Health Care

Health Insurance Marketplace to Open Tomorrow

Icon September 30, 2013 - 19:03 It’s finally here. Tomorrow, October 1, the Affordable Care Act’s (ACA) new Health Insurance Marketplace will open for enrollment for those who are uninsured or those who currently pay too much for their insurance. You have until December 15 to sign up for your insurance to take effect on January 1, 2014, so there is plenty of time for you to explore your options and talk to your family about the right plan for you.     The Kaiser Family Foundation has a great cartoon you can watch that helps better explain the Affordable Care Act and how the Health Insurance Marketplace will work. You can find that by clicking here.   If you watch the video, you’ll notice that there are some people who will be left out of the ACA and unable to access insurance because some states have chosen not to expand Medicaid. Virginia is one of the states that still needs to expand. But, there is hope and you can help!   Virginia’s Medicaid Innovation and Reform Commission (MIRC), the body responsible for reforming and expanding Medicaid, will be meeting again on Tuesday, October 15. They need to hear from you! If you are able to attend the meeting, it will be held at the General Assembly Building in Richmond in House Room D at 1 p.m. The purpose of that meeting is to hear from the public, so it is important that people attend. If you are unable to attend the meeting, please consider making a comment in support of Medicaid expansion.Please click here to be taken MIRC’s public comment submission page.   By now, you’ve likely heard that the government is going to shut down at midnight (September 30). A government shut down will not affect the opening of the Health Insurance Marketplace. Funding for the ACA comes from sources not affected by the shutdown.   As more information becomes available, we will post to our website, Facebook page, and Twitter. Later this week, Enroll Virginia! will have more information on their website about how to get help signing up for insurance in the new Marketplace.   Open enrollment closes on March 31, 2014 and there are some rules about when you can enroll and when coverage will begin. Please be sure to visit for more information on enrollment dates and coverage start dates.   Don’t forget to share this information with your family and friends that might need to get health insurance coverage!

Explanation of New Health Plan Draws a Crowd

Icon September 24, 2013 - 14:04 By Kate Thisdell New health insurance marketplaces will be open for business in just one week.  On Oct. 1, the new federal marketplace goes live online as a virtual “supermarket” for shopping for health insurance policies. You’ll be able to compare policies under different companies in an apples-to-apples manner, said Dr. Chris Lillis, a Fredericksburg internist who spoke to a standing-room only crowd at a forum Monday evening on the Affordable Care Act. “For the first time, policies will be standardized,” Lillis said at the informational meeting held at the Central Rappahannock Regional Library in Fredericksburg. “You won’t have to read the fine print to see what’s covered and what’s not.” But while health insurance plans must cover certain things—such as preventive care, prescriptions, hospital stays, mental health care and blood tests—picking a level of care for an individual leaves many with questions. The marketplace isn’t for everyone, explained Lillis and Bill Botts, the new health care navigator for the city and 16 counties. He is tasked with explaining the law and how people should get insurance under it. Botts, a longtime attorney with Rappahannock Legal Services, and a team of volunteers, will open a Fredericksburg office on Oct. 1 as well, and is taking appointments. He encourages everyone to research options at, and not to rush a decision. The federal exchange is for people who don’t have insurance and can’t get it through work, can’t afford private insurance plans and don’t qualify for Medicare or Medicaid. Virginia chose not to have a state-run exchange. You don’t need the exchange if you’re eligible for Medicare or Medicaid; if you get insurance through your employer; if you’re paying for a private insurance plan; or if you’re in Tricare or veterans health programs. Tuesday’s forum, hosted by Virginia Organizing, focused on two groups—the uninsured and small-business owners, likely the two most affected, Lillis said. One in 7 Americans have no insurance right now, said Lillis, also a columnist with The Free Lance–Star. The Affordable Care Act is expected to put a “good dent” in the 40 million to 45 million uninsured, though it won’t help everyone at the start, he said. The lowest income bracket will still be covered by Medicaid; an expansion of the program is under debate by legislators. Lillis said a large gap will remain, leaving millions of low-income adults with no affordable options in the meantime. For those who make 100 percent to 400 percent of the federal poverty level, coverage can be purchased through the exchange and, depending upon income levels, they will receive a subsidy from the government. That tax credit, which will be based on current income levels and will be paid directly to the insurance companies, can drastically reduce a person’s premiums. For example, a family of four that makes $50,000 could choose a plan that costs $924 per month. Tax credits would reduce the cost to $280 per month. Any changes would be reconciled in the next year’s tax filings. But Lillis and Botts said they couldn’t go through every example at the forum—that’s what the health care navigator is for. During the question-and-answer part of the two-hour forum, Lillis said that every individual’s circumstance will be different from the next, and even though the exchange goes live next week, it’s open for months. Coverage begins on Jan. 1, 2014, and there’s a 15-day waiting period after a premium is paid before a policy starts. If you purchase by Dec. 15, your coverage will go into effect at the new year. But that’s not the final deadline. The exchange will be open for six months this year, meaning March 21 is the last day to sign up until open enrollment begins again, in October 2014.

