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Editorial: Tragic Consequences

Money lost by refusal to expand health coverage, but also life, health and livelihood.

The Virginia General Assembly’s refusal to expand Medicaid, extending health coverage to as many as 400,000 Virginians has resulted in the loss of about $1 billion in direct payments.

But that understates the loss, failing to calculate the cost of the lost health of thousands of Virginians.

Consider one relatively young man, treated by the Health Wagon, who is losing his vision to untreated diabetes because he has no health coverage, his diabetes went undetected for years and can’t afford monitoring or medicine. Once diabetes begins to take its toll, it cannot be reversed. Once the man is blind and unable to work, he will likely be covered by Medicaid because he is permanently disabled.

The Centers for Disease Control says chronic illnesses are “the nation’s leading causes of death and disability, leav[ing] in their wake deaths that could have been prevented, lifelong disability, compromised quality of life, and burgeoning health care costs. … Heart disease, stroke, cancer, diabetes, obesity, and arthritis are among the most common, costly, and preventable of all health problems.”

Consider the hundreds or thousands of Virginians who are not receiving routine care or screenings of any kind, whose cancer or high blood pressure or heart disease or diabetes, or even mental illness, rob them over time of their ability to work, to care for themselves or their families. Many will die of illnesses that could have been prevented or treated. The human toll is incalculable, unbearable and unnecessary.

It is unfair that health coverage depends on what state you happen to live in, that an ideologically driven General Assembly can determine your fate. If you are poor and live in a state that has chosen to accept expansion of health care with Medicaid, you have health insurance, for example in the bordering states of West Virginia, Kentucky and Maryland. But if you are poor and live in Virginia, or one of the other states that has refused to expand Medicaid, you are out of luck, out of health and possibly out of life.

Business groups and chambers of commerce around Virginia, including the Fairfax County Chamber of Commerce, support the expansion of Medicaid in Virginia under the Affordable Care Act. One persuasive factor for the business community is that expansion would create an estimated 30,000 jobs and pump hundreds of millions of dollars into Virginia’s economy. Hospitals support expanding Medicaid which would offset many of the costs of caring for uninsured populations.

In Virginia, Medicaid eligibility for adults without disability is almost nonexistent, limited to parents with incomes below 51 percent of poverty, or about $11,900 a year for a family of four, according to the Kaiser Family Foundation. Adults without dependent children remain ineligible regardless of their income.

Under the Affordable Care Act, people with incomes 100 - 400 percent of poverty qualify for subsidies on their health insurance premiums when they purchase coverage through a Marketplace. Because the Affordable Care Act envisioned low-income people receiving coverage through Medicaid, people below poverty are not eligible for Marketplace subsidies. As many as 400,000 adults in Virginia fall into the coverage gap because they don’t qualify for Medicaid under Virginia’s rules, among the most stringent in the nation, but earn less than the poverty rate, so not enough to qualify for subsidies.