oversee the requirement, much as the state already does for people who receive welfare and food stamp benefits.

“We’re trying to make sure it’s something that is complied with,” he said.

Federal waiver

The new budget proposal also would allow the state to seek a federal innovation waiver under Section 1332 of the Social Security Act for the state to develop ways to reduce soaring increases in commercial insurance premiums in the individual marketplace. Four states already have been granted such a waiver and others are considering it because many middle-income families and small businesses can’t afford health insurance without federal subsidies.

“States are trying it because it’s a big problem everywhere,” said Del. Mark Sickles, D-Fairfax, who commended Jones for the proposal to address the insurance issue as part of the budget package for expanding Medicaid.

Across town, Northam made his Medicaid pitch to a business-minded crowd at a luncheon hosted by the Virginia Chamber of Commerce and ChamberRVA. The governor said the state has a moral responsibility to help Virginians who could face financial ruin because of an illness. He said the safeguards in place to unwind expansion if federal money disappears make sense from “a business perspective.”

“If they renege in a year or four years, it is still resources that we have today,” Northam said. “So let’s act on today.”

Speaking to reporters afterward, Northam said he’s willing to talk to GOP leaders from both the House and Senate.

“We’ve got everything on the table right now,” Northam said.

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Staff writer Graham Moomaw contributed to this story.

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Gov. Northam OKs paying “Norfolk Four” $3.5M for wrongful rape, murder convictions

Gov. Northam OKs paying “Norfolk Four” $3.5M for wrongful rape, murder convictions

Posted by on Apr 10, 2018 in News | 0 comments

Capital News Service Updated 

RICHMOND, Va. (AP) — Gov. Ralph Northam has signed legislation to provide nearly $3.5 million in compensation to the “Norfolk Four,” the U.S. Navy sailors who were wrongfully convicted and imprisoned for a 1997 rape and murder.

Northam last week signed identical House and Senate bills to compensate Danial Williams, Joseph Dick, Derek Tice and Eric Wilson, who were wrongly convicted in 1999 of raping and killing 18-year-old Michelle Bosko.

Under the legislation, Williams will receive $895,299; Dick, $875,845; Wilson, $866,456; and Tice, $858,704.

On Thursday, Northam signed the measures containing the compensation package – Senate Bill 772, proposed by Sen. Scott Surovell, D-Fairfax, and House Bill 762, proposed by Del. Chris Jones, R-Suffolk.

The legislation notes that the “Norfolk Four” defendants “spent nearly four decades in prison collectively for crimes they did not commit, and another collective 30 years after release from prison under highly restrictive parole and sex offender registry conditions that imposed onerous barriers to their reentry to society.”

The four men were “imprisoned and experienced assaults and other horrific experiences during the imprisonment that irreparably broke them in a manner that no time or money will ever fix,” according to the legislation.

The defendants were convicted because of their coerced confessions, even though the real rapist and murderer, Omar Ballard, confessed in 1999 to committing the crime alone and his DNA was found at the crime scene, bills state.

Ballard is currently an inmate at Sussex II State Prison and serving two life terms plus 42 years for capital murder, two rapes, two counts of malicious wounding, and abduction.

In 2009, then-Gov. Tim Kaine granted conditional pardons to Williams, Dick and Tice. That action ended their sentences, but the men remained on the sex offender registry. Wilson had already been released from prison in 2005 after serving more than eight years behind bars.

A decade after their convictions, U.S. District Judge John Gibney dismissed the convictions of Dick and Williams.

“Considering the evolution of their admissions, their subsequent recantation and the other physical evidence, the admissions of guilt by Williams, Dick and Tice are far from convincing,” Gibney’s decision stated. “Any reasonable juror considering all of the evidence would harbor reasonable doubt as to whether Williams, Dick, or anyone else, was with Ballard in Bosko’s apartment.”

In March 2017, then-Gov. Terry McAuliffe granted the “Norfolk Four” unconditional pardons, fully restoring their civil rights. However, the legislation signed by Northam states that “all four men have struggled to rebuild their lives and have lived vastly reduced lives due to the strong stigma of their wrongful convictions.”

