A NEW STAN­DARD FOR HEALTH CARE

Daily Press (Sunday) - - Opinion -

Med­i­caid ex­pan­sion is here, but that doesn’t

mean leg­is­la­tors can rest on their lau­rels

The com­mon­wealth placed a larger blan­ket of Med­i­caid cov­er­age over the shoul­ders of Vir­ginia’s poor­est res­i­dents on Jan. 1.

That pro­tec­tion is ex­pected to ease the bur­dens of pay­ing for med­i­cal cov­er­age for nearly 400,000 ad­di­tional peo­ple dur­ing the next two years. And the ex­panded ser­vice will be sup­ported by avail­able fed­eral funds, spread­ing the bur­den of pay­ing for it across the na­tion, rather than just this com­mon­wealth.

The newly in­sured will be en­rolled with pri­vate in­sur­ance companies called man­aged care or­ga­ni­za­tions, which have been cov­er­ing Med­i­caid pa­tients in Vir­ginia for decades.

A sig­nif­i­cant num­ber of ben­e­fits will come from the Gen­eral Assem­bly’s vote — and Gov. Ralph Northam’s lob­by­ing — to ex­pand Med­i­caid, al­though there are still some ar­eas of con­cern.

In the com­ing months, leg­is­la­tors should be pre­pared for the cas­cad­ing reper­cus­sions that can ac­com­pany grav­i­ta­tional shift that may af­fect free clinics (as well as other health care providers), pa­tients and busi­nesses that pro­vide pri­vate cov­er­age.

Ex­panded Med­i­caid cov­er­age now in­cludes Vir­gini­ans earn­ing up to138 per­cent of the fed­eral poverty level — which comes to about $16,700 an­nu­ally for a sin­gle adult and $28,670 for a fam­ily of three.

An­other tier of vul­ner­a­ble Vir­gini­ans ex­ists though, in­clud­ing about 300,000 res­i­dents who earn be­tween $16,700 and $24,000 a year and still can­not af­ford Oba­macare, ei­ther. Many of these peo­ple are con­sid­ered the “work­ing poor” and must de­cide whether to spend their pay­checks on food, util­i­ties or other ne­ces­si­ties. Of­ten times, they work sev­eral part-time jobs, none of which of­fer med­i­cal cov­er­age.

Tra­di­tion­ally, dozens of free clinics across Vir­ginia have served poorer pop­u­la­tions. Those clinics, how­ever, are now fac­ing con­straints be­cause Med­i­caid ser­vice re­quires oner­ous amounts of pa­per­work that clinic op­er­a­tions are not set up to han­dle. So each clinic must de­cide whether to ac­cept Med­i­caid and the com­pli­ca­tions that come with it or re­fer those new Med­i­caid pa­tients to an­other med­i­cal ser­vice else­where.

The state could help al­le­vi­ate these is­sues by cre­at­ing li­aisons for the clinics to help with the grow­ing mound of Med­i­caid pa­per­work.

The state must also en­sure el­i­gi­ble res­i­dents take ad­van­tage of the Med­i­caid and that the ser­vice is de­liv­ered ef­fi­ciently and ef­fec­tively. Res­i­dents who fall through the cracks must be guided to the best pos­si­ble med­i­cal provider, rather than be­ing turned away at free clinics or sur­prised by over­whelm­ing med­i­cal bills at tra­di­tional hos­pi­tals.

In the fi­nal week of De­cem­ber, more than 200,000 peo­ple had al­ready en­rolled. The Depart­ment of Med­i­cal As­sis­tance Ser­vices ex­pects to have 360,000 peo­ple en­rolled by the end of 2019 and 375,000 en­rolled by mid-2020.

Of­fi­cials have said the faster pace of en­roll­ments would in­crease the state’s share of the cost to ex­pand Med­i­caid by about $80 mil­lion over two years. Those costs would be paid for through taxes levied on hos­pi­tals.

Make no mis­take, Vir­ginia needs ex­panded health care cov­er­age.

Ail­ments that re­quire long-term care can be par­tic­u­larly costly. An av­er­age of 37,000 Vir­gini­ans are di­ag­nosed with di­a­betes each year, a con­di­tion that of­ten causes peo­ple who suf­fer from it to in­cur reg­u­lar doc­tor vis­its and treat­ments.

The scourge of opi­oid-re­lated deaths — in­clud­ing those in­volv­ing heroin and fen­tanyl — con­tin­ues to rise, and so do the health-re­lated prob­lems sur­round­ing the drugs.

The rates of Hep­ati­tis C cases re­ported for peo­ple ages18-30 con­tinue to in­crease. It has re­mained the top com­mu­ni­ca­ble dis­ease in Vir­ginia over the past decade and is eas­ily spread by shar­ing nee­dles or other equip­ment to in­ject drugs.

The in­creased rate of e-cig­a­rette use — es­pe­cially among young adults — will have neg­a­tive health con­se­quences on younger gen­er­a­tions of Vir­gini­ans. While the to­tal­ity of those out­comes is not yet known, the state’s health care sys­tem will ul­ti­mately have to treat the health prob­lems as­so­ci­ated with such be­hav­iors.

The ben­e­fits of the pro­gram man­i­fested in a bet­ter qual­ity of life will surely out­weigh the costs of pro­vid­ing the health care ser­vices.

Med­i­caid ex­pan­sion is new to Vir­ginia, but it is not new in this coun­try.

Our com­mon­wealth’s lead­ers would do well to learn from the mis­takes and suc­cesses of other states in their ef­forts to pro­vide fed­eral health care to their res­i­dents.

In do­ing so, the Gen­eral Assem­bly must rely on the best data avail­able to fore­cast op­er­at­ing costs, rev­enues and par­tic­i­pa­tion rates, culled from other states.

Med­i­caid has be­come a mine­field for many leg­is­la­tors. But the peo­ple served by it, and the taxpay­ers who ul­ti­mately foot the bill, must not be sur­prised by costs pre­vi­ously un­fore­seen be­cause of po­lit­i­cally in­flu­enced fore­casts.

Ex­panded Med­i­caid of­fer­ings that are de­liv­ered ef­fi­ciently and ef­fec­tively to Vir­gini­ans can ul­ti­mately be an as­set for this com­mon­wealth that at­tracts fam­i­lies to live here, im­proves the qual­ity of life for ex­ist­ing res­i­dents and makes ob­tain­ing med­i­cal cov­er­age eas­ier for those who need longterm care.

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