david kerr H&S

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There were lots of disappointments, but with persistence and endless lobbying, the Virginia General Assembly did something amazing last year.  With almost unanimous Democratic support (Democrats had been pushing this change for years) and a strong Republican crossover Virginia finally signed up to the expanded Medicaid provision of the Affordable Care Act.  This was monumental for the commonwealth. The Affordable Care Act has a provision that allows states to expand their Medicaid programs, with the federal government footing 90% of the bill. Its purpose is to expand healthcare to the nation’s working poor.  

Now, just to backtrack.  Medicaid and Medicare are easily confused.   Medicare provides healthcare for people age 64 and above.  Medicaid is a state managed, state and federally supported program, that provides medical care to the indigent.  However, to qualify for Medicaid a person needs to be below the poverty level. A determination based on income and family size.  Ah, but there is always a Catch-22. Many people in Virginia weren’t prosperous enough to pay for Obamacare insurance and at the same time weren’t poor enough to qualify for Medicaid.  So, they had no coverage at all.

Most of these people are what demographers call the working poor.  Folks who generally make at or near the minimum wage, many are single heads of households, many are self-employed, while others work for companies that can’t afford to participate in insurance programs.   You see them all the time. But, since they don’t carry a sign that says, “working poor can’t afford Obamacare and make too much for Medicaid,” we usually don’t know who they are.

It was a sad state of affairs.  The estimated size of this population was 400,000.  The exact number was a little sketchy, but it was a significant part of the workforce and the population.  Sadly, in the all anti-Obamacare rhetoric their plight, that of decent hard-working Virginians, went by the wayside.

That is, until the rules on Medicaid access changed and they were allowed to enroll.  Many have railed on about the cost. However, Gov. Ralph Northam, a doctor, has repeatedly noted that, while there was a cost to include them in Medicaid, there is an even bigger cost to exclude them.  This part of the population wasn’t getting the kind of preventative care most of us are used to — things like cancer screenings, blood pressure screenings, COPD screenings, as well as advice on diet and healthy behavior. Preventative care does cost money, but the cost of treating strokes, heart attacks, emphysema and cancer is far more expensive.  

Last month we got some of the first numbers on Medicaid sign ups and it was terrifically encouraging.  Virginia is on its way to having a healthier population. Some 300,000 people signed up for Medicaid coverage.  Roughly 60% were women and 40% were men. Locally, in Stafford, 3,838 people signed up for the expanded Medicaid Coverage, while in Prince William, 11,500 people joined the program.  In Fairfax there were over 20,000 new Medicaid participants.

Just what does this mean?  I think an example is the best illustration.  Years ago, I remember talking to a local doctor who volunteered at a local free clinic.  Remarkable man. Far more interested in medicine than his bottom line and the stories he told could be disturbing.  He had one patient with hypertension, usually a very treatable condition, who couldn’t afford his medication or regular monitoring.  So, the patient, a tree trimmer by profession, opted to take half the dose he was prescribed. According to my doctor friend, this lower dose completely negated the benefit of the drug.  Indeed, when he came to the clinic he was showing symptoms of severe hypertension. A stroke seemed to be only a matter of time. Fortunately, they worked out a treatment protocol to address his high blood pressure.  But it took a charity program and a long wait to do that. Had he had Medicaid, the patient would have had his medication immediately and been regularly monitored.

According to the state data at least 33,000, roughly 10% of those under the new Medicaid program, have hypertension.  Keeping this condition managed and under control saves the state, which ends up picking up the bill — a fortune in medical costs —  once these people become seriously ill.

Sadly, though Virginia Speaker of the House Kirk Cox, a Republican, joined in the campaign for expanded coverage, many in the Virginia GOP still vehemently oppose the change.  Stafford’s, Del. Bob Thomas, R-28th, voted for increasing the scope of Medicaid eligibility. He was vilified for this vote during the Republican Primary and ended up losing the party’s nomination.  

For many voting to expanding Medicaid coverage in Virginia was an act of political courage.  All who voted “aye” on this bill deserve a “well done.” As the numbers indicate, we’re all the better and healthier for it. 

David Kerr, a former member of the Stafford School Board, is an instructor in political science at VCU. He can be reached at staffordnews@insidenova.com.  

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