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Health care’s forced error

SoVaNow.com / August 07, 2013
Last week in this space, we looked at the impending arrival of the Affordable Care Act — neé Obamacare — and what the law might mean for local residents who don’t have health insurance through an employer or who purchase coverage on the open market. If you already have insurance, you’re not likely to feel the effects of the ACA, aside from the comfort of knowing your policy will remain intact should something go seriously wrong with your health. The law is intended, above all else, to help the estimated 1 in 6 Americans who currently have no real protection against the ravages of injury or disease. Whether the ARA will work in practice remains to be seen, but the early signs are hopeful.

The new law has run into one big problem, however, and it’s entirely the result of efforts by Obamacare’s political enemies to frustrate its implementation at every turn. As it happens, Mecklenburg County has a huge stake in the outcome of this fight: potentially, nearly half of local residents who don’t have health insurance — 2,081 people in all — could gain coverage if this exercise in obstruction fails. If not? Not only will people suffer needlessly, but the county will lose jobs and see a rare opportunity to improve its quality of life vanish.

The issue: expansion of Medicaid. It’s a big deal. Alas, Virginia is dragging its feet. As envisioned under the ARA, Medicaid would be broadened to cover non-insured individuals making up to 138 percent of the poverty line — which in 2012 worked out to $26,344 for a family of three, $15,415 for an individual. Just to offer some perspective on how these numbers relate to Mecklenburg County, in 2011 the median average household income was $36,327. With income levels like these, it’s not surprising that 4,000 county residents would be vulnerable to financial disaster if their health goes south — to say nothing of the hardship that results from not having access to insured care in the first place.

The expansion of Medicaid would be a blessing for an estimated 400,000 uninsured Virginians, nearly half of whom work for a living or who are uninsured or underinsured veterans, according to the Commonwealth Institute, a non-partisan think tank that studies Virginia economic and fiscal policy. The program’s expansion also would create an estimated 30,000 new jobs, hundreds of which would surely spring up in Mecklenburg County and across Southside where the need for improved access to health care is acute. Yet Virginia so far has balked on implementation. Virginians are in the midst of a governor’s race where one candidate is dead-set against Medicaid expansion and the other candidate is all for it. The outcome of the election probably will determine the direction that Virginia takes.

What it Medicaid, exactly? It’s a shared state-federal program to shoulder the medical costs of the very poor, children, and the disabled. (Medicaid also covers most long-term nursing home care, which is essentially a different program for the sake of this argument. And as long as we’re working through various asides, Medicaid is also distinct from Medicare, the federal single-payer system for persons 65 and older.) Medicaid’s expansion is being underwritten by the federal government — 100 percent of the costs in the first three years, 90 percent after that. With expansion, Medicaid would be opened up to hundreds of thousands of poor adults who don’t qualify now — Virginia’s income limit is an absurd $5,950 a year — with the feds picking up most of the tab. The cost to Virginia taxpayers would be a pittance, and there are credible estimates to suggest the number is actually zero. Benefits of expansion, including the job creation effects, clearly outweigh any possible downsides.

Who stands to gain the most from expanded Medicaid? The Commonwealth Institute (http://www.commonwealthinstitute.org), which came up with the estimate of 2,081 Mecklenburg residents who would come under the program with full implementation of the ACA, notes that out of the 160,000 eligible workers statewide, 79 percent work in five sectors — tourism, retail trade, education, health and social services, construction and various low- to mid-level professional occupations — that together make up a huge chunk of Mecklenburg County’s employment base. Somewhat famously, Wal-Mart, one of the richest companies on Earth, pays such low wages that many of its workers qualify for Medicaid in states with higher income eligibility limits. In places like Southside Virginia, Wal-Mart jobs are generally welcomed, although I suppose you will find differences of opinion on this score. There’s no doubt about one thing, though: low-wage jobs are preferable to no jobs at all, even if they leave the holder unable to afford health insurance.

Medicaid’s expansion would take the sting out of this predicament for many Southside Virginians, a sizeable number of whom have had to downshift into low-wage positions as higher-paying manufacturing and construction jobs have vanished. Expansion would also remedy a major problem that now exists: Medicaid and offshoots such as Virginia’s FAMIS program cover children, but adult members of these low-income families often must go uninsured even when the kids aren’t. With all the other challenges that these hard-pressed families face, a basic level of health care shouldn’t loom as some unattainable objective.

Conservative opponents of Obamacare have been so all over the map with their criticisms of the law that it’s hard to know what they really think — one thing we can be sure of is that the Republican Party has failed utterly to offer a serious alternative — but let’s just take a moment to state the obvious: if Virginia doesn’t accept the federal government’s Medicaid money, it surely will end up going somewhere else. That’s why even such right-wing governors as Jan Brewer in Arizona and Rick Scott in Florida have pushed their GOP-dominated legislatures to relent on the Medicaid issue. In Virginia, Bob McDonnell made a putative deal with General Assembly Democrats to back expansion in return for their support of the governor’s transportation bill, but since then the issue has gotten lost in the political weeds.

More than likely, the outcome will depend on what happens in the gubernatorial race. Terry McAuliffe, the Democratic candidate, supports the program’s expansion, while the Republican in the race, Ken Cuccinelli, is ardently opposed. (Cuccinelli has been dismissive not only of Medicaid, but Medicare, too, saying the program breeds dependence among the elderly. Well, Ken, these are folks who’ve worked their entire lives and paid into the system. If 80-year-olds aren’t allowed to depend on Medicare to pay their medical expenses, whom exactly should they depend on? You?)

This is more than your usual political squabble. People’s health and lives hang in the balance. The stakes are all the higher because of a quirk that has arisen with the Affordable Care Act, for which you can thank Supreme Court Chief Justice John Roberts. The story, in a nutshell: In upholding the constitutionality of Obamacare, Roberts opined in a 5-4 ruling that states are not required to participate in the law’s expansion of Medicaid, which is how the authors of the ACA envisioned providing coverage for low-income Americans. The law includes different mechanisms to help middle-class individuals purchase insurance, but the Roberts decision, combined with the intransigence of GOP-dominated states, leaves many of the poor out in the cold.

Many of the right-wing attacks on Obamacare long ago crossed the threshold into parody — remember the death panels? — but the bitter-end campaign continues, destined for failure though it may be. This is a fateful time for Southside Virginia. Although the region is almost certainly in for its share of bumps with implementation of the new law, we have much more to gain than to lose if the Affordable Care Act proves to be a success. Politics may obscure this reality for the time being, but it’s within our power to chart a positive direction for the ACA in Virginia, starting Nov. 5 with the governor’s race. With luck, we won’t have to someday look at other states that have achieved good results with the law and wonder why that couldn’t have been us.







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