Entering the final week of my fifth session of the House of Delegates, I am concerned that partisan politics is about to inflict lasting harm on citizens of the Commonwealth. The Republican majority in the House has made it abundantly clear that there is no room for compromise on the issue of expanding access to medical services for thousands of low wage-earning, working Virginians. Thirty other states are moving to expand their Medicaid programs to cover uninsured low income individuals and families. Funding for this expansion is already approved in the federal budget under the ACA. This funding will cover 100% of the cost of expansion for two years and no less than 90% thereafter. Let me repeat, this Federal program is funded in the current budget, in part by hospitals who have already agreed to accept lower Medicare reimbursement rates, because the program will reduce the enormous burden of providing indigent care to families with no coverage as part pf the ACA..
Governors, chambers of commerce and legislatures nationwide who have rejected Medicaid expansion have done so over the furious objection of hospitals, clinics, and doctors in their states. Health care providers are understandably upset that their reimbursement rates will be cut, but not offset by a lower cost of indigent care. Republican decision-makers have made an art form out of dodging the facts on this act of ideological irrationality. They argue that “We can’t afford it,” substituting volume and repetition for facts; that the Federal government’s commitments can’t be relied on, and states could be left “holding the bag.” Clear language in the statute to the contrary is no protection, in their view. They argue that Medicaid is a bad program with lots of fraud and abuse and that it perpetuates dependency. But, the states are in charge of administering Medicaid, and many, including Virginia, think they do a pretty good job.
A key concern is that Medicaid is an entitlement providing “free” services, with no incentive to control cost. This objection triggered an alternate proposal in Virginia, originated by Republicans in the Senate, to use Medicaid expansion funding for a “Virginia Marketplace,” that will fund private insurance premiums for eligible recipients. Policies would require a co-pay administered by the private insurer. The Senate plan would cover at least 250,000 Virginians who earn up to 138% of the poverty level. Many of these people are non-disabled healthy single workers without dependents who earn less than $16,000. They are not currently eligible for Medicaid. Implementing Marketplace Virginia would require a waiver from the Federal government, but such waivers have already been granted to several states.
Implementing Marketplace Virginia would return $1.7 billion in federal taxes to the Virginia economy. Even the reliably conservative state Chamber of Commerce urges support for the program. Beyond economics, there’s the quality of life improvement for hundreds of thousands of Virginians who no longer will suffer the debilitating effects of untreated illness or fear financial devastation from injury or serious disease.
The Republicans in the House have been steadfast in their opposition to any discussion regarding Marketplace Virginia. Perhaps, it is true that most Republicans don’t support health care as part of the social safety net. If so, they should recommend hospitals be permitted to turn away indigents seeking care. Or do they simply prefer the status quo, with these costs buried in hospital and provider overhead expenses? This will be the result of the current House Budget.
I am afraid my Republican colleagues are making a fairly straightforward calculation. They believe the Republican crusade against Obamacare is an issue that “has legs” with the electorate. Celebrating the Republican victory in the democratic-leaning 100th District, a Republican Delegate stated in his newsletter: “The voters spoke loud and clear in this election – reject Medicaid expansion in Virginia.” Republicans in safe districts think their opposition to expansion will inoculate them from primary challenges on the right. They may also believe it will help them carry Virginia for the Republican candidate in 2016 and propel them back into the Governor’s mansion in 2017.
Delegate Kory represents the 38th District in the Virginia House of Delegates. She may be emailed at DelKKory@house.virginia.gov.