Details still murky about health insurance exchanges under 'Obamacare'

Icon July 16, 2013 - 13:39 By Laurence Hammack and David Ress Over the course of five years, Charlene Humphrey’s kidney stone has grown to nearly the size of a walnut, demanding an operation she cannot afford. Humphrey makes $9.25 an hour working the front desk of a Christiansburg motel. While it’s not enough to pay for health insurance, Humphrey does not qualify for Medicaid, the government health program for the poor. Not long ago, Humphrey’s doctor warned her that without surgery, her left kidney could become infected and shut down. “It’s kind of like I’ve got a ticking time bomb inside my body,” she said, “and I have no idea when it might go off.” Humphrey — who like many working-class Virginians has lived without health insurance for much of her life — is one of many who would benefit from a government program to make private insurance more affordable with subsidized plans available through an online marketplace. Under the Patient Protection and Affordable Care Act, people with incomes between the federal poverty level ($11,490 for an individual, $23,550 for a family of four) and four times that level will qualify for subsidies. Participants will be able to go online and shop for the best coverage, much like someone booking an airplane flight would browse the websites Expedia or Orbitz. But if searching for flights, juggling departure times and accounting for hidden airfare costs seems complicated, shopping for insurance could be even more so. Many details about premiums, out-of-pocket costs, benefits and which doctors, hospitals and drugs the plans will cover remain up in the air, less than three months before enrollment is scheduled to begin Oct. 1. This much is clear: Each state will have its own marketplace, also known as an exchange. They are a key part of a sweeping overhaul of the country’s health insurance system, still on track despite a recent one-year delay in a requirement that employers with more than 50 full-time employees offer insurance or face financial penalties. All of the exchanges will follow the same federal formula, offering subsidies on a sliding scale based on income, with the greatest savings going to the poorest applicants. Even if Virginia decides to expand Medicaid, as called for by the Affordable Care Act but by no means a certainty, Humphrey would not be eligible for that program. Her annual salary of $19,000 is slightly above the eligibility cutoff. “I think it’s incredibly unfair,” she said of her current inability to afford health care. A subsidized insurance plan through the marketplace could be her only hope for coverage — and for surgery to remove her staghorn kidney stone before it’s too late. Humphrey also suffers from diabetes, high blood pressure and high cholesterol. She gets some help from free clinics and Carilion Clinic’s charity care program, but she still must juggle the medical bills with the costs of other essentials, such as food and the small cabin in northwest Roanoke that she rents from a church. “There’s a really big gap there for people who can’t get the help they need — basic medical care,” she said. A lot of questions At a recent seminar in Roanoke, Beth Maiden had the daunting task of explaining how the Affordable Care Act will play out in Southwest Virginia. Maiden, a client executive with BB&T Insurance Services, described how Virginia will use an insurance marketplace run by the federal government, rather than create its own as some states are doing. People who want to buy insurance on the marketplace can sign up starting Oct. 1 for plans that will become effective on the first of next year, she said. As for the details, she didn’t have many. “We are just a few short months away, but we are all scratching our heads and saying: ‘What are these exchanges going to look like?’ ” Maiden told the small crowd gathered at the Roanoke Higher Education Center. U.S. Rep. Morgan Griffith, R-Salem, who will be among the people shopping for coverage on the exchange, also finds it confusing. (Although the Affordable Care Act requires members of Congress and their staff to use the marketplaces, they will not qualify for subsidies.) “Button, button, who’s got the button; exchange, exchange, who’s got the exchange?” Griffith said, referring to the traditional children’s guessing game. “We can’t tell what is the exchange going to have.” Part of the uncertainty stems from the massive task, currently being undertaken by the federal government, of building a so-called “data hub” that will serve as a conduit to the state marketplaces. The data hub will be used by the exchanges to verify an applicant’s income and other information, which is needed to determine what kind of subsidy they qualify for. That will entail tapping into records compiled by about a half-dozen agencies, including the Internal Revenue Service and the Social Security Administration. Whether the system will be ready by Oct. 1 is questionable, said Dan Schuyler, a director at Leavitt Partners, a health care intelligence firm that is assisting nearly a dozen states with their marketplaces. “There is a calculator, if you will, to determine what the subsidy levels will be,” Schuyler said. “It’s the verification process that is up in the air.” Several critical tasks, including final testing, have yet to be completed, according to a June 19 report by the U.S. Government Accountability Office, the investigative arm of Congress. Whether the system will be up and running smoothly by the open enrollment date “cannot yet be determined,” the report stated. Schuyler said it’s possible there will be a lag time of several weeks, rather than the real-time verification of information envisioned by the law. Another possibility is that the process will be completed on paper — which had been planned only as a backup for those without access to a computer — while the kinks are worked out. Timothy Jost, a law professor at Washington and Lee University and an expert in health care law, said a short delay should not cause problems. “If on Oct. 2 they announce it’s going to take another five days to get it running, I’m sure the Republicans will say the sky is falling … but frankly it won’t make any difference,” Jost said. Enrollment will continue through the rest of the year, and as of last Wednesday the government was saying the marketplace was still on schedule to open Oct 1. A marketplace run by the federal government will be used by 27 states, according to the Kaiser Family Foundation. Another 16 states and the District of Columbia are building their own systems. Seven states are partnering with the federal government. In Virginia, the mechanics of running the marketplace will be left to federal officials while the state will monitor the insurance companies that sell plans through the system. Total dependence on the federal system could be risky, Schuyler said. “You’re getting this gray box, if you will,” he said. “And if you have an issue with it, you have to call the federal government.” Costs headed upward Some of the most important pieces of information that people will need in order to shop for coverage — details on monthly premiums, deductibles, copayments — are still under review by the State Corporation Commission’s Bureau of Insurance. One theme emerging from the thousands of pages of paperwork filed by insurers is that there likely will be healthy competition to attract the Virginians who don’t have coverage now, said Doug Gray, executive director of the Virginia Association of Health Care Plans. Four companies — Aetna Life Insurance, Anthem Blue Cross and Blue Shield’s HealthKeepers, Coventry Health Care and Optima Health Plan — have told the bureau that they plan to offer coverage in the Roanoke Valley and most of the New River Valley. There will be four firms chasing business in Bedford County, three in Botetourt and Floyd counties, and two in Alleghany County and most of the rest of Southwest Virginia, except for Grayson and Lee counties. The filings suggest that health plans see widely varying prospects and risks. They do agree, however, that the basic trend in medical costs is that they are likely to outpace inflation, with increases ranging from 6 percent to 10 percent. Carriers expect an even bigger cost increase — roughly double the hit from rising drug prices, doctors’ fees and hospital charges — from the new customers signing up for coverage through the exchange. One reason is that the Affordable Care Act says insurers can no longer turn people down because of poor health, a practice known as “health underwriting” in the insurance business. On top of that, insurers are looking for as much as a 10 percent boost in costs from pent-up demand that will come from newly insured people seeking treatment they’d postponed because they had no coverage. All of those factors will go into determining the premiums that insurers will charge. The bureau needs to make sure those premiums will generate enough money to pay for claims. The bureau expects to finish