Hanger and other legislators returned to Richmond Wednesday to finalize a state budget. Hanger, R-Mount Solon, said he knows Gov. Ralph Northam and the Virginia House of Delegates "want a provider tax" on hospitals as part of the expansion of Medicaid.

While federal funds would pay for 94 percent of the expansion of Medicaid, the governor and Virginia House have proposed assessing Virginia hospitals to pay the remaining 6 percent. Expansion of the health care program would reach between 300,000 and 400,000 Virginians who now lack health care.

Hanger refuses to budget on a provider tax on hospitals.

"I'm not excited about it, and I think we can [expand Medicaid] without the provider assessment," Hanger said.

The senator is co-chairman of the Senate Finance Committee. He predicts approving the budget and the answer on Medicaid expansion could well take the rest of April to finalize.

Hanger said he wants to see a broader plan attached to Medicaid expansion. He wants the new recipients of Medicaid to get work training so they can increase their income and not stay on Medicaid.

Of the work component, Hanger said in an opinion piece last week he wants to see the Medicaid recipients offered "education or skill training they might need and then matches them up with a job."

Hanger also wants to stabilize insurance rates in the commercial market for middle income Virginians.

The momenturm on Medicaid expansion in the General Assembly was heightened last week with the support of Republican Sen. Frank Wagner, R-Virginia Beach. Two Republican votes are needed in the Senate to gain approval of Medicaid expansion.

Wagner offered an Op-Ed column on Friday in which he said he could support both the expansion of Medicaid and a tax credit to help middle class Virginians.

Wagner said a tax credit for Virginia taxpayers could be used to help them with health insurance "co-pays, premiums and deductibles." The senator said a portion of the money from a provider tax on Virginia hospitals could fund a $250 tax credit to middle class taxpayers earning $30,000 to $50,000 per year.

Wagner also said that the expansion of Medicaid would provide funds to hospitals for which they currently receive little or no payment.

Weighing in on Medicaid on Monday was the Virginia Hospital and Healthcare Association.

Spokesman Julian Walker said in a statement that while the association has traditionally opposed a provider tax on hospitals, "Virginia's hospital community is willing to consider an assessment in an effort to support a compromise on coverage expansion."

But Walker stressed that any provider tax should "be used solely for Medicaid reimbursement and rate improvement." Walker said Wagner has touched on a major issue facing Virginians, the cost of health insurance premiums.

"In the past year alone, commercial health insurance premiums on the individual market in Virginia rose between 34 percent and 81 percent," Walker said.

Meanwhile, Hanger expects concessions will be made to finalize a state budget. He anticipates the House will reject Senate amendments to the budget.

"It is very rare for one side to concede completely," he said. "That is where the interplay comes in."


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