Commentary: Alexandria Addresses Lack of Medicaid Expansion

Commentary: Alexandria Addresses Lack of Medicaid Expansion

Three weeks ago the headlines read, “Obamacare lives!” And that was truly great news for the hundreds of thousands of “near poor” (those with incomes slightly above poverty) and lower middle-class individuals throughout the Commonwealth (including a few thousand in Alexandria) who qualified for subsidies and purchased an insurance plan under Obamacare.

Sadly, however, Obamacare’s survival to the onslaughts of “repeal and replace” is virtually meaningless to the estimated 5,000 “very poor” (individuals with annual incomes below $12,000) mostly childless, nonelderly adults — many among the “working poor” — in Alexandria whose only path to health insurance under Obamacare has been blocked for the past three years by the refusal of the Virginia General Assembly to expand the Medicaid program.

Many may appropriately ask: Why does this matter? It matters greatly because research has consistently shown through the years that without insurance the health of those who are poor tends to suffer greatly. Specifically, experience indicates that compared to the low-income insured population (i.e. those covered by Medicaid), the uninsured poor:

• are far less likely to have a source of health care, i.e. a “medical home”;

• have a higher likelihood of being diagnosed with late-stage cancers;

• have lower five-year survival rates, and,

• are far more likely to experience preventable hospitalizations.

The City of Alexandria deserves considerable praise for its early leadership on and attention to the health and well-being of those uninsured residents who have been denied Medicaid coverage. While most other local governments waited, hoping Governor McAuliffe would convince the Assembly to expand the Medicaid program, then Mayor Euille and the Alexandria City Council developed a back-up plan just in case it didn’t happen.

The Mayor, with approval by City Council, appointed a Special Advisory Panel to come up with a set of recommendations for improving access and coverage for those low-income uninsured with the greatest need. Since the panel’s report almost two years ago, the city and community have come together to implement two of its most significant recommendations: hosting a free health fair for the city’s uninsured and expanding access to primary (preventive) health care services for those low-income uninsured who are without a routine source of care or a “medical home.”

Over each of the past two years, the city, along with numerous community-based, faith-based and health care partners, have hosted annual Free Community Health Fairs for Alexandria’s Uninsured. More than 600 low-income uninsured adults and children attended those fairs at which they received a variety of preventive health screens to inform them of their health status, with many being referred to the city’s safety net community health center, Neighborhood Health, for important follow-up care and treatment.

In early 2016, the Alexandria City Council, at the request of Councilman Tim Lovain, increased the cigarette tax by 11 cents a pack and devoted almost all of the new revenues (about $103,000) to Neighborhood Health to expand its capacity to provide comprehensive primary care to approximately 700 low-income uninsured adults in the city. The City Council is expected to continue that contribution to Neighborhood Health in its FY 2018 budget.

Research indicates that financial coverage for primary health care services should go a long way toward reducing financial barriers to seeking health care for many uninsured residents. The significance and value of such preventive health strategies was underscored by Dr. Basim Khan, the CEO of Neighborhood Health, when he noted recently: “Our goal is to find the person with chronic illness, like diabetes, which affects 20 percent of the adult patients at Neighborhood Health, before the patient needs dialysis or amputation.”

The city’s leadership and actions on behalf of the low-income uninsured are genuine manifestations of City Council’s recent declaration that “Alexandria is a city of kindness and compassion” and that council is “committed to diversity and … inclusiveness that respects the dignity and worth of every person…”

In our opinion, there are few other things a city or community can do to “respect the dignity and worth” of its most vulnerable residents than to assure them access to a quality health care provider when they need one. The mayor and City Council and city manager have made significant strides in that direction and should be applauded for their efforts.