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Editorial: Expanding Medicaid Good for Virginia

Real health coverage for an additional 400,000 people is in reach.

Virginia has an opportunity to expand Medicaid in a way that could extend health coverage to more than 400,000 residents who currently have no health insurance while the Federal government picks up the tab; Virginia would pay 10 percent of the additional cost after 2020.

The Medicaid expansion would give medical insurance to 25,000-30,000 Fairfax County residents, where more than 132,000 have none.

More than 12 percent of the slightly more than 1 million people who live in the wealthiest county in the nation are without health insurance. Household income in Fairfax County averages more than $122,000 a year.

In Arlington, 17 percent of adults under age 65 lack health insurance.

Under the health care reform act, many of Virginia's uninsured residents could be covered by an expansion of Medicaid to cover residents who earn up to 133 percent of the poverty line, and that expansion would be paid for almost entirely by federal funds. But while the reform act itself was upheld by the U.S. Supreme Court, the court also opened a door for states to opt out of the expansion of Medicaid.

Virginia’s current eligibility requirements for Medicaid are so strict that although it is the 11th largest state in terms of population and 7th in per capita personal income, Virginia ranked 43rd in Medicaid enrollment as a proportion of the state’s population and 47th in per capita Medicaid spending, according to a 2013 Fairfax County report.

The report says that new coverage would extend to individuals earning less than $15,302 per year or families earning less than $31,155 per year, low income children who lose Medicaid when they turn 19, and adults with disabilities not currently eligible.

It isn’t as if there were no health care costs for these currently uncovered residents. Right now, they access health care when they are very sick by going to an emergency room, where the hospital spreads the cost of care around. But this is inefficient, expensive and unhealthy. Expanding Medicaid coverage would allow far less expensive preventative care and lead to better health outcomes.

A new analysis by the Commonwealth Institute shows that expanding Medicaid to 133 percent of the poverty level would generate state general fund savings and new revenues that would total $2.08 billion and more than offset the state’s share of expansion costs over the next eight years, plus provide significant numbers of new jobs and economic growth. Expanding health care will add tens of thousands of new jobs. People with access to preventative and early health care use fewer sick days and are more productive on the job as well.

From a practical perspective, declining federal money to provide healthcare to uninsured Virginians makes no more sense than declining federal funds for transportation because you don't like the feds telling you to wear your seatbelt.

From a human perspective, passing up the chance to offer health coverage to 400,000 Virginians is inconceivable.

SUPPORT HOUSE RESOLUTION NO. 129

Offered Jan. 15, 2013

Encouraging the governor of the Commonwealth of Virginia to work together with the General Assembly to extend the commonwealth's program of medical assistance pursuant to Title XIX of the United States Social Security Act as authorized by the Patient Protection and Affordable Care Act.

Patrons: Hope, BaCote, Brink, Bulova, Carr, Dance, Filler-Corn, Herring, Hester, Howell, A.T., James, Johnson, Keam, Kory, Krupicka, Lewis, Lopez, McClellan, McQuinn, Morrissey, Plum, Scott, J.M., Sickles, Spruill, Surovell, Torian, Toscano, Tyler and Ware, O.

WHEREAS, more than one million Virginia residents, or approximately 14 percent of the commonwealth's total population, do not have health insurance; and

WHEREAS, the commonwealth's program of medical assistance established pursuant to Title XIX of the Social Security Act and administered by the Department of Medical Assistance Services in accordance with the state plan for medical assistance provides medical services for low-income individuals who meet certain eligibility criteria who do not have access to health insurance; and

WHEREAS, the Patient Protection and Affordable Care Act, signed into law on March 23, 2010, includes provisions allowing states to extend eligibility for medical assistance to include household incomes below 138 percent of the Federal Poverty Level, an option that would extend eligibility for medical assistance services to an estimated 400,000 or more Virginians, including more than 84,000 children; and

WHEREAS, the federal government will pay 100 percent of the cost of medical assistance services for newly eligible individuals for the years 2014 through 2016, 95 percent for 2017, 94 percent for 2018, 93 percent for 2019, and 90 percent for 2020 and subsequent years; and

WHEREAS, while extending the commonwealth's program for medical assistance services in accordance with the option included in the Patient Protection and Affordable Care Act would cost the commonwealth an estimated $1 billion over the next 10 years, the commonwealth would receive an additional $20 billion during this same period for the purpose of providing medical assistance services in the commonwealth; and

WHEREAS, implementing the extension of medical assistance services in Virginia would provide an estimated $3.9 billion in economic growth in the commonwealth; and

WHEREAS, spending of federal funds associated with the extension of the commonwealth's program of medical assistance could support more than 30,000 new jobs in the commonwealth; and

WHEREAS, while most of the direct benefits resulting from extension of the commonwealth's program of medical assistance would accrue to the health care sector, significant benefits would also be enjoyed by individuals, families, and businesses; …

Now, therefore, be it resolved by the House of Delegates, That the governor of the Commonwealth of Virginia be encouraged to work together with the General Assembly to extend the commonwealth's program of medical assistance pursuant to Title XIX of the United States Social Security Act as authorized by the Patient Protection and Affordable Care Act and seek broad state flexibility to (i) reform and strengthen the existing state program of medical assistance services, (ii) design a benefit package and delivery reforms better suited for a potential newly covered population of low-income able-bodied adults to improve quality and reduce costs, and (iii) take advantage of the health improvement and economic benefits resulting from expenditure of federal Medicaid funds.