Commentary: What Happens to Uninsured Virginians?

Commentary: What Happens to Uninsured Virginians?

With the recent release of what is looking to be a detrimental and ill-planned Republican healthcare bill, and with major GOP candidates for Governor endorsing an irresponsible Medicaid block grant, Virginians are once again paying for the legislature’s ongoing failure to expand Medicaid.

Both President Trump and the GOP in Congress promise to drastically change many of the health programs upon which millions of Americans rely. In addition to their plans to “repeal and replace” the successful Affordable Care Act (ACA) where an average of 34,445 Virginians per congressional district gained insurance from the Marketplace, there are threats to Medicaid and Medicare.

As your delegate to Richmond, I will do everything in my power at the state level to both prevent cuts to existing programs and promote needed improvements.

Even Virginia’s GOP budget-committee leaders recognize a block grant of Medicaid funds would expose the Commonwealth to hundreds of millions, perhaps billions, of dollars in health care costs that the federal government would no longer share with the state.

The proposed block grant would lock in Medicaid funds to states at their current rates. The irony of this proposal is that it would prove relatively harmless to the states that expanded Medicaid under Obamacare and punish the red states that did not. That is because the states that expanded Medicaid have benefited from a healthier population, decreasing their costs over time, whereas states like Virginia that failed to expand Medicaid saw a compounding 6.5 percent increase in Medicaid expenditures through 2012 and 16 percent annual Medicaid cost increase since 2012, as more sick people find their way onto our Medicaid roles with the requirement they have health insurance and their inability to qualify for ACA subsidies until they reach the federal poverty level.

About one million Virginians rely on Medicaid. Children, pregnant women, parents, seniors and people with disabilities are the primary beneficiaries of our Medicaid program. Despite the size and cost, Virginia’s program is very restrictive and we rank only 47th in the country for per capita Medicaid spending.

In fact, we cannot legally spend any less on our program without violating requirements of the Social Security Act.

Upending the traditional 90:10 federal and state cost-sharing agreement, a Medicaid block grant would save federal dollars but push the expenses over to the state and require the General Assembly to raise your state taxes as your federal taxes would likely remain the same.

Block grants or “per capita caps” shift costs to states and hampers our ability to improve programs or respond to changing demographics, economic circumstances and medical innovations. Because of Virginia’s restrictive eligibility and refusal to expand Medicaid, the state would be seriously harmed if the federal government enacted the proposed restructures.

Experience suggests the most predictable result of merging social programs into broad block grants is substantial erosion in funding over time, with negative consequences on efforts to assist the people most in need.