New State Budget Brings Steps to Expand Medicaid
More than 9,000 children in the 44th District receive their healthcare from Medicaid.
Last week, I wrote about the transportation legislation that passed the General Assembly. The other major policy change this session was the expansion of Medicaid. This was especially critical for the 44th District.
Medicaid is a federal-state health insurance program for low-income and disabled people. It is also the only provider of long-term nursing care for many Americans, since Medicare coverage and coverage by most private insurance policies is quite limited. Virginia has one of the most restrictive Medicaid programs in the United States — you have to be very poor to be eligible. Most rankings put Virginia at 48th in Medicaid expenditures and 7th in per capita income. In other words, we are a relatively wealthy state and we do not help the poor much.
The 44th District has the largest uninsured population and the largest Medicaid population in Fairfax County. More than 9,000 children in our community receive their healthcare from Medicaid. That is equal to one in three children in the 44th District and 15 percent of all residents of the 44th District. Approximately 70 percent of uninsured Virginians are employed and only 37 percent of small businesses (less than 50 employees) provide employee health insurance benefits. Approximately, 5.6% of the uninsured or 56,000 people are Virginia veterans and their family members.
Virginia already spends millions indirectly on uninsured care including about $100 million per year subsidizing uninsured care at state hospitals, $515 million per year in charity care at hospitals, and about $300 million per year is provided at free clinics and through charities. Most analyses conclude that about 10% of private health insurance cost is for uninsured individuals.
The Patient Protection and Affordable Care Act (AKA Obamacare) allowed each state to expand Medicaid with the federal government picking up between 90-100% of the cost over an eight-year period. The actual cost to Virginia taxpayers is largely neutral due to the elimination of uninsured care, charity care, reduced demand for free clinics, and uninsured care paid by private insurance.
The analyses prepared by Senate Finance staff also found that the Virginia Medicaid expansion would create 33,000 Virginia jobs. Coverage for preventative care would also reduce overall system expenditures as people will get help before they become too sick.
Most states have agreed to expand Medicaid after analyzing the consequences and rather than seeing their federal tax dollars go to other states. Recently, even Republican Governors Christie (NJ), Kasich (OH), and Rick Scott (FL) have moved forward. At the beginning of the session, Governor McDonnell opposed expansion. In the last few days of session, he moderated his position, but a large contingent of downstate legislators continued to oppose the expansion.
The compromise struck on the last day created a panel of ten Virginia legislators who are tasked with certifying that the federal government has agreed to certain reforms – mainly the implementation of managed care in the provision of services compensated by Medicaid. Upon the panel’s certification, the Governor would be required to proceed with expansion.
Attorney General Cuccinelli issued an opinion that this system is unconstitutional, but he issued the opinion without reading the actual bill. This issue will be litigated.
I voted for the final state budget largely due to the inclusion of this language in the final amendments. I am hopeful that it will be sustained because it is absolutely critical to getting our health insurance costs under control and providing economic security to the working poor and other families in the 44th District.
Next week, I will provide a third update on other measures in the state budget and other legislation that passed this session.
It is an honor to serve as your state delegate.
Beka Martinez
8:05 am on Wednesday, March 6, 2013
Me Surovell - I would personally like to thank you for screwing up our healthcare costs so expertly! My husband and I are both receiving social security and have 2 sons who have monumental needs: 1 is severely handicapped for life & totally dependent on us; & the other is currently severely impacted by his disability but has hopes for eventual recovery. We pay $500/mo for health insurance, w/a $3,000/per person/per year deductible to which co-pays do not apply. The insurance gladly pays for well-doctor visits - which I never found to be a problem, because we don't go to the doctor if we are not sick - but doesn't kick in a dime on these other costs until after we pay out the $3,000 apiece - which is problematic as I don't have any money left over after I pay the premium! Use Medicare/Medicaide? Well, that's a problem because no one wants to take Medicaide because they can't make any money at it unless they game the system - and Medicare is going to be in the same shape if y'all don't stop tampering with it. I can honestly say that I think someone who gave up 16 additional years of their life & took on the exorbitant debt-load involved in paying for med school AND the costs for mal-practice insurance, deserves to make a good living - unlike attorneys, who gave up far less but charge just as much.
Scott Surovell
9:07 am on Wednesday, March 6, 2013
Thanks for your comment Beka. I'm not clear where your issue lies, but I have a couple thoughts.
First, Medicare is a federal program. Congress runs that. State government has no control over it.
