Comprised of five senators, five delegates and two governor's appointees, the commission was established as a brakeman on expansion of the federal-state partnership that helps underwrite the costs of medical care for the elderly, needy, disabled, blind and low-income families with children.
MIRC's specific mission is to assess whether specific cost-reduction and efficiency benchmarks McDonnell has set as an absolute prerequisite for expanding Medicaid in Virginia have been satisfied. If MIRC determines they have, the law would then extend Medicaid eligibility to people with incomes up to 30 percent over the federal poverty level.
At the heart of the McDonnell administration's conditions for Medicaid expansion is federal waivers allowing Virginia broad flexibility in administering the program in Virginia. Those include 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.
"There's a lot of confusion about this, but it was and is a creature of the legislature," said Dr. Bill Hazel, the secretary of health and human resources under McDonnell and one of the two executive branch appointees to the MIRC.
"Some people think we've already expanded Medicaid. I was speaking at a conference today in Washington and I asked how many thought Virginia just expanded Medicaid, and about half the hands went up. Then I asked how many thought we weren't expanding Medicaid and about as many hands went up," Hazel said in an interview Friday.
McDonnell's conceptual support of such a commission was critical in breaking a legislative logjam that not only threatened to wreck the $880 million-per-year highway funding reforms but perhaps even the budget. Senate Democrats, adamant that some pathway to Medicaid expansion be preserved, hold half of the Senate's 40 seats, and unless at least one breaks ranks, Senate Republicans lack the 21 votes necessary to pass revenue or appropriations bills.
So far, seven of the dozen MIRC members who begin work in June have been appointed. The five delegates named last week have conservative records on fiscal issues.
Hazel, an orthopedic surgeon respected across Capitol Square for his candor and his comprehensive knowledge of the health care industry, has been McDonnell's point man on developing the reform goals. The other gubernatorial appointee is Finance Secretary Ric Brown, whose steely eyed fiscal counsel has helped two governors guide the state through the deepest economic downturn in 70 years. MIRC's five Senate members have not been appointed.
But will MIRC ever get to discharge its duties?
The issue of the Medicaid expansion split the legislature's Republican majorities down the middle with conservatives bitterly opposed and moderates voting yes, leaving an overwhelmingly supportive Democratic vote in both the House and Senate to provide the margin for passage.
Republican Del. Ben Cline, an attorney from Rockbridge, almost destroyed the fragile bipartisan accord on the General Assembly's penultimate day by asking conservative Attorney General Ken Cuccinelli's opinion. Within hours, Cuccinelli ruled that it was unconstitutional for the legislature to vest its full discretionary power in a small subset of its members. The coalition was salvaged with an amendment that took away the commission's discretionary authority and limited it solely to a fact-finding role.
"The way I look at this: how quickly will someone file a lawsuit to see whether this commission is unconstitutional?" Hazel said.
Not long, said Del. Robert G. Marshall, who successfully sued five years ago to scuttle a freshly passed law that would have set up unelected boards to levy transportation taxes in Hampton Roads and northern Viginia. He's already asked Cuccinelli to rule anew on MIRC's amended legislative charter, but he's not really awaiting Cuccinelli's answer.
"I'm looking for an attorney right now and trying to find the money I need to pay him," Marshall said.