RICHMOND, Va. — The White House budget director waded into Virginia’s ongoing debate over whether to expand Medicaid on Thursday, saying the Trump administration is “committed to addressing the unsustainable growth” of the program.
The Office of Management and Budget issued director Mick Mulvaney’s brief statement “on the Obamacare Medicaid Expansion in Virginia” on Twitter.
“The program has resulted in an explosion of state and federal spending, and abundant evidence suggests new enrollees are not experiencing health improvements to justify this dramatic increase in cost,” the statement said. It went on to say President Donald Trump’s budget “supports increased flexibility for states to design solutions that best meet the needs of their low-income and most vulnerable populations.”
The comments come at a critical time in Virginia’s effort to expand Medicaid under former President Barack Obama’s health care law to provide health coverage for 300,000 low-income Virginians, a top priority for Democrats that Republicans have fought off for years.
The state House has passed a budget that accepts federal funding for expansion; the Senate budget has no such provision. A conference committee will meet to hash out that and other differences.
Sen. Ryan McDougle, chairman of the Senate Republican caucus, said Mulvaney’s statement confirms his chamber’s position is the correct one.
“That message seemed to be unequivocally direct in that we need to pursue directions that do not include expansion because the dollars are not going to be coming with it,” McDougle said.
Trump’s recent budget proposal called for repealing Medicaid expansion and overhauling the program to limit future federal financing. But it’s highly unlikely that Congress will move ahead with that plan.
Congressional Republicans tried to do just that last year and failed, drawing widespread opposition that included a number of GOP governors whose states expanded Medicaid.
Polls show strong public approval of Medicaid and its expansion so serve more low-income working people. The expansion remains the law of the land, and the Trump administration would find itself in federal court if tried to turn down a new request from Virginia or any other state.
The Office of Management and Budget is not the agency that approves or denies Medicaid waivers. That agency is the Centers for Medicare and Medicaid Services, part of the Health and Human Services department.
Lawmakers in the House said the statement was unclear and didn’t think it would affect the debate.
House Appropriations Chairman Del. Chris Jones said the statement was a mixed message at best.
“Some people read it one way, some people read it another,” said Del. Terry Kilgore, a Republican from southwest Virginia who recently endorsed expansion after years of opposition.
Asked for further comment, an OMB official said the tweet speaks for itself.
Democratic Gov. Ralph Northam, a pediatric neurologist, has said expansion is one of his top priorities. Northam and his team met with several federal health care officials last weekend in Washington, his spokesman, Brian Coy, said.
“They were assured that the Trump administration will continue to evaluate applications for expanded coverage, and would look favorably on waivers to connect Virginians with work and incentivize healthy choices,” Coy said.
In Washington, Virginia Democratic Sen. Tim Kaine chided the Trump administration for “trying to limit the number of people who have access to life-saving health care.” Kaine said he believes Virginia leaders are committed to “doing the right thing” by expanding Medicaid.
Associated Press health care writer Ricardo Alonso-Zaldivar in Washington, D.C., contributed to this report.