Covering the poor while growing the economy
Date published: 1/30/2013
By Dr. Christopher Lillis and Jill Hanken
GIVEN a roomful of people, most people can’t tell by looking which ones don’t have health insurance. But the emergency-room doctor knows who they are. They’re the patients who show up when they’re too sick to ignore their medical problem any longer. When they leave with their prescriptions, they probably won’t fill them, because they can’t afford to.
The legal-aid attorney knows them, too. They are low-wage workers or people who lost their insurance when they lost their jobs. They broke a leg, or developed cancer, or went into heart failure that required hospitalization. Now, they’re seeking relief from constant calls trying to collect on impossibly high bills for the care that saved their lives.
More than 1 million Virginians are uninsured—one in eight citizens of the commonwealth. Virginia now has a chance to bring 400,000 of them into the Medicaid program. The federal government will foot the bill for those newly eligible, at 100 percent for the first three years and no less than 90 percent after that
Who would benefit? All of us.
People whose annual income is within 138 percent of the federal poverty line—about $15,400 per year for an individual and $32,000 for a family of four—would be covered. They would have access to care that most take for granted: yearly check-ups, prescriptions, cancer screenings, and medical intervention at an early, treatable stage.
Regular primary care with an emphasis on prevention and healthy lifestyles will help them be more productive employees and more effective parents, at a lower overall cost.
The rest of us would benefit, too. After all, we are already paying for the care of the uninsured. Our premiums are higher because we subsidize what the uninsured cannot pay. Our federal, state, and local taxes also support indigent care.
By extending Medicaid, we would ensure that Virginians’ federal tax dollars would come back to help Virginia’s low-income workers and families, instead of paying for expansions in other states.
ECONOMY WOULD BENEFIT
Virginia’s economy will benefit, too. After comprehensive study, Virginia’s Medicaid agency concluded that over a 10-year period, the commonwealth would receive more than $20 billion in federal funding, while spending less than $150 million for the state’s portion of the expansion.
When the costs, savings and economic impacts are fully evaluated, several studies show that that the expansion is a major benefit to Virginia that pays for itself.
Projected outcomes such as these have drawn a diverse array of supporters. The 3,361-member Virginia Chapter of the American College of Physicians—made up of internal medicine physicians and medical students—endorses the expansion.
“Extending Medicaid coverage to Virginia’s low-income uninsured will improve health status and quality of life,” the chapter concluded in its recent “Report from Virginia’s Internal Medicine Physician Specialists: How Will the Medicaid Expansion Benefit Virginia?”
Without the expansion, “[W]e will be leaving our poorest residents with no other way to get coverage—resulting in poorer health outcomes for them, more uncompensated care for hospitals and physicians to take care of , more cost-shifting for the rest of us, and ultimately, higher cost to the Commonwealth,” the internists concluded.
COVERAGE FOR ALL
On Jan. 16, Healthcare for All Virginians, a 50-plus-member coalition of consumer groups, hospitals and other health-care providers, held a press conference to call attention to the Medicaid expansion opportunity.
There, Wayne Hamlett, 61, told his story. He was laid off in 2008 after more than three decades working in the auto-parts business. While he was job hunting, he went to the Fan Free Clinic in Richmond for insulin for his diabetes—a lucky break, because free clinics are often not able to meet the demand for their services. Hamlett eventually found a job with health insurance, but dropped the coverage when the premiums reached an unaffordable $460 a month. Then he needed heart surgery.
Again, he was fortunate—the Bon Secours Health System treated him through its charity program. But his employer reduced him to 22 hours a week, so now he’s back at the Fan Free Clinic for insulin and other medications.
“The people who want to work, who’re willing to work, who love to work—if the government could do something to help them out with health care and insurance, that would be awesome,” Hamlett said.
For the sake of Hamlett and hundreds of thousands of others, the General Assembly should accept the federal offer, expand Medicaid, and extend health coverage to Virginia’s low-income uninsured. The expansion is compassionate, good stewardship of tax money and good business sense.
Dr. Christopher Lillis is an internal medicine specialist who practices in Fredericksburg. Jill Hanken is the health-law attorney for the Virginia Poverty Law Center, which advocates for low-income Virginians.