its work several weeks before Oct. 1 so consumers will have a chance to see what their premiums will cost, and balance that against the cost of deductibles and co-payments. The stakes are high. “If you’re going to offer richer benefits and health underwriting is going away, if you’re an insurer you’ve got to figure out how you’re going to afford that,” Gray said. Supporters of the marketplace say that spreading the costs among a larger group of healthier people will make coverage for the uninsured more affordable. They also argue that subsidies from the federal government, countered by savings from other parts of the Affordable Care Act, will help balance the books. Critics don’t see it that way. Rep. Bob Goodlatte, R-Roanoke County, thinks consumers’ insurance choices will shrink on the exchanges. He shares Griffith’s concern about how implementation of the plans is moving. Dave Schwartz, Virginia director of Americans for Prosperity, a conservative advocacy group, said the system will drive up costs for all consumers. “You’re bringing in a pool of folks with pre-existing conditions … insurance companies and government will now have to pay for expensive procedures for folks who didn’t have coverage,” he said. “There’s not going to be enough people to make up for that.” $300-$325 a month Assuming all goes as planned, someone who visits the website on Oct. 1 in Virginia will find four basic levels of coverage: bronze, silver, gold and platinum. The plans will differ in their requirements for co-payments, or the share of a bill that a patient pays, and deductibles, the amount a person pays before the insurer starts covering bills. The networks of doctors, hospitals and clinics available could differ. There could be differences in the kinds of procedures or medications or medical devices covered. Premiums will vary, with lower monthly costs attached to plans that require higher out-of-pocket spending from patients. None of that information is generally available now. But overall, health plans expect that people in the Roanoke area who buy coverage through the marketplace will pay about the state average for exchange-based plans, according to their filings. For a nonsmoker in his or her 40s, that’s in the $300 to $325 a month range, the documents show. Rates will be slightly higher than the state average in the New River Valley. For someone like Humphrey, making $19,000 a year, those rates amount to a heavy burden — about 20 percent of her income before taxes. That’s where the Affordable Care Act subsidies come in. Under the law, someone with an income that’s 65 percent above the poverty line, as Humphrey’s is, should not have to pay more than 4.7 percent of her income for a middle-of-the-road silver plan. That’s $74.50 a month. “That sounds pretty good,” said Humphrey, who would have to pay about $300 a month for coverage through her employer. Her subsidy would be based on the difference between the $74.50 and the actual premium for a silver plan, which is still unknown at this point. With that subsidy, she also could opt to save on her monthly premium by choosing a bronze plan with its higher deductibles and co-payments. Or she could decide to spend more each month on premiums for a gold or platinum plan in order to hold down her out-of-pocket expenses. Annual out-of-pocket expenses are capped — for Humphrey at $2,250, while for people with incomes greater than 250 percent of the poverty line, the cap will be $6,350. As many as 870,000 people in Virginia could be eligible for subsidized coverage, U.S. census numbers suggest. Small businesses would also be allowed to purchase plans for their employees through the marketplace. ‘I don’t want anything for free’ When Humphrey’s back began to ache several months ago, she first thought it was yet another new ailment. After a visit to the doctor, she learned the problem was linked to her kidney stone. Humphrey, 42, went to a free clinic for help, only to learn that she would still have to pay for her anesthesia and hospital stay. At the time, she was about $20,000 in debt, living off food stamps and a job that paid just a little more than the minimum wage. “My bills are really stacking up right now,” she said last month. As a taxpayer who has worked all her life, Humphrey believes a government-subsidized insurance plan is not too much to ask for. “It’s not like I want to sit back and let the government take care of me,” she said. “I don’t want anything for free. I just want to be able to afford the care I desperately need.”