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One House speaker honors another as ‘a special, special man’

One House speaker honors another as ‘a special, special man’

Posted by on Mar 8, 2018 in News | 0 comments


For a moment, the Virginia House of Delegates stood with two speakers of the House.

“Good afternoon, Mr. Speaker,” House Appropriations Chairman Chris Jones, R-Suffolk, greeted House Speaker Kirk Cox, R-Colonial Heights.

Jones then turned to former House Speaker Bill Howell, R-Stafford, standing with his family in the center aisle of the institution he served for 30 years, including 15 as its undisputed leader.

 “Good afternoon, Mr. Speaker,” Jones said to the man who named him to the powerful budget committee more than four years ago.

Howell’s return to the House was emotional for more reasons than his memory. On Jan. 2, a day after he officially retired as a state employee, Howell was stricken by a heart attack and taken into emergency surgery.

“There is life after retirement, though I haven’t found it yet,” he quipped during the House ceremony on Wednesday.

As the year began, the House that Howell had led with a quick wit and firm hand had been transformed by an electoral tsunami that flipped 15 seats to Democratic control and whittled a two-thirds Republican majority to two seats. As he recovered in a Fredericksburg hospital, political control of the House rested on a random drawing of lots from a bowl to determine the winner of a tied election in Newport News.

Del. David Yancey, R-Newport News, won the drawing and the House elected Cox as its new speaker, but instead of the firewall that Howell had erected against Medicaid expansion, the Republican leadership adopted a state budget built on it and the billions of dollars in federal money available under the Affordable Care Act.


‘Integrity and character’

Howell was remembered on Wednesday less for his political bearings than his moral example, which Cox called “Bill Howell’s integrity and character.”

“You’re a special, special man,” Cox told Howell, who stood with Cessie, his wife of 51 years, as well as sons Billy and Jack.

Earlier, Howell had appeared on the other side of the Capitol in the Virginia Senate. It also honored the man named as Outstanding Virginian of 2018 by a committee in partnership with the University of Virginia Frank Batten School of Leadership and Public Policy “to recognize leaders who have made an indelible mark on the commonwealth,” according to the resolution adopted by both chambers.

“I tell you, Bill Howell is a man of true integrity and honor, and he’s someone who’s always going to be known for doing what he thinks is right, even if it’s going to be difficult,” said Sen. Richard Stuart, R-Stafford, who introduced the former speaker in the “other” chamber.

For Jones, the proof was Howell’s role in reshaping the way Virginia raises money for highways and mass transit, as well as how it sets the priorities for spending it.

In 2013, Howell sponsored legislation on behalf of then-Gov. Bob McDonnell to overhaul transportation funding in Virginia for the first time in almost 30 years.

But the $6 billion package that emerged looked much different than it did when Howell introduced House Bill 2313. “It became clear that much more was needed to be done to solve the challenges for our commonwealth,” said Jones, who led the House effort to pass the legislation.

The law, raising taxes at the state and regional levels, became the legacy achievement of McDonnell’s term, but also made Howell and other supporters political targets in GOP primaries two years later. Howell won his 2015 primary challenge handily and the subsequent general election for his 15th and final term.


Retirement system reform

Howell’s achievements also include playing a major role in pushing for reforms of the Virginia Retirement System to reduce its long-term unfunded liabilities and require the legislature to fund the full state contribution required to keep pension plans for state employees, teachers and local employees on sound actuarial footing.

This year, the pension plans will be fully funded, ahead of the schedule adopted in the reform package that Jones carried for the House and Howell in 2012.

However, the former speaker was denied his long-held dream of establishing a system of 401(k)-style retirement savings plans instead of traditional pensions for new state employees. Legislation he had championed as chairman of a joint commission on employee benefits and pension reforms died in a Senate committee on the last day of the 2017 session.

“Beneath the affable demeanor was one of the most savvy and intelligent leaders Virginia has ever known,” Jones said.

Howell, who announced his retirement at the end of the last session, praised his wife for her steadfast support, “not just in the late unpleasantness, but for 51 years,” and thanked his legislative colleagues.

“The only thing I love more than Virginia, perhaps, is the Virginia House of Delegates,” he said to one last thundering ovation.

