Vir­ginia can’t af­ford not to em­brace Obama care

The Washington Post Sunday - - METRO - Robert Mccart­ney

Hav­ing failed to stop Obama care in the Supreme Court or the pres­i­den­tial elec­tion, con­ser­va­tives still might sab­o­tage at least part of it in such GOP-con­trolled states as Vir­ginia.

Gov. Bob McDon­nell and some fel­low Repub­li­cans in the leg­is­la­ture are con­sid­er­ing block­ing one of the pro­gram’s key re­forms: ex­tend­ing Med­i­caid, the fed­eral health in­surance pro­gram for the work­ing poor.

That would be a costly mis­take, for two rea­sons. First, it would mean a missed op­por­tu­nity to help hun­dreds of thou­sands of Vir­gini­ans strug­gling to make ends meet.

The po­ten­tial re­cip­i­ents aren’t dead­beats, as op­po­nents of the health law of­ten make them out to be. More than two-thirds are in house­holds where some­one works but does not earn enough to af­ford pri­vate health in­surance.

One is Jesse Carr, 58, of Lees­burg. The former Navy Se­abee earns $11 an hour as a home health-care worker. He gave up health in­surance six years ago be­cause it was too ex­pen­sive. That means he can’t get a colonoscopy or dental work he knows he needs.

“If you’ve got a job with in­surance, you’re lucky,” Carr said. “A lot of peo­ple don’t have it. Any­body who waits on you at a restau­rant prob­a­bly doesn’t have it.”

Vir­ginia Repub­li­cans said ini­tially that help­ing peo­ple like Carr is a lux­ury the state can’t af­ford.

But it turns out that judg­ment was based on faulty arith­metic. That’s the sec­ond rea­son Med­i­caid should be ex­tended.

Be­cause of how Obama care is struc­tured, states give up bil­lions of dol­lars in fed­eral grants if they keep Med­i­caid un­changed. Repub­li­can gov­er­nors have sheep­ishly con­ceded that point with dra­matic turn­arounds to ac­cept the ex­pan­sion in Ohio, Ari­zona and else­where.

The same logic holds for Vir­ginia. In the first five years of the Af­ford­able Care Act, ac­cord­ing to an anal­y­sis by the Vir­ginia Hospi­tal and Health­care As­so­ci­a­tion, the Old Do­min­ion would forgo re­ceiv­ing $9.9 bil­lion for Med­i­caid pay­ments to Vir­ginia ci­ti­zens if it re­fused to ex­pand the pro­gram.

More­over, re­gard­less of what the state does, Vir­gini­ans will pay $10.2 bil­lion in ex­tra taxes be­cause of Obama care.

Which would you rather do? Pay more than $10 bil­lion in taxes and get none of it back for ben­e­fits? Or get back nearly all of it if you’re will­ing to swal­low your pride and set aside your re­flex­ive anti-government ide­ol­ogy?

In ad­di­tion, look­ing just at the state bud­get over the five years, ex­pand­ing Med­i­caid would yield a net ben­e­fit for Vir­ginia of $317 mil­lion.

In light of those num­bers, McDon­nell and some other Vir­ginia Repub­li­cans have started hedg­ing their bets as the moment of de­ci­sion ap­proaches in the cur­rent Gen­eral As­sem­bly ses­sion.

Many in the GOP are now say­ing they might ex­tend Med­i­caid af­ter all, pro­vided the move is ac­com­pa­nied by re­forms to curb the cost of the pro­gram. (They also want an op­tion to pull back if the fed­eral government scales back its promised pay­ments.)

I’m all for such re­forms, in prin­ci­ple. They would help ful­fill one of Obama care’s over­looked goals of rein­ing in health-care costs. Wor­thy changes would in­clude re­duc­ing un­needed emer­gency room vis­its and med­i­cal tests.

In prac­tice, though, there’s a fair chance that Vir­ginia Repub­li­cans will use the need for cost-cut­ting as an ex­cuse to pre­vent Med­i­caid from ex­pand­ing at all.

If they did so, it would be largely be­cause they can’t get past the mis­taken idea that the peo­ple who’d ben­e­fit don’t de­serve the help.

“There seems to be a mis­im­pres­sion about who th­ese folks are. They are hard­work­ing peo­ple who’ve done ev­ery­thing right . . . but the price [of health in­surance] kept go­ing up and up, or all of a sud­den their em­ployer dropped it,” said Deb­o­rah Oswalt, ex­ec­u­tive di­rec­tor of the Vir­ginia Health Care Foun­da­tion.

Con­sider Vel­lon Har­ris, 48, of Ar­ling­ton. Like Carr, she’s a home health worker who cares for mostly el­derly pa­tients. Her wages, $11.46 an hour, are cov­ered by Med­i­caid. But she earns too much to be el­i­gi­ble for that pro­gram and can’t af­ford pri­vate in­surance her­self.

Har­ris can’t af­ford doc­tor’s vis­its and re­lies on the emer­gency room when nec­es­sary, such as when she needed surgery to re­move gall­stones a year ago. When she got sick with flu­like symp­toms in late Novem­ber, she suf­fered through it.

“No money, no any­thing. I was tired, sweat­ing, aching. I couldn’t get up, couldn’t eat,” Har­ris said. “I lay there. I couldn’t do any­thing but pray.”

For the sake of bud­get sense and com­mon de­cency, Vir­ginia shouldn’t turn down bil­lions of dol­lars to im­prove life for Har­ris and oth­ers like her.

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