On March 1, the Virginia Poverty Law Center, The Commonwealth Institute for Fiscal Analysis, and Virginia Organizing delivered a presentation on the status of Medicaid expansion in Virginia following the action of the 2013 General Assembly Session. >>Get the slides here.

Healthcare for All Virginians Coalition Urges Budget Conferees to Adopt Attainable Medicaid Reforms and Extend Coverage to 400,000 Hardworking, Uninsured Virginians.

The Healthcare for All Virginians (HAV) coalition strongly disagrees with Governor Bob McDonnell’s opposition to the expansion of health insurance coverage to more Virginians and his statement that Virginia will not expand Medicaid “until major reforms are authorized and completed, and until we receive guarantees that the federal government’s promises to the states can be kept without increasing the immoral national debt.”

The HAV Coalition urges the House and Senate budget conferees to move forward with attainable Medicaid reforms and extend coverage without delay. The HAV coalition is comprised of 65 organizations from across the state that advocate for accessible and affordable quality health care for all Virginians. (See list of supporters.)

Noting that the Governor’s eight-page letter never mentions the health needs of uninsured Virginians, Jill Hanken, attorney with the Virginia Poverty Law Center, says “Where’s the morality of denying health insurance to 400,000 low income Virginians who work hard but can’t afford coverage on their own? We know that every single day uninsured Virginians are unable to get necessary treatment to stabilize their chronic illnesses. When their conditions deteriorate the result is poor health or even death for them, more uncompensated care for hospitals, and higher costs for people with health insurance.”

Governor McDonnell argues that Virginia should delay Medicaid expansion in order to pursue reforms first. But, according to a new analysis by The Commonwealth Institute, many reforms are already in place and underway — and can save the state enough money to offset the cost of expansion. These reforms will produce an estimated $325 million in savings from fiscal year 2014 to 2022, more than double the $137 million state cost of expansion. In addition, Virginia already has the ability to implement many other reforms that the Governor has requested such as adopting a more commercial-like benefit package, placing reasonable limits on non-essential benefits, and requiring cost-sharing in the Medicaid program.

“There is no need to delay expansion since Virginia can already achieve important goals of reducing cost, aligning incentives better within the program, and improving health outcomes among people who have Medicaid coverage through reforms,” says Michael Cassidy, President of The Commonwealth Institute.

The Governor also raised concerns that the federal government will decrease the federal fund match rate in the program, burdening the state with more of the costs than promised. But lawmakers can – and are — adopting ways to deal with that possibility. Federal law allows Virginia to reduce coverage if the federal match rate declines and language in the House budget amendment already makes this reduction automatic to protect the state.

“The HAV Coalition believes the Medicaid reforms and extension of coverage should proceed simultaneously, on parallel paths,” says Bill Kallio, AARP Virginia State Director. “The conferees should also protect state funding by allowing for an end to expanded coverage if the promised federal funding is reduced.”

The Governor’s letter also ignores the consensus of Virginia’s business community, hospitals and health care providers who all support Medicaid reform and extension, which would bring about $2 billion per year of federal money to Virginia to support jobs and boost Virginia’s economy. These are just some of the benefits noted by the Virginia Chamber of Commerce which recently endorsed the expansion.

“If Virginia rejects the federal funding, hospitals will lose hundreds of millions of dollars, and some smaller rural hospitals may not survive at all,” says Don Harris, spokesperson for Inova Health System. “We would also lose financial support for 30,000 new jobs, something all lawmakers, including the Governor, should be concerned about.”

The Governor’s letter demands reforms that are simply unattainable. “The Governor has ‘moved the goal post,’ insisting on unreasonable conditions such as fixing the federal budget and amending the Affordable Care Act,” says Dr. Chris Lillis, a physician with the Virginia Chapter of Doctors for America. “I would like to introduce the Governor to the patients I care for in the Fredericksburg Free Clinic so he can understand what his decision really means for uninsured Virginians.”

On February 3 the House Appropriations Committee adopted budget language (Item 307 #11 h) requiring a long list and “3 phases“ of Medicaid reforms as a condition of Medicaid expansion.  The language requires the expansion to be approved by the General Assembly after “completion” of the reforms, and prohibits expansion before July 1, 2014.

The Senate Finance Committee Budget (Item 307 #38s) also requires certain Medicaid reforms.  It also calls for action by the 2014 General Assembly before the expansion could be implemented.  This delays implementation until at least July 2014.

The conditions and delays built into the committee budgets unnecessarily postpone the Medicaid expansion for an unknown length of time.  Both require at least a 6 month delay – and it could be longer – or never.

The HAV Coalition opposes delayed implementation of the expansion.  The extension should begin on January 1, 2014.  We do not oppose efforts to reform the Medicaid program to implement improvements and efficiencies.  But those changes should be implemented along with the expansion.

The House and Senate should amend their budgets to modify the contingency language which delays implementation of the expansion.

Each day of delay means Virginia loses about $5 million of federal funding.  This funding isOUR federal tax dollars which would support health insurance, create 30,000 jobs, and boost Virginia’s economy.

400,000 uninsured Virginians are waiting for coverage and the health care they need!

What happens if Virginia delays the Medicaid extension?

• 400,000 low income Virginians will remain uninsured. Most will be unable to get private coverage through the Exchange, leaving a huge gap in coverage.
• Hospitals that serve the uninsured will lose more money.
• Private health insurance premiums could rise even higher because of ongoing uncompensated care and fewer people in insurance risk pools.
• Virginia loses the economic benefit of over $2 billion in federal spending each year and continues to pay for health programs/services for indigent care, CSB services, etc. with state/local money.
• Virginians’ federal tax dollars will help people in other states.

The 2013 session of the Virginia General Assembly is under way. As a coalition dedicated to accessible affordable quality health care for all Virginians, we have two main priorities.

Priority #1

Adopt the Affordable Care Act’s Medicaid Expansion

A primary goal of the Affordable Care Act (ACA) is to provide affordable, quality health coverage to all Americans.  In addition to new marketplaces (Exchanges) that will sell affordable private insurance, all states have an option to expand their Medicaid programs to offer insurance to more low-income people
(See VPLC’s Latest Update on the Consequences of Delaying Medicaid expansion)
(Check out our resources on Medicaid Expansion)

Priority #2

Protect and Improve Payments to Medicaid / FAMIS Providers.

Every day, hospitals, physicians, and nursing facilities care for Medicaid and FAMIS patients and are paid less than it costs to provide the care. Some of the burden of these unfunded costs is shifted to commercially covered patients, while much of it goes uncompensated. Virginia needs to hold the line on reductions to Medicaid and FAMIS providers, and ultimately improve the rates to keep pace with the cost of care.