Heres a good read on the Medicaid Expansion by Sen. Dave Marsden. Friends, I spent the last few weeks, ever since the completion of this year’s General Assembly regular session, calling individuals who e-mailed me with strong objections to Medicaid expansion. While a few of these individuals had some grasp of this complicated policy issue, most did not know the details of the plans. Governor McAuliffe has proposed accepting federal funds to expand our current Medicaid program, making medical care available to an additional 300,000 to 400,000 people. The federal government would provide funding to cover 100% of the costs for 3 years (2014-2016), then gradually decrease its share until stabilizing in 2020 at 90% of the cost each year. The Commonwealth of Virginia would pay 10% of the cost from then on. Expanding Medicaid would create 30,000 new jobs and provide about a $2 billion boost to the Virginia economy. Expanding Medicaid would also enable us to save Virginia about $250 million a year that we now spend on indigent health care and mental health and substance abuse services for people who would be covered by the expanded Medicaid program. An analysis by Price Waterhouse found that the savings the Commonwealth would receive would exceed our share of the expanded Medicaid costs by $1.1 billion between 2014 and 2022. The Governor has proposed putting some of the net savings over the next two years in reserve funds and spending the remainder on high priority initiatives, including a 2% pay raise for teachers, eliminating cuts to Pre-K education, and enhancing mental health services that badly need it. The plan that the Senate passed earlier this year, known as Marketplace Virginia, would also use those same federal funds to make private health insurance available to those same 300,000 to 400,000 people, with the expectation that over 200,000 people would sign up quickly. It would be paid for by the federal government in the same manner as Medicaid expansion, 100% for 3 years and then gradually reducing to 90%. Instead of enrolling people into Medicaid it would assist them in buying health insurance through the free market from already existing health insurance companies. This plan would also create close to 30,000 new jobs and billions in economic development. It too would generate net savings of $1.1 billion. Those funds would be used to help innovate health care to drive costs down for all of us. We have included a “kill switch” that would end the program if the federal government cut funding and would use a portion of the money saved to transition people out of the program. We have also included a requirement that unemployed people actively search for employment and that people pay up to 5% of their salaries towards the purchase of this health insurance. Both plans would alleviate the problem our hospitals are facing if we do not do something. Hospitals, by law, have to provide health care to anyone who shows up in need. This is done at great expense because providing health care in emergency rooms, instead of by going to a doctor long before it becomes an emergency, is quite expensive. Hospitals pass along those costs to all of us who have health insurance, driving up the costs and our premiums. Hospitals also receive millions of dollars in payments from the federal government and our Commonwealth to help cover part of the cost of providing those services. We are already paying for health care for the poor and working poor. We just do it in a way that is more expensive and less effective. This is why the federal government is changing how to pay for care of these folks and will no longer fund it in a way that doesn’t work. Isn’t that what we want from our government? Medicaid or Marketplace Virginia is less expensive and more efficient. If we do not innovate, many of our hospitals will close. Most of the objections I received by e-mail to expanding Medicaid center around the idea that the federal government will one day stop funding the program (we already receive $23 billion from the federal government for our two year budget, and, while the number does change, they have consistently maintained funding commitments for decades and we’ve included the “kill switch” in the Senate plan), they say Medicaid expansion is socialism (we are already paying for the health care of these folks inefficiently and the Senate plan for Medicaid uses the private sector for a managed care approach, that requires individuals to pay up to 5% of their income towards their insurance), and lastly they just do not like the President (even if you don’t like the President that’s not a good enough reason to dislike a sensible policy). When I explain all of the details of the two plans, they seem to think it is a good idea and that it would be of great economic benefit to the Commonwealth. They had no idea that the Commonwealth and federal government are paying for indigent hospital care in such an inefficient manner. They were unaware that it was going to cause hospitals to close if they did not get reimbursed for indigent care and there was no Medicaid funding to replace this government subsidy. But, they are still against it. The facts don’t seem to matter. The benefits of the program don’t seem to matter. They have been told that Obamacare is bad and that this is Obamacare, so it must be bad. They don’t know how, but it has to be. Closely held beliefs are tough to change. It is difficult to negotiate with the House of Delegates because they have no competing idea. They just say no. 27 states have taken action to accept Medicaid expansion, and Virginia is in the process of turning down more than $1.8 billion a year. Why would the House of Delegates do this? There is some concern that our nation’s debt is problematic, and I agree that we need to keep it under control. However, today our deficit is under better control and our nation is solvent with the capacity to pay for this moral imperative. It is estimated that up to 1000 Virginians die annually because of delayed care and arrival at emergency rooms too late. Medicaid expansion has the potential to save those lives and to create jobs and economic development that will improve our economy and help drive down the deficit. How can someone be against something with so many benefits and such a small downside? The answer is simple, any Republican who votes for anything perceived as Obamacare will receive a Tea Party primary challenger and fears losing his or her seat in the legislature. In a Senate district of 200,000 people, 3,000 conservative activists can send one of them home without so much as a “thanks for your service” card. I have spoken with several of my Republican colleagues who know Medicaid expansion is probably the right thing to do, but that they cannot even consider it. Members of the House have been reduced to sophomoric beard growing contests and pinning notes on the Senate door when we are not in session to deal with the embarrassment of doing something they know to be wrong. Health care reform is a complicated process. It has been doubly so in America because only one side of the political spectrum is in search of a solution. Politics make it impossible for my colleagues on the other side of the aisle to even try. We return to Richmond on April 7th to once again consider a budget that we mostly agree on with the exception of the issue of Medicaid. The two are intertwined and have huge budget implications that make it difficult to separate the two, regardless of the rhetoric you hear from the other side of this issue. Virginia is a wonderful state and we have a tradition of effective and efficient government. We also have a history of getting the big social issues wrong (our Senators voted against social security in 1936, school de-segregation, the Civil Right’s Act, inter-racial marriage and marriage equality, and now Medicaid expansion). These were and are serious issues; solutions to these problems have made us the great country we are. Medicaid expansion is another moment of truth for our Commonwealth. It is a serous policy with life and death consequences. There are legitimate concerns with the Affordable Care Act, Medicaid expansion, and the national debt. We need a serious discussion and solution to these vexing problems. It is disheartening that there is no one to debate, negotiate with, or compromise. Our House of Delegates has already checked out of the debate. I hope that changes when we go back to Richmond on Monday. Sincerely, Dave Senator Dave Marsden
Posted on: Sat, 05 Apr 2014 17:52:51 +0000
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