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The time for politics is over: Expand Medicaid! / May 28, 2014
W. Scott Burnette
Community Memorial Healthcenter

The budget impasse between the Virginia House of Delegates and Senate rests solely on the question of whether to expand health insurance coverage to hundreds of thousands of Virginia’s working poor. For those most opposed, the issue of whether to expand coverage appears to be more of a matter of party politics where supporting party ideals has taken precedence over doing what is best for the citizens of the Commonwealth.

As part of the Affordable Care Act (ACA) that was passed by Congress, all hospitals in the country began experiencing cuts in Medicare funding in January 2010. Collectively, over $150 billion in reductions in Medicare payments to hospitals will occur between 2010 and 2020. These cuts were implemented to help pay for an expansion of eligibility for Medicaid in all states and to help underwrite the creation of insurance exchanges designed to help lower income families finally be able to afford commercial health insurance. Medicaid expansion was to be 100% paid for by the federal government in 2014, 2015 and 2016 with the states gradually assuming 10% of the cost by 2020. The healthcare industry was going to recoup the cuts in Medicare reimbursement by experiencing a reduction in the number of uninsured patients seeking medical care because they would now have coverage either through the insurance exchanges or through federally funded health insurance programs. However, as we all know, Virginia has not yet taken affirmative action to expand coverage, which leaves Virginia’s hospitals with the burden of adjusting operations due to reduced payment for services rendered, which will threaten the viability of critical programs and services currently offered in communities.

And adding further insult to injury, as if the ACA payment cuts were not enough, in 2013 our federal legislators failed to perform their duty of preparing a workable federal budget. To help make up more federal deficits, they implemented “sequestration cuts”, which reduced Medicare reimbursement to hospitals by an additional 2%. For Community Memorial Healthcenter, those reductions from the ACA and sequestration amount to almost $6 million over the next two years! In rural areas and in many inner-city locations, the local hospital is the only place where patients can turn for needed medical attention, something that is available 24 hours a day, 365 days a year.

It is time that our legislators stop catering to party politics and start paying attention to some facts.

FACT: Virginia’s healthcare industry (hospitals, nursing homes, physician practices, etc.) employs thousands of Virginians and accounts for over 6% of Virginia’s gross domestic product. Despite the fact that our state could recoup hundreds of millions of dollars from the federal government to assist this industry that is facing serious financial challenges, the leadership in the Virginia House of Delegates has adamantly opposed accepting federal funds. In addition to restoring lost revenues to Virginia’s hospitals, it has been projected that the additional funding would create 30,000 new healthcare jobs in the state as well.

Despite this benefit to the state’s economy, the majority of the House of Delegates and many members of the state Senate stand opposed to taking affirmative action that simultaneously improves the quality of life for hundreds of thousands of Virginia’s citizens.

FACT: Virginia’s private citizens and businesses are paying billions of dollars in ACA-imposed federal taxes. By not accepting federal dollars to fill the health insurance coverage gap, we are sending those billions of dollars to Washington to be used in other states or for other federal spending programs. About $5 million a day of Virginia taxpayer money leaves state and can be used to support healthcare expansion in other states. By passing the Senate budget as proposed, those funds would be returned to Virginia to help provide coverage for up to 400,000 citizens.

FACT: The Senate budget, which includes a bi-partisan free-market approach to expanding healthcare coverage, will actually save the Commonwealth of Virginia over $300 million over the next 2 years. These figures have been verified by state agencies. Conversely, the House budget will actually cost the state an additional $45 million and will do nothing to provide coverage for the uninsured.

I have received comments from some legislators who offer the following “explanations” for their stance on not supporting expanding healthcare coverage.

1. “We need to fix the Medicaid system first.” My response is multifaceted: A) The Senate plan does not involve expanding the current Medicaid program. It is a private insurance option that does not operate through the Medicaid program and has been proven to work in the Commonwealth already. B.) Even if this were an expansion of the Medicaid program, a bi-partisan Medicaid Innovation and Reform Commission was created in 2013 to look for ways to help improve the program. It has been reported that, as of this time, all of the recommended reforms have been implemented or are in the process of being implemented. C) If the Medicaid system is so broken, why did the House budget propose significant increases in spending for the current program? No doubt there is more work to do; however, in my opinion, the “let’s fix Medicaid first” is nothing more than an attempt to hide from proactively working to improve healthcare for lower income Virginians.

2. “We don’t think the feds will be able to afford to fund this program long-term, so we shouldn’t implement it for fear of the financial burden to sustain the program shifting to the state. My response: Since the Senate proposal involves a commercial insurance policy, if the federal government ever stops paying the premiums, then the insurance policies would be canceled; therefore, the state would not be at risk financially. If our legislators are living in fear that the federal government will default on the payments, then we should not be looking to secure any additional defense industry funding for new ships or services. After all, that industry relies quite heavily on the largess of the federal defense spending program.

3. “Governor McAullife has the authority to implement this program without legislative approval. He’s just trying to lay the blame on the Republican Party.” My response: I am no legal expert, but even if there is a legally questionable path the Governor can take to bypass Virginia legislators, the risks in so doing would be great and it would create an opportunity for anyone opposing the effort to tie the expansion of healthcare coverage up in the Virginia court system for years. Furthermore, do we really want the Governor of Virginia to be looking for legal loopholes so he could bypass our state legislature every time a disagreement exists between the legislative and executive branches of our state government? I am surprised that any legislator would support such a tactic.

4. On a more local level, “CMH is going to become part of a larger health system, so their financial worries are over.” My response: This statement couldn’t be any further from the truth. While our new affiliation will provide significantly enhanced clinical services to the region, every healthcare system in Virginia is feeling the impact of reduced reimbursement, especially those who provide care to a large percentage of uninsured people. Continued reductions in reimbursement for Medicare will place the same strain on those organizations as it does on CMH, albeit on a much larger scale. Furthermore, CMH will have to continue to be a financially viable division of the health system in order to support the enhanced clinical services being brought to this region.

I’ll end by noting that it has been shown that when people have access to basic medical care through a primary care physician, their quality of life improves dramatically and the need for unnecessary and expensive visits to the emergency department declines. Since the House of Delegates has failed to produce any alternative plan to help provide basic healthcare services to low income uninsured Virginians, can that be interpreted to mean that they are content in knowing that, even though they have the means to have a positive impact on the quality of life for hundreds of thousands of people, they are declaring that those people don’t matter?

The case for filling the healthcare coverage gap, both from an economic and a social standpoint is compelling and it is time for our legislators to put party politics aside and act for the betterment of the citizens of Virginia.

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