Down in Richmond, the General Assembly will soon renew its stalemated debate over whether to expand Medicaid for 170,000 uninsured Virginians under the Affordable Care Act.

In preparation, three health policy heavy-hitters gathered Jan. 13 at the Arlington Committee of 100 to highlight the local impact of our health system’s strains on low-income citizens.

All three, not surprisingly, hail from Arlington, where to many the resistance of downstate Republican legislators to accepting already-appropriated federal dollars seems mysterious.

Nancy White, for the past five months executive director of the Arlington Free Clinic, said Obamacare has had a small effect on her operation that serves 1,700 uninsured low-income patients a year.

More than 150 patients “have transitioned to coverage under ACA, which has allowed us to accept others” from the clinic’s monthly lottery and referrals from Virginia Hospital Center, she said. But that leaves thousands without insurance because many of her clinic’s patients earn too much to qualify for Medicaid but not enough to use the Obamacare exchanges.

“The average annual income is $15,000,” said White, whose clinic off Columbia Pike relies on donations and volunteer providers. “Many of those we take care of are minimum-wage workers – office cleaners, child-care givers, food service workers.”

Expanding Medicaid would help 20-35 percent of the clinic’s patients, said White, a physical therapist by background. But “we’re only meeting 20-30 percent of the needs out there.”

The hospital industry’s case for expanding Medicaid came from James Cole, chief executive officer of the Virginia Hospital Center, the main donor to the free clinic ($1 million a year) and Arlington’s third largest employer. (A show of hands from the audience confirmed that nearly all still call his institution Arlington Hospital.)

“The most important impact of not expanding Medicaid,” Cole said, “hits when patients are discharged with no doctor to follow up.” The result is “a downward spiral” for those with diabetes or asthma.

The federal law reduced Medicare payments to hospitals on the assumption that they’d gain new paying patients, Cole said. So Virginia’s rejection of Medicaid expansion is “a financial hit” as well. Virginia Hospital Center on most days is at full capacity, which is why it is seeking additional buildings.
The political case for expansion was made by former state Sen. Mary Margaret Whipple, who now works for the Virginia Hospital and Healthcare Association. “There’s nothing I’d like better” than to have Virginia join 30 other states and close the Medicaid gap, she said. Her 107 hospitals provide $600 million annually for charity patients but receive only 66 percent reimbursement under Medicaid.

Expansion would add $2.5 billion to the economy and 30,000 new jobs, she added. Hospitals recently agreed that if the legislature would act, the industry would cover the 10 percent drop in federal money slated to kick in during future years, one argument Republicans used against the plan.
Whipple pronounced herself “baffled” that Republicans resist the federal money. When pressed on motives, she suggested that some oppose it as a “handout.” (I suggested Republicans are stalling for a new president who will repeal Obamacare.)

She remains optimistic about a scenario in which one GOP senator in the evenly split chamber switches and votes for expansion. That, she said, would allow the bill to go to conference and become law without Republican delegates having to put their fingerprints on it.

***

Arlington’s decade-old push to count the homeless paid off last week. The county announced it had become the second community in these United States to reach “functional zero” in finding stable housing for its known homeless military veterans, who number 20.

That feat dovetails with the federal government’s multi-agency push to end veterans’ homelessness. The key was human contact, according to Kathy Sibert, president and chief executive officer of the nonprofit A-SPAN. “We literally kept a list of our homeless vets by name and sat down in face-to-face meetings on a regular basis to assess how they were progressing toward the goal of stable housing.”

The county goal for 2016: end all Arlington homelessness.