Second, Virginia has some of the strictest medical malpractice rules in the United States. You cannot file suit without certification from a doctor that malpractice has occurred and we have a total damages cap of $2 million which is very unusual. The Medical Society of Virginia is very happy where things stand on that in Virginia.
Third, I suspect that the decision to expand Medicaid or not has little to do with your complaint. Expansion was a question about whether we take a bunch of federal money just sitting there or let it go to other states. The federal government is picking up 100% of the cost in the first two years and 90% in the out years. The cost savings to Virginia taxpayers by opting in virtually offset the 10% we pay. Plus it creates 30,000 jobs.
It sounds to me like your issue might have to do with the balance of the program - e.g. that Medicaid reimbursement rates are too low. I agree with you about that. To raise rates, we'd need to either (1) cut secondary education, (2) cut higher education, (3) release incarcerated felons, (4) undo the transportation plan we just entered, or (5) raise taxes.
What's your preference?
Elaine Kolish
8:40 am on Wednesday, March 6, 2013
Scott-I am grateful, and I know many others are too, that you are trying to look out for our less fortunate neighbors in the 44th district, particularly children. Your approach shows heart and smarts, as your analysis showed it is cost effective to expand Medicaid's coverage in Virginia, and the right thing to do. Thank you. Elaine Kolish
Cathy Hosek
9:32 am on Wednesday, March 6, 2013
Thank you Scott for your hard work. People who are fortunate enough to not have to worry about healthcare costs today may be the exact people who need this help down the road. Well visits are an important part of hour medical care. You shouldn't go to dr only when you are sick - you need the baseline tests so if something should go wrong you can hopefully catch it early and spend less time and money trying to take care of it. That is why most insurances pick up that cost - preventative medicine which more people SHOULD use would help reduce costs overall.
Stuart Daniel
10:58 am on Wednesday, March 6, 2013
Scott - we are a rich state because our policies encourage "doers" to come here, and takers flock to places like Maryland. I'm thrilled people like you represent me and try to encourage takers to come here and chase people like me away. Suppose it's off to a state where elected officials care more about people who make and pay taxes than leeches who don't. Buy your votes and enjoy your lifetime job as an man elected by and for the lazy. Your legacy will speak for itself. As for me, hellooooo Texas!
Scott Surovell
11:12 pm on Thursday, March 7, 2013
Thanks for the feedback Stuart.
I've met many families who are transferred here with the military or for a job who have intellectually and/or developmentally disabled children who can't get a Medicaid waiver to care for their child at home.
Not everyone comes here willingly.
Many of my constituents claim tax deductions for mortgage interest and state incomes taxes that vastly exceed what the low income families receive from the government. For some reason, some people don't equate deductions with TANF or SNAP funds although the impact on state taxpayers is identical in terms of dollars.
Are you suggesting that Virginia stop allowing taxpayers to deduct mortgage interest or real estate tax payments from their state income taxes?
Kari Wright Warren
2:28 pm on Wednesday, March 6, 2013
From what I understand about all of this, if our representatives do not take advantage of this funding for Medicaid, then the money will flow to other states. Why in the world would anyone have a problem with helping a fellow Virginian? Northern Virginia is one of the most expensive places to live in the entire country. Income guidelines are not pro-rated accordingly. I can't imagine why someone would have a problem with their neighbor, if they duly qualify, receiving the benefits.
Scott, I commend you for this action. This has been a huge problem for so many in our community. Let this action allow for some reprieve for these families!
Scott Surovell
11:14 pm on Thursday, March 7, 2013
Kari
That's correct. The question is largely whether we take this money on the table or let it go to the other states.
I'm pretty sure most of my constituents would like to take this money rather than allow Virginia's money to go to other jurisdictions.
Chris Christie, Rick Scott and John Kasich reached the same conclusion after studying it.
Stuart Daniel
2:48 pm on Wednesday, March 6, 2013
Kari - I, for one, love helping my neighbors, friends and family. Have voluntarily done so for years. This is different. This is about giving something away for free. It is not the role of Scott Surovell or the state to force me to help my neighbor by taking away what I have worked hard for and earned. And if you think this is just free money from the Feds (not free, as our federal taxes are going up), you are mistaken. This will be a bill to VA TAXPAYERS (key word there is PAYERS), and option 5 in his response to Beka above shows you that we will foot the bill, and that is his intent.
