Should Virginia expand Medicaid, form an exchange?
In the wake of the U.S. Supreme Court’s ruling upholding most of the federal health care overhaul, Virginia’s political and health care leaders began the debate over the value of expanding Medicaid coverage and implementing a state-run benefits exchange.
“This is a $2.2 billion unfunded mandate on the people of Virginia,” said Gov. Bob McDonnell, citing the 10-year cost of expanding the Medicaid program that serves the poor.
“It’s major new bureaucracy. It is a major intrusion into the freedom of the American people. This is a policy that stands between doctors and their patients in making the appropriate choices.”
Others say the expansion should take place in Virginia, but cautioned that the financial implications must be considered as well.
Dr. Daniel Carey, a past president of the Medical Society of Virginia, said the Medical Society, which lobbies on behalf of Virginia physicians, would support expanding Medicaid only if it was properly funded to reimburse doctors fairly.
Should the expansion take place as many as 420,000 Virginians would gain Medicaid coverage, according to Virginia’s Department of Medical Assistance Services.
Additionally, the debate over forming a state-run health insurance exchange continued.
McDonnell and the General Assembly decided earlier this year to delay action on creating an exchange, partly because of uncertainty over how the Supreme Court would rule. Some legislators and insurance providers have warned that Virginia could run the risk of having the federal government design an exchange for Virginia if the state fails to act.
House Republican leaders said Thursday that the legislature soon will begin work to set up an exchange. But McDonnell said the state does not need to rush.
(Michael Sluss, The Roanoke Times Richmond-based political reporter, contributed to this entry.)
June 28, 2012 - 6:07 PM
Totally confused. Is care for the 420,000 mandated, or does Virginia have any choice about expansion? What do you mean about “should the expansion take place” ?
Ty, A question raised by the Supreme Court’s decision is whether states will decline to participate in the law’s expansion of Medicaid. Virginia’s leaders are debating if Virginia should decline to participate.
The law, as passed by Congress and signed by Obama, extended Medicaid coverage to non-elderly individuals with incomes up to 133 percent of the poverty line. The court said the act could not force states to expand Medicaid by threatening to withhold federal funding that currently goes to support Medicaid programs in the states. Instead the court said the federal government could only withhold state funding for expanding Medicaid. In Virginia the expansion of Medicaid would add about 420,000 new people to the existing Medicaid roles, according to the state’s estimate.
Without the threat of withholding funding, the question being asked is should the state move forward with expanding Medicaid to those 420,000 Virginians.
I am glad to hear that house GOP leaders plan on setting up exchanges. It makes sense that governor Bob wants to delay action as long as possible since he is still hoping to attain national office by appealing to the far right base of the GOP. It should be noted that VA is already has the dubious distinction of having the lowest expenditures per capita on Medicaid of all the states, apparently this is a badge of honor for the Ayn Rand school of governance.
Even the networks and major papers seemed confused about what the law really says/means. Why not interview the person(s) whow wrote the law so a full and complete meaning can be given to everyone?
Dr. Carey of all people should know that Doctors are being reimbursed very fair. When you drive into the Roanoke Memorial parking garage look at the cars parked in the Doctors parking spots and see the Jaguars there along with other very expensive cars. I think Doctors and Lawyers are being paid too much.
Virginia should expand Medicaid coverage. The cost is $2.2 Billion over ten years, or $220 million annually. I believe the Fed Governement will reimburse Virginia approximately 75 cents on each dollar, so in effect the state can insure its poor for $55 million per year. These people will continue to use healthcare regardless of whether they are insured, so the cost is much less to cover them than to incur the bad debt and writeoffs that it otherwise generates.
How would you pay for the expansion?
In short, the federal government pays for the expansion at 100 percent for the first three years. After that, I believe the Feds pay 90% with the states picking up the rest.
The Federal government is bankrupt if you haven’t already heard.
Correct me if I am wrong, but the Affordable Care Act changed nothing about Social Security Act of 1965 that created Medicaid. That act is the basis of what is mandated and what is not mandated. Wouldn’t the States be in violation of federal law if they choose not to expand Medicaid, a presumed mandated action?
@James I haven’t posed that exact question to any of the experts I’ve consulted and am unsure of the answer tonight. I’ll see what I can find out Monday.
@James
The Patient Protection and Affordable Care Act includes an expansion of medicaid to cover anyone under 133% of the federal poverty level. Currently medicaid covers some poor children, poor pregnant women and some poor elderly. The original bill was written in such a way that would pull existing medicaid funding from the states if they didn’t expand to cover the new provisions, but the supreme court ruled this unconstitutional, so it is going to be left up to the states to decide if they cover those people.
@Don – A good many of those “overpaid” doctors that you refer to still have tens of thousands of dollars in students loans, following 8-12 years of college and years of residency, and a good many of them work 70-80 hours a week or more to earn their “overpaid” salaries. Perhaps if more of us were willing to put in that many years of education and that many hours of work every week, we would be driving fancier cars as well. Having worked for both doctors and lawyers in the past, I will grant you that lawyers are GROSSLY overpaid for what they do; however, most doctors put in the hours and earn every dime of what they make.
All those luxury cars are owned by a finance company, not the docs. None of the docs will be able to retire before age 70, unlike the federal and state employees who can usually retire at 55-62. Unfortunately, they are all going to the poor house.
Interesting comments. As the direct relative of someone whose house was repoed (liened to death)by a major university healthcare provider in the late 1980′s due to any insurability issue, I submit that all you Tea party libertarians and neo con fox news mainliners should just walk a mile in my family’s shoes. Do you read the WSJ? What did they say about the largest employer’s collection practices in our fair city a few years ago?
You have to buy car insurance if you want to drive a car or auto for your employer in Virginia even if you don’t own a car or motorcycle. Otherwise you must pay a fine to the DMV. Most folks follow the law there or risk losing their driving priveledges.
Chief Justice Roberts split the horns of the dilemma with his historic ruling. Educate your selves because most of you neo cons sould like sophomores after an all nighter.