By Carten Cordell and Kathryn Watson │ Watchdog.org, Virginia Bureau
ALEXANDRIA — Beyond this year’s state elections, the hot debate to watch in Virginia is whether it will expand its Medicaid eligibility rolls as part of the Affordable Care Act.
Twenty-six states have signed on to open Medicaid eligibility to more residents, but Virginia’s decision rests on the recommendation of the Medicaid Innovation and Reform Commission, a 10-member bipartisan panel exploring the feasibility of expansion.
With billions in federal funding and additional state budget costs on the line, here are four issues the commission must weigh:
1. The federal budget: The federal government is offering billions to states expanding Medicaid. The Affordable Care Act provides for the federal government to pay the complete cost of the expansion until 2016, and 90 percent of the cost thereafter.
What’s troubling some lawmakers is the cost to the state budget. The current plan, they say, doesn’t account for possible budget cuts or adjustments to federal funding levels, which would leave Virginia to cover the cost of a possible 400,000 more Medicaid beneficiaries.
Delegate Johnny Joannou, D-Portsmouth, asked about those concerns in a MIRC meeting Monday.
“What happens if we’re in a federal financial crisis in Washington,” Joannou said, pointing out that Washington has failed to pass a budget on time in years.
Vernon Smith, a Medicaid expert from Health Management Associates said, “The short answer is if that were to happen, then the state would be on the hook. The longer answer is that something like that has never happened.”
2. Doctor shortage: If Virginia does take on the expansion it will provide the residents with more options to become insured, including the 400,000 then eligible for Medicaid coverage.
But MIRC is also weighing whether there will be enough doctors to provide care. Medicaid payments to doctors are often a slow process with lots of red tape, leading many to refuse it as payment.
“We think it’s a foolish idea to expand Medicaid when there are problems with the existing system,” said Bob Williams, president of State Budget Solutions. “… Where are you going to find the doctors to take care of these patients?”
Health Affairs estimated, in a July 9 report, that more than 33 percent of primary care physicians nationwide would not accept new Medicaid patients. Virginia’s numbers were in line with the national average, but other experts point out the state has good Medicaid compensation rates for doctors and other avenues of care were still available.
3. Proposed reforms and alternatives to Medicaid: Tea party leaders and conservative members of the House of Delegates have considered drastic changes to the program.
One idea is a block grant, in which Virginia would get a designated amount of money from the feds to distribute as it sees fit. There’s a flexibility factor there.
Some, like Larry Nordvig, executive director of the Richmond Tea Party, suggest doing away with Medicaid entirely and going to a more privatized system.
“The free market will work out, like it always does,” Nordvig said.
Delegate James Massie, a Republican member of MIRC, said there’s never been a better chance to do something drastic.
“Given how badly the Obama people want us to expand, I think we’ve never had a better opportunity to do those kind of things,” Massie told Watchdog.org. “Never waste a crisis.”
4. Public input: If all goes as planned, Virginians will have a chance to weigh in on the debate.
Sen. Emmett Hanger, MIRC chairman, said the commission will open a session purely for public input sometime in late September or early October. Hanger said the commission will set up an online portal for public comments, which should be up and running by the beginning of September.
We’ll see if Virginians are taken seriously.