RICHMOND, Va. (AP) - Gov. Bob McDonnell told state legislators Tuesday that Virginia policymakers need more answers from President Barack Obama's administration about Medicaid before they respond to the U.S. Supreme Court ruling upholding the federal health care reform law.
In a letter to Virginia senators and delegates, McDonnell said there is no need for a special legislative session on the issue because too little is known about the state's options under Medicaid, a program for the needy, elderly, blind, disabled and poor families with children that is funded jointly by federal and state governments.
He also said it's too early to determine whether to create a state-based health benefits exchange or let the feds do it.
McDonnell said that while the court upheld the Affordable Care Act's centerpiece - its requirement that everyone be insured or pay a penalty - it also ruled that the federal government can't withhold existing Medicaid funding for states that choose not to expand the program.
He said his health policy advisers, led by Health and Human Resources Secretary Bill Hazel, must learn more before Virginia retools its Medicaid program, already among the leanest in the nation.
In the past 30 years, McDonnell wrote, Medicaid spending in Virginia has increased by 1,600 percent, and grown from 5 percent of the state budget to about one-fifth of it.
"This is an unsustainable trajectory that demands improvement and greater efficiency. A great expansion of Medicaid, without significant reform of the current so-called, 'federal-state partnership' is not responsible. Before an expansion decision is made, we must discuss with (U.S. Health and Human Services Secretary Kathleen Sebelius) the necessity of including clear and fair rules and state flexibility in decision making for the Medicaid program," McDonnell wrote.
Two years ago, the state Department of Medical Assistance Services projected a $2.2 billion annual increase in Medicaid costs to Virginia under Obama's health care reform bill. McDonnell said he asked DMAS to update the estimate after the Supreme Court ruling, and that it should be available this fall as he prepares his legislative package and amendments to the two-year state budget that took effect July 1.
The letter largely stayed away from overt partisan cheerleading by the Republican governor and potential vice presidential running mate to Mitt Romney. But in explaining that the General Assembly should defer action until its regular winter 2013 session, McDonnell noted that GOP victories November's presidential and Senate elections could make the issue moot.
"It remains my hope that a repeal of the existing law will occur after the next election, and that Congress will enact prudent market based health reforms, and states will be given the freedom they need to implement healthcare solutions that work best," he wrote, noting Romney's pledge to repeal and replace the Democratic reforms.
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