Cathy Hosek
3:09 pm on Wednesday, March 6, 2013
I don't understand your logic. You are paying into the system in the hopes you will never have to use it. I don't think people on Medicaid/Medicare want to be there. If you are in need of these services, you will be happy they are there. All the systems that government pays for are necessary for someone. For example, take the FDA - if you are vegetarian and don't eat meat, then you would probably argue we don't need meat inspectors. Well, I don't need them, so let's get rid of them! I don't want my tax dollars paying for something I don't use. Unfortunately, that isn't the case and we all need to take care of each other. Just be glad that isn't the only way you can get health care, when for so many of our neighbors in this district it is!
Stuart Daniel
4:09 pm on Wednesday, March 6, 2013
Cathy - where does the role of government providing necessities end and charities pick up? Charitable organizations used to provide housing, food, medical care and emergency money. Charity has been replaced by section 8, food stamps, Medicaid (now expanding to more "needy" if Surovell gets his way), and welfare. Where does it end? And, I would ask you, what additional charitable services not funded now should the government provide at the expense of taxpayers and charities?
Cathy Hosek
4:32 pm on Wednesday, March 6, 2013
Unfortunately, churches have proven that they don't support everyone - gays, and women's birth control to name two off the top. I don't know where that line ends, but lately I haven't been real impressed with churches or the people who claim to be church going. Unfortunately, society has brainwashed us into thinking we need to spend spend spend when we should be focusing on what we need and not want. $200 for a pair of shoes or $50? I will go for the $50 pair every time no matter what celeb is telling me I need to spend more. I don't believe in free handouts, but telling people to support themselves and their families on minimum wage jobs isn't going to cut it. Do CEO's really need private jets and 3 vacation homes? I think not. Close some loopholes and give everyone a level playing field i.e. a strong education base and health care and food, then maybe things will even out.
Stuart Daniel
5:08 pm on Wednesday, March 6, 2013
For what it's worth, people making minimum wage shouldn't be supporting large families. Having 5 kids doesn't entitle you to freebies because you don't have the skills to land a job to support em. Giving things away only encourages such behavior.
And those private jets you bemoan employ pilots, maintenance personnel, catering, and administrative support. Good jobs that pay taxes to support the goodies you want give away.
As for charity, I wasn't only speaking about churches. Charities such as the gay men's health crisis popped up to fill voids that churches wouldn't fill. If your whole point for having the government pay for everyone's healthcare is your supprt for an elective procedure (abortion / birth control), i would ask you to look in the mirror to see who the greedy one is - then go get those $200 shoes. The additional percentage of sales taxes you pay may just fund a month of birth control for one of the "less fortunate."
Cathy Hosek
5:18 pm on Wednesday, March 6, 2013
Really - one one or two pilots - catering - on call I suppose - I don't imagine those jets fly every day. How much catering do you need for a jet? How often do you service a jet - a few hours a week? Even if it is more, it is certainly not a full time job. That's not a really justification for those huge tax breaks that imploy few people.
What about all the breaks oil companies get? Those are the loopholes that need to go. Corporations, banks, the real greedy people in the country who take hundreds of millions of dollars away from the tax payers and not the people on welfare who pale in comparison as to what they "take" from taxpayers.
"giving things away only encourages such behavior" You are right, I wouldn't want people to eat if they have more than 3 kids. Unfortunately, if we don't provide access to proper food and health care for the less fortunate, they are doomed to fail.
Stuart Daniel
5:41 pm on Wednesday, March 6, 2013
Cathy - I'm glad we have morality police like you to tell the rich how not to spend their money and belittle jobs like small aircraft pilots.
I wish you and Scott well in your endeavor to turn Virginia into the fiscal utopia that California and Maryland have become. As you enjoy paying for all of your new less fortunate neighbors, I will be in Texas paying lower taxes and keeping more of what my blood and sweat have earned so I can feed and support my family - all the while giving what's leftover to charities to help folks who have temporarily fallen on hard times. Heck, I will sell my house to someone less fortunate and give you a new neighbor.
You need people greedy people like me (and god forbid CEOs and pilots and people who sell expensive shoes) to pay for your do-gooder agenda. Unfortunately for you, Atlas will eventually shrug and go elsewhere - leaving takers outnumbering taxpayers.
Cathy Hosek
6:51 pm on Wednesday, March 6, 2013
Stuart - I am not belittling those jobs - I am merely stating that saying that people should be able to take tax breaks for having private jets because they provide jobs for <20 people is a ridiculous reason!
Speaking of morality police, I believe you are determining how many children people can have! I don't care if people want to pay thousands of dollars for shoes, if they can in good conscience go to sleep knowing that millions of people in America go to bed hungry every night.
I am not impressed with the buy buy buy more more more mentality people in America have. You will do well in Texas where bigger is better and where more is always more.