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House of Delegates drives new Medicaid vehicle onto the legislative freeway

House of Delegates drives new Medicaid vehicle onto the legislative freeway

Posted by on Mar 6, 2018 in News | 0 comments

House Appropriations Committee Chairman Chris Jones, R-Suffolk, drove a new vehicle for Medicaid expansion onto the legislative freeway as the General Assembly entered the final week of its scheduled 60-day session.

Jones, the architect of a House budget that includes Medicaid expansion, commandeered a bill on Monday that was the model for the limited expansion of Medicaid services that the Senate included in its version of the budget without money to pay for it.

The committee stripped a financial contingency clause — linking enactment to funding in the budget — out of Senate Bill 915, proposed by Sen. Siobhan Dunnavant, R-Henrico, and whisked it to the House floor on an 18-0 vote, hours before the deadline for committees to complete work on all legislation.

 “This is to continue the dialogue in the arena of expanding health care coverage for Virginians,” said Jones, who is leading the six-member House contingent on a conference committee with the Senate that is trying to reconcile the competing budget proposals.

After the meeting, he said, “this keeps another vehicle for further discussion on this issue.”

The budget discussions began Sunday with a wide gulf between the chambers, primarily because of the House’s insistence on expanding Medicaid coverage for more than 300,000 uninsured Virginians and accepting billions of dollars in federal money to pay at least 90 percent of the bill.

The House budget also includes a “provider assessment” — essentially a tax on hospital revenues that the industry has conditionally supported — to pay the state’s share. The House version also includes an estimated $371 million in savings from using federal money to replace state tax dollars in paying for indigent care at hospitals, inmate medical costs, community mental health services and other Medicaid programs that currently receive less federal matching money.

The Senate budget would not expand Medicaid or impose a provider assessment, although two Republican-controlled committees approved an early version of Dunnavant’s bill that included a hospital tax to pay for limited expansion of Medicaid services for people with mental illness, addiction or complex medical conditions.

It also would extend Medicaid waiver services to a waiting list of about 2,300 Virginians with developmental or intellectual disabilities, create a new waiver program for people with brain injuries, and require screening of almost half a million children for childhood trauma.

Finally, it would require a statewide program of alternative transportation for people in psychiatric emergencies to be evaluated for additional involuntary detention.

The “Priority Needs Program” proposed by Dunnavant is part of the Senate budget, but only as what Senate Republicans call “aspirational goals” without any money to pay for them or apply for federal approval of waivers to carry them out. The Senate amended the legislation on the floor to eliminate the provider assessment before sending the bill to the House with a clause that links enactment to budget funding.

The Appropriations Committee did nothing with the bill until Monday, when Jones proposed to remove the contingency clause and send the measure to the House floor, where he expects a substitute amendment to be proposed that would expand Medicaid.

If the House were to amend the bill with Medicaid expansion and approve it, the Senate would have the option of accepting the amendment or not. Republicans control the Senate by a 21-19 majority, but Senate Finance Committee Co-Chairman Emmett Hanger, R-Augusta, remains an unpredictable vote on an issue that he has long championed.

Hanger voted against Medicaid expansion in the House budget and refused to support a provider assessment in either budget proposal. But he publicly voiced hope in a newsletter emailed to constituents over the weekend that the Senate will approve a more comprehensive approach to expanding coverage while bolstering the struggling federal marketplace and commercial insurance markets.

“With the House including some of the Medicaid expansion components in their budget, this certainly advances the conversation,” the senator wrote in “Emmett’s Virginian Voice.”

“The majority of the Senate has still not agreed to any such plan but I believe other conservative senators will emerge to stand with me,” Hanger wrote. “If not, I will stand with anyone willing to make bold moves to address the need because it impacts all of us, our budget, and my personal beliefs tell me it is the right thing to do.”

Gov. Ralph Northam said Friday that he is prepared to propose an amendment with Medicaid expansion if the assembly approves a budget without it. Lt. Gov. Justin Fairfax, a Democrat who supports Medicaid expansion, may not break a tie vote on the budget itself, but he could vote on either a gubernatorial amendment or the potential House substitute for Dunnavant’s bill.

Jones told the committee on Monday that sending Dunnavant’s bill to the House floor would allow “further discussion” on the issue until it is ready for a vote.

“I assume there would be a substitute that would be presented at that point in time for the body to consider,” he said.

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