One Tuesday, Two Healthcare Systems

Icon July 10, 2013 - 15:38 By Dr. Chris Lillis Last week was a typical busy week for me.  As a primary care doctor I typically see 20-25 patients a day in my private practice.  My community is gearing up for changes and is planning measures to integrate the many private practices locally.  I was asked to serve on a committee evaluating software solutions to connect the disparate electronic medical records in the community, and had several hours of meetings at the hospital at the beginning of the week.  Also on the calendar was my monthly shift at the local free clinic.  I have volunteered at the free clinic for the 5 years I have been practicing here.  I sometimes have trouble finding the energy to put in a few hours there on a Tuesday or Thursday night, but I always leave glad that I did.   Last Tuesday at the free clinic was especially poignant for me.   Aside from starting my day with early morning hospital IT meetings and seeing patients in my office, I returned to the hospital Tuesday evening to visit a family member who had been admitted with heart disease.  My family member had state of the art care from her cardiologist, coordinated through her excellent primary care physician.  After experiencing chest pains, my family member had a stress test as an outpatient.  That stress test was abnormal, and within 24 hours had seen a cardiologist, and within days had a cardiac catheterization showing a blockage in one of the heart arteries.  Without missing a beat, that blockage underwent angioplasty and stenting, rendering my family member chest pain free.  I was able to visit my family member after the stent while recovering overnight in the hospital last Tuesday night.   It’s hard to appreciate as a lay person all that went into this seamless episode of care.  From the primary care visit, to the testing, interpretation, and consultation with a specialist finally culminating in a highly specialized procedure there were no gaps in care.  My family member has Medicare, and had the assurance that whatever was medically necessary would be completed by the best our healthcare system has to offer.   After spending some time with my family at the hospital, I ventured across the street to the free clinic.  Initially, many of the patients I was seeing at the free clinic were doing rather well.  I refilled some medications, prescribed some new ones for acute symptoms, provided referrals to needed specialists, and was able to engage in some preventive care for the first several patients I saw last Tuesday night.  But my last patient of the night at the free clinic was far from routine. My last patient was in his early 50s.  He was very thin - an unhealthy appearing thin.  He had worked in construction his entire life, and fell on hard times when our area’s housing boom burst a few years ago.  He seemed very confused.  He told me he was in the hospital, but there were no records in his chart to this effect.  He could not tell me why he had been in the hospital, or what medical condition prompted his hospital stay.   From there, the clinic director and I turned from medical providers to detectives.  We investigated the hospital’s electronic medical records from across the street only to find he had not had an encounter there in several years.  A new hospital opened a few years ago about 5 miles south of the free clinic, so we decided to call them (we don’t have electronic access to their records at the free clinic).  It took several phone calls to a number of departments to solve the mystery: it was 9PM and the medical records department was closed.  After calling the Emergency Room, I found a helpful nurse who was able to read to me some of the results of his visit 2 weeks prior.  He had several abnormal tests. Despite staying for several days in the hospital, there were more questions than answers regarding his condition.  He had reduced blood counts, which could be from any number of causes.  The scant information we were able to obtain Tuesday night did not give us many clues.  He has findings on radiology imaging suggesting he had prior exposure and toxicity from asbestos - no doubt from his years in construction.  But more worrisome than either of these was his confusion.  He thankfully was not homeless, but lives with family. I left the clinic after spending one hour trying to investigate his prior care and determining where next to go.  As a patient of the free clinic, every test and every referral needs to be carefully weighed.  What tests should I order without exhausting the limited resources of the clinic?  Who will follow up those test results?  The next physician he is likely to see will be another volunteer like me unfamiliar with his care.   After some deliberation, I ordered some blood tests and asked that the complete records of his hospitalization be sent to the free clinic.  I flagged his chart for the medical director of the free clinic so that there would be some continuity to his care.  The glaring difference in his care, compared to that of my family member, leaves me worried about his future health.  He is one of the 400,000 Virginians who would benefit from the expansion of Medicaid, and gaining this coverage would allow him to access primary care services rather than rely on the charity of the free clinic.  Having a primary care doctor would allow for the same coordination of care that my patients, and my family depend on during episodes of illness.  Having Medicaid coverage, and primary care, would also save our local health systems countless dollars - rather than duplicating tests and procedures that may be performed just 5 miles down the road since a primary care doctor could keep track of his diagnostic work up. Alas, Virginia has not yet accepted the billions of dollars allocated to our Commonwealth to expand Medicaid as prescribed in the Affordable Care Act.  As many as two thirds of Americans will not benefit from the life saving access to care afforded through expansion of Medicaid if states like Virginia, Texas, and Florida stand in the way of progress.  I only wish those legislators blocking Medicaid expansion had the opportunity to tag along with me last Tuesday.

