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Our view: McAuliffe and Medicaid: Beware the precedent

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The last royal governor of Virginia was the high-handed Lord Dunmore, one of whose chief political sins was his persistent refusal to consult with the elected House of Burgesses.

The relationship went south and Dunmore eventually went east, home to Great Britain, somewhat forcibly.

Not content to run off their governor, Virginians promptly stripped his name from Dunmore County, preferring the more picturesque name “Shenandoah.” Instead, they named a street in Norfolk after him, to note what is supposedly the last place where the royalist autocrat trod upon Old Dominion soil.

Centuries later, Lord Dunmore is still persona no grata in his former colony. When Morgan Griffith of Salem became House Majority Leader in the General Assembly in 2000, one of his first acts was to have Dunmore’s gubernatorial portrait unceremoniously removed from the Capitol and put into storage.

This history lesson could be useful in contemplating the upcoming Independence Day holiday – or Gov. Terry McAuliffe’s announcement last week that he intends to bypass a recalcitrant General Assembly and figure out a way to expand Medicaid through executive action alone. What Democrats hailed as “this is what leadership looks like” (Del. Patrick Hope, D-Arlington), Republicans condemned as the act of an “elected Emperor” (Del. Greg Habeeb, R-Salem).

McAuliffe’s move exists on two levels - policy and process.

The policy debate goes like this: Democrats see a moral imperative to extend Medicaid coverage to 400,000 low-income Virginians - and the chance to do so through provisions of the Affordable Care Act, aka, “Obamacare.” Republicans see both a fiscal shell game - the federal government will foot the bill for the first three years, but what happens after that? - plus a philosophical objection to more government involvement in health care.

The process debate goes like this: Virginia’s constitution requires all funds be appropriated by the legislature, even “pass-through” funds from Washington such as these. The Republican-controlled General Assembly has blocked Medicaid expansion; McAuliffe’s response is to figure out something else. What that something else is we won’t know until later; he’s given his health secretary until Sept. 1 to come up with a plan. Republicans question the constitutionality of McAuliffe’s move, but since he hasn’t said what it is, well, who knows?

We do know this, though: Both parties are playing up (or down) to their respective stereotypes. Democrats have lots to say about why Medicaid expansion is important, not so much about what happens if the federal money ever runs out. Likewise, Republicans seem lost for words, or position papers, when it comes to talking about how they’d like to see those 400,000 Virginians covered - or if they even should be. House Speaker William Howell questioned whether there are really that many people who are “truly needy” enough to need coverage. “The key point is we’re not talking about 400,000 people,” he said to the Richmond Times-Dispatch. “Maybe we’re talking about 40,000.” That number seems more flip than factual.

The Republicans have the easier time here. They think Medicaid expansion is bad policy and shouldn’t be enacted, period. Democrats think it’s good policy, but have to clear the hurdle of how to enact it, constitutionally. To fret about the paperwork may seem cramped and uncaring; on the other hand, we have checks and balances in government for a reason, even if we don’t always like the outcome they produce. Democrats may cheer McAuliffe now, but someday could rue the precedent if a future Republican governor can’t get his way with the legislature.

Two other governors confronted with legislative opposition have expanded Medicaid through executive action - Democrat Steve Beshear in Kentucky and, curiously, Republican John Kasich in Ohio, who otherwise opposes Obamacare but bucked his own party because he thought Medicaid expansion was a better deal for Ohioans than the alternative. He explained it to talk show host Laura Ingraham this way last winter: “Conservatism means that you help people so they can help themselves and that they can enter into the economic strength of our country.”

Those, however, are different states with different laws and different constitutions.

As McAuliffe and his lawyers scrutinize the Virginia constitution for a loophole they can use, he might want to spend a pleasant summer weekend floating down the North Fork in Shenandoah County - and remember why he’s not in Dunmore County.

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