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Healthcare in Virginia?

By JAMES PEELE

Special to The SWT

What is the prognosis for healthcare in Virginia post election? As Attorney General, Ken Cuccinelli was the first AG to file suit against the Affordable Care Act (ACA) so Virginians had a good idea of that diagnosis had he been elected Governor. Where does healthcare stand now that Terry McAuliffe is Governor-elect? What do we know about the ACA since the Oct. 1 launch date and how will it affect Virginians?

Virginia was one of 27 states not to set up a state run exchange, instead deferring to the federal government exchange, Healthcare.gov. Of the remaining states, 17 and D.C. have implemented state insurance exchanges; the remainders have hybrid variations of the exchange although no specific state run exchange. The current debacle with the healthcare.gov website pales in comparison to the number of individuals who have lost their health coverage since Oct. 1due to the new requirements of the ACA. To date, close to 5 million individuals across the U.S. have lost their individual policies and just over 100,000 have signed up for insurance under the ACA, and this number includes those who didn’t actually purchase the coverage, just signed on and put a plan in the online shopping cart.

Virginia was also one of the states that decided not to expand the Medicaid feature of the ACA. After the Supreme Court ruling that allowed states to opt out of this requirement, Virginia elected to do so. There is an estimated 400,000 individuals in Virginia who would be eligible for this coverage due to the relaxed eligibility guidelines and some in Virginia say it is a moral imperative to extend this coverage and vilify those who “deny” healthcare coverage to the impoverished. No one is denied healthcare, especially in an emergency, as federal law requires emergency rooms to treat everyone, regardless of whether they have insurance or the ability to pay for the services rendered. Who bears the cost of this treatment is of course, you, the taxpayer. This is one of the central arguments in support of the ACA and proponents point out that the federal government will reimburse the state for the additional expenses of expanded Medicaid under the ACA, an estimated $10 billion a year. The argument fails when one examines it a bit closer; the federal government only reimburses the state for two years. Who is responsible for the expense after that, you, the taxpayer? Virginia, like most states, is required to balance its budget. How does one incur an additional $10 billion in expenses without raising taxes? What could be cut from the existing budget to free $10 billion to fund Medicaid? The same pundits accusing the current state administration of hurting the poor and denying them adequate housing, healthcare, food assistance, and welfare benefits will decry any cut in any plan regardless of the additional burdens on state government and the taxpayer.

Terry McAuliffe has stated his support of the ACA, expanded Medicaid, and has already discussed methods of implementing these plans in Virginia. The difficulty will be in getting around the House of Delegates that maintained its current Republican dominance, nearly 2 to 1, and with the loss of two Democrats in the Senate, there is a possibility of picking up one of those on the Republican side, neutering the tie-breaking vote of Lt. Governor Elect Ralph Northam. Even though Democrats gained two of the statewide races, and possibly the AG as well, not much change is expected in Virginia in regards to the implementation of the ACA. The real fear is the unexpected cancellations of individual healthcare policies in Virginia and the higher costs of insurance under the ACA. Tammie Smith writes in the Richmond Times Dispatch (http://www.dailyprogress.com/news/local/health-policy-cancellations-hit-virginia/article_f21b81b8-4993-11e3-93ef-001a4bcf6878.html) that individual policies are “about 10 percent to 12 percent of the health insurance market in Virginia.” Many of these will be affected by the ACA, and that may result in 500,000 individuals subject to cancellation encountering higher rates under the ACA, a severe blow to already stretched family budgets.

The recent partial shutdown of the federal government should give pause to Virginia’s Democrat Senators and three Democrat Representatives. The Republicans consistently have voted to delay the ACA mandates and signups by a year for individuals as President Obama did unilaterally, if not legally, for businesses. Rather than contemplate the possible problems with the ACA, the Democrats refused to debate this Republican offer resulting in the partial shutdown, a stance that many Democrats may look back on and regret, especially if the Republicans can use that to gain some federal seats in the Senate or House. It is reminiscent of the actual passage of the ACA, when no one read the bill, there was no debate on the bill, a bill written solely by Democrats, and voted on in the dead of Christmas Eve and passed with the trick of Reconciliation, only needing 51 votes to pass the Senate. Not one Republican in the Senate or House voted for the ACA, a bill that can best be described with the infamous quote by House Minority Leader Nancy Pelosi, “You have to pass the bill so you can find out what is in it.” An apt description even if it was not meant to be.

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