It doesn't take a student of health policy to recognize that Virginia has a lot of unmet needs when it comes to providing health care for all its citizens.
According to the U.S. Census bureau in 2000, 12. 7 percent of the population of Virginia had no health insurance. The income threshold for Medicaid is incredibly low and few providers will accept it. Fewer and fewer providers are taking Medicare and when it comes to mental health services, the waiting lists can be endless.
(Medicaid is a federal system of health insurance for the very poor including those in nursing homes, but the income threshold and the amount of reimbursement is determined by each state. It is paid for by both the federal and state governments. Medicare is also a federal health insurance system created in 1964 for those 65 and over, for those who have a work history but are now disabled and for those disabled before age 18 who receive social security disabled survivors benefits based on a parent's work record. Reimbursement rates are determined by the federal government which also pays for the program,.)
BUT WHAT IF NORTHERN VIRGINIA were to secede from the rest of the state? Would health care be better? More compassionate?
Professor Sheri David who teaches American history at the Manassas campus of Northern Virginia Community College would like to think so. David is a frequent speaker on health policy.
As for the needs of the poor and uninsured, David, a resident of Reston, said "I would like to think we would be compassionate, that my neighbors would support more community-based free clinics. I certainly would hope so."
Less sanguine about the whole idea of a state of Northern Virginia was veteran State Delegate Marian Van Landingham (D-45th). Van Landingham said discord among the elected officials of Northern Virginia could derail any vision of more resources for health care.
"We would have to have two states of northern Virginia," Van Landingham said. "Between the inner beltway and the outer reaches there is certainly a different emphasis on education and transportation, urban life versus far suburban life.
"THE INNER BELTWAY gets more support from downstate than we do from Loudoun and Prince William. What used to look like a powerhouse for Northern Virginia isn't anymore."
Even in terms of health care and social services Van Landingham didn't think there would necessarily be improvement.
But Davis was optimistic that Northern Virginia would be able to better things.
"If we were to be a separate entity we would be able to concentrate our resources to suit us," she said, concentrating on urban-suburban priorities of Northern Virginia.
"We could fill in the Medicare, Medicaid gaps and set up more community-based services."
She suggested a creative idea to stop the number of doctors leaving the Medicare system and refusing to be providers.
"We couldn't do much about Medicare reimbursement," she said, "but what if we told providers if you accept Medicare patients we will take over malpractice and liability insurance?" It would be an exchange type of system she noted
The new state could also be expected to be quicker to approve new medical facilities such as a hospital for Springfield, because "we wouldn't be competing with the lower part of the state which also needs facilities."
"Regarding Medicaid, because of Northern Virginia's higher income I assume a larger state match would be required. The present match is 49 percent," Van Landingham said. She said she did not know what the new state might spend on indigent care and noted that we could no longer send our criminals "southside, although I suppose we could pay Virginia to continue to house them."
While planners and politicians were willing to speculate about future changes, providers of health care weren't convinced that changing states would make a difference
Cathleen Thomas, a spokesperson for INOVA said the hospital system which includes five hospitals and a variety of other facilities in Fairfax County, Falls Church and the City of Alexandria said the company did not want to comment on a speculative issue as did the spokesperson for Reston Hospital Denise Dancy
"It's all so speculative," said Robin Norman, senior vice president and CFO for Virginia Hospital Center in Arlington. "If you look at the regulations of other states they have minor differences but I would be hard pressed to say if there would be differences.:
Norman noted that the hospital takes Medicare assignment and has a fair load of Medicaid patients as well. Asked whether the funding might increase with a new state, Norman said it would depend on that state's priorities. "Northern Virginia is affluent but it could put priorities on transportation, education. It might put a priority on health."
She said she thought the hospital was already a pretty full service hospital. "We don't have a high-level trauma center but there are others so I don't see that changing."
STEVE MARY I KEPT RAW QUOTES FROM MARIAN BECAUSE THERE IS STUFF HERE DAVID OR SANFORD MIGHT WANT TO USE IN THEIR ARTICLES CONCERNING EDUCATION
MaryAnn, I assume this is an elaborate spoof, but am just too tired this evening to think of all the programs and problems that would have to be re-established. Regarding medicaid, because of No.Va.'s higher income, I assume a larger state match would be required. I believe the present match is 49 percent. I can't speak to the amount of money that the new state would
need to give hospitals to help with indigent care. In the public safety area, we could no longer send our criminals to the southside or the far southwest....although I suppose we could pay Virginia to continue to house them....rent a bed. The biggest loss would be the hit Northern Virginia parents would have to pay in out-of-state tuition for their kids to go to colleges and universities downstate. Of course, the much higher fees charged
would be wonderful for Virginia higher ed.!
By the way, would the capitol of NOVA once again be the big house in the 400 block of Prince St. where it was during the Civil War? Marian
"We would have to have two states of northern Virginia,"van Landingham said. "Between the inner beltway and the outer reaches there is certainly a different emphasis on education and transportation, urban life versus far suburban life.
"The innter beltway gets more support from downstate than we do from Loudoun and Prince William. Loudoun, which needs 24 schools voted against the education referendum. Prince William worked against the education referendum.
What used to look like a powerhouse for northern Virginia isn't anymore."