Gov. McDonnell stern with Sec. Sebelius on Medicaid growth - WSLS 10 NBC in Roanoke/Lynchburg Va

BOB LEWIS
AP Political Writer
    
RICHMOND, Va. (AP) - Under fire from the conservatives in his own Republican Party, Virginia Gov. Bob McDonnell sent the Obama administration a letter Tuesday ruling out Medicaid expansion in the 10 months left in McDonnell's four-year term.
    
In the seven-paragraph letter, McDonnell bluntly states to U.S. Health and Human Services Secretary Kathleen Sebelius that the expansion of the federal-state health program for the poor, elderly and disabled is his prerogative, not that of a commission. He also lectures her on shortcomings he sees in the President Barack Obama's Patient Protection and Affordable Care Act.
    
"As Governor, while the decision currently rests with me on whether or not to expand, I am not going to do so given the vast reform required to make our program cost effective," he wrote.
    
Just before the legislature adjourned, McDonnell agreed to an amendment in the state budget that lets a 12-member commission assess whether daunting reforms necessary to expand Medicaid had been met. Seven of the Medicaid Innovation and Reform Commission's members - five House of Delegates members and two members of McDonnell's cabinet - have been appointed. Its five Senate members have yet to be named.
    
Its intent was to keep open the prospect of Medicaid expansion - no matter how unlikely. Without it, Senate Democrats would have doomed his signature transportation funding legislation.
    
McDonnell writes in the letter that some "media outlets and elected officials have labeled this approving Medicaid expansion in Virginia. This is absolutely incorrect."
    
The budget, McDonnell writes, "places a firewall against expansion consideration" unless specific cost-reduction and efficiency benchmarks McDonnell has set as an absolute prerequisite for expanding Medicaid in Virginia have been satisfied. Among them are his demand that the federal government allow Virginia broad flexibility in administering the program, including benefits that are tighter and commensurate with those in most private insurance coverage, demanding co-payments or cost-sharing of new recipients and greater use of managed care.
    
But in the letter, McDonnell suggests that the mission of the panel as passed on Feb. 23 as a budget line item may not remain the same now that the budget is before him to approve, amend or veto.
    
"...(M)y office is currently reviewing the budget language to see what changes may be necessary," he wrote.
    
"My view of necessary reform for our state and nation may be more comprehensive than what is currently contained in the budget," he wrote, referring Sebelius to his attached "Five Tenets of Medicaid Reform."
    
The governor, who was a favored proxy last year for Mitt Romney, repeated the GOP presidential nominee's desire to repeal and replace Obama's health care reforms. He wrote that the "federal mandates, regulations, taxes and spending create an expensive, top-down bureaucratic system."
    
He also reminded Sebelius that "that Virginia will not operate a state based health exchange, and thus understand that the federal government will build, operate and fund a federal health exchange for Virginia as required by law."
    
McDonnell was under no obligation to write Sebelius. Spokesman J. Tucker Martin said the letter was intended to clarify what McDonnell feels has been widely misreported as an imminent expansion of Medicaid to 400,000 Virginia residents just above the poverty level.
    
The letter, with its tough talk, comes after conservatives in the state GOP scored McDonnell over what they perceive as a bargain with liberals that keeps the prospect of Medicaid expansion alive in exchange for transportation funding reforms that required some new taxes.
    
The 11th-hour legislative maneuverings created bizarre short-term alliances. It put McDonnell at odds with Republican lawmakers and the presumptive GOP gubernatorial nominee - Attorney General Ken Cuccinelli - who contend the Medicaid commission is unconstitutional and pledge to challenge in court. It found him in agreement the unchallenged Democratic gubernatorial nominee, Terry McAuliffe, in support of the transportation funding measure.