Talk to your family members about health insurance!

Icon July 3, 2013 - 14:05 Did you know that health care reform means people without insurance can start enrolling in the Health Insurance Marketplace on October 1?   Virginia Organizing wants to make sure that people all over Virginia know about the new Health Insurance Marketplace and we think you can help!   We’ve come up with a few helpful tips on how to talk to your family members and friends about health care while you’re waiting for the burgers, hot dogs and veggie burgers to finish cooking! You can also take a look at our helpful flyer by clicking here.   Thanks for your help on getting the word out about health care reform and the new benefits for thousands and thousands of people!   Virginia Organizing’s Helpful Tips for Talking About Health Insurance   1.     Start by asking your family members and friends if they already have health insurance or if they will need to enroll. If they already have insurance, there is no need for them to do anything unless they are looking to change plans!   2.     It might be helpful to share a health experience you had. For example, “Remember when Uncle Bob was in the hospital for his heart? He would have lost his house without health insurance!”   3.     Be sure to point out that October 1, 2013 is the start of open enrollment for the new Health Insurance Marketplace and the sooner people enroll, the sooner they will start receiving coverage (as early as January 1, 2014).   4.     Not everyone is happy with the new reforms. Make sure you stay on topic by acknowledging concerns with the law but also stating that it is the law and most people without health insurance will need to be covered or face a penalty tax.   5.     Make sure you emphasize how easy it is to get information about all the plans available! Just visit for more information. At, you can: ·      Find out what plans you are eligible for ·      Learn more about health insurance terms used ·      Starting this fall, you can compare plans and prices ·      Get answers to your questions about health insurance and your eligibility   6.     Ask your family and friends to share this information with those they know. Almost everyone must have health insurance to avoid paying a penalty tax. The more people who know, the more people will be covered come January 1, 2014.   If you have any questions, please don’t hesitate to contact Bob Becker, one of our organizers who is doing a lot of work on health care reform.  Bob can be reached at or 804-937-0752.

Action Alert: MIRC Meets Monday!

Icon June 13, 2013 - 18:36 Next week, the Medicaid Innovation and Reform Commission (MIRC) is planning to meet. As you know, this commission is tasked with ensuring that certain reforms to Medicaid are met before moving forward with expansion.   We need your help to remind the committee members how Virginia feels about Medicaid expansion! We need to remind them that Medicaid expansion will create jobs, provide insurance for hundreds of thousands of Virginians, lower health insurance rates, and not cost Virginia a dime for the first several years.   Will you take a moment and call members of the committee and let them know that Virginia needs Medicaid expansion as soon as possible to create jobs, save lives, and boost our economy?   I know you can’t call every person on this list, but maybe you can call a few that are close to you before the weekend and make sure they know we support Medicaid expansion in Virginia!   Virginia Delegates: Steven Landes (25th District- Albemarle, Augusta, and Rockingham) 804-698-1025   James Massie (72nd District- Henrico) 804-698-1072   John O’Bannon (73rd District- Henrico) 804-698-1073   Beverly Sherwood (29th District- Winchester, Frederick, and Warren) 540-667-8947   Johnny Joannou (79th District- Norfolk, Portsmouth) 757-399-1700   Virginia Senators: Walter Stosch (12th District- Henrico and Hanover) 804-698-7512   Janet Howell (32nd District- Northern Virginia) 703-709-8283   Emmett Hanger (24th District- Shenandoah Valley) 804-698-7524   John Watkins (10th District- Metro Richmond) 804-379-2063   Louise Lucas (18th District- Eastern Virginia) 804-698-7518   Thank you for your continued work to bring Medicaid expansion to Virginia!

