I am writing to ask Virginia's General Assembly to expand Medicaid in Virginia.
As a family physician in Richmond, working with some of the Commonwealth's poorest and most-marginalized citizens, I believe that the expansion of Medicaid coverage up to 133% of the Federal Poverty Level (as called for in the Affordable Care Act) is critical to the health of our citizens, and to the state's economy.
I would like to provide a few examples as to why this expansion is so important:
- Medicaid expansion in other states has been associated with reduced mortality: http://www.nejm.org/doi/full/10.1056/NEJMsa1202099
- In Oregon, access to Medicaid was associated with improved healthcare outcomes (though at the cost of increased costs early on--presumably as patients took advantage of newly available coverage): http://www.nejm.org/doi/full/10.1056/NEJMp1108222
- Medicaid expansion will cost Virginia less, both in the short and the long term: http://www.thecommonwealthinstitute.org/2013/02/01/revised-medicaid-expansion-still-saves-money-in-virginias-budget/ and http://www.timesdispatch.com/news/state-regional/government-politics/medicaid-expansion-would-save-initially-va-official-says/article_e379990f-75b1-5fc0-9931-241fa922c4fb.html
- Finally, it is critical to note that the ACA reduces funding to hospitals that treat a disproportionate share of uninsured patients. These so-called DISH funds are being eliminated under the ACA because the cost of caring for these patients was expected to be covered by the law's Medicaid expansion. At this point, there is no mechanism in place to account for reduction in DISH funds under the ACA. This combination of events not only puts hospitals at significant risk, but also threatens to increase all commercial insurance costs to all Virginians--individuals and employers as hospitals face shortfalls from the increase in uncompensated care and passes those costs along to all insured Virginians. It is also worth noting that, at least at VCU, DISH funds help cover not just in-hospital care but also the VCC program that provides community-based primary care for uninsured patients, meaning that these patients will lose access to preventive and primary care services.
Given that it is very difficult for adults to currently qualify for Medicaid in Virginia, many receive care through volunteer services and through free clinics. These programs do excellent work, but I believe many are already running at or near capacity and would struggle to take on additional patients should the safety net unravel any further. The ACA's health insurance marketplaces (exchanges) do not benefit anyone under 100% FPL, meaning that a failure to expand Medicaid ensures our poorest citizens will left out of our current system.
Expanding Medicaid in Virginia holds the potential to provide better patient outcomes, and to save money. Failing to expand Medicaid access threatens a financial crisis to healthcare providers, hospitals, and anyone who is insured--and I have not heard of ANY action in the General Assembly or from the Governor that would address this potential crisis.
I believe the way forward is clear: expand Medicaid as called for in the ACA.
Mark Ryan, MD, FAAFP
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