Expand Medicaid, save money, lives

Icon June 10, 2013 - 21:44     The Virginian-Pilot© June 6, 2013 The folly of failing to expand Medicaid, as outlined in the federal Affordable Care Act, was underscored again this week with the publication of yet another study of the consequences. Leaders in more than a dozen states have refused to expand eligibility criteria to let more uninsured, lower-income residents enroll in the government-sponsored health coverage. Last year, the U.S. Supreme Court provided that option in upholding the constitutionality of the health insurance overhaul. The lead author of the latest study, conducted by the RAND Corp., noted that residents in every state will pay the taxes associated with implementation of the Affordable Care Act, regardless of whether they expand Medicaid. Researchers evaluated 14 states - not including Virginia - seen as least likely to expand the program because of their governors' opposition. The financial toll is significant. Those states are poised to lose $8.4 billion annually in federal payments, and could have to spend another $1 billion to treat the uninsured, according to findings published in the journal Health Affairs. The human toll, too, is staggering: With 3.6 million people more left uninsured, an estimated 19,000 deaths could result annually due to lack of care. "States that do not expand Medicaid will not receive the full benefit of the savings that will result from providing less uncompensated care," said Carter Price, the study's lead author. "Furthermore, these states will still be subject to the taxes, fees and other revenue provisions of the Affordable Care Act, without reaping the benefit of the additional federal spending." Still, many Republicans have maintained their opposition, including in Congress, where the House has held three dozen votes to repeal the law. These legislators, and their counterparts in state capitols, are shirking their fiduciary duty. Voters appear to be catching on. A recent survey by the Joint Center for Political and Economic Studies showed a majority of residents in Deep South states - Georgia, Alabama, Louisiana, Mississippi and South Carolina - actually favor Medicaid expansion, despite their leaders' strident opposition. Virginia lawmakers established a commission this year to determine whether to expand Medicaid, a move that allowed General Assembly Republicans and Gov. Bob McDonnell to defer a decision until federal officials accept a series of cost-cutting reforms. The strategy is just as misguided as outright refusal. Virginia, previous analyses have shown, would get back nearly all of the tax dollars its residents pay over the next several years if the commonwealth expands Medicaid. While the cost of Medicaid is generally split between states and the federal government, expansion under the ACA would be entirely covered by the federal government for three years, then gradually phase to 90 percent by 2021. That time period is critical for at least two reasons. First, states would provide health coverage for more residents without paying more for three years, and in fact, would save millions of dollars that they now spend on treatment of the uninsured and indigent. Second, as a study by Virginia Commonwealth University's medical school has shown, an uninsured person's health care costs decrease dramatically over the first three years in which he or she obtains coverage. That's because regular access to care helps to better manage chronic conditions and draws patients to family physicians rather than hospital emergency rooms. In short, failure to expand Medicaid is not only unwise; it is indefensible, on both moral and financial grounds.  

Virginia takes another step on the pathway to Medicaid expansion

Icon May 22, 2013 - 14:36   The Commonwealth Institute Virginia has taken a significant step toward Medicaid expansion, keeping the state on track to extend health insurance to nearly 400,000 low-income Virginians. Today, Virginia gained approval for an innovative demonstration project to better coordinate the care for individuals who receive care through both Medicare and Medicaid, according to an announcement from Governor McDonnell. This new program, called Commonwealth Coordinated Care, will launch in early 2014, and will serve more than 78,000 Virginians eligible for both Medicare and Medicaid. This reform holds the potential to not only help better manage people’s care, but also to save the state money. The state projects this demonstration project will save $11.3 million in fiscal year 2014 and $22.6 million in 2015. These, along with other reforms required for Virginia to expand Medicaid, stand to save the state up to $341 million over the next nine years. The creation of Commonwealth Coordinated Care is great news for Virginia since moving forward with this project satisfies one of the requirements for Virginia to expand Medicaid as part of health care reform. —Massey Whorley, Senior Policy Analyst