McDonnell: No Medicaid expansion

Posted: November 9, 2012

The Winchester Star

WINCHESTER — With President Barack Obama’s re-election Tuesday, it’s clear that the Affordable Care Act will not be repealed and nearly all remaining provisions will go into effect. But state officials still have a big say in how the law is carried out.

On Wednesday, Virginia Gov. Bob McDonnell cited costs as the reason behind his decision to default to a federally run health insurance exchange as opposed to establishing a state-based one in Virginia. He also said he will not expand the state’s Medicaid program — a key component of the health care act’s goal of insuring most Americans.

States face a Nov. 16 deadline to decide whether to set up their own exchange for people to shop for private health insurance policies, which would allow them more control.

“I don’t want to buy a pig in a poke for the taxpayers of Virginia,” he said in a story published Thursday in the Richmond Times-Dispatch.

According to the Commonwealth Institute, a Richmond-based fiscal policy group, McDonnell’s decision on Medicaid — which provides care for the elderly, blind, disabled and poor families — may mean that up to 526,000 Virginians won’t gain health insurance.

His stance is frustrating health-care providers and advocates for the uninsured.

“I hope he’ll reconsider,” said Mark Merrill, president and CEO of Valley Health, which operates Winchester Medical Center and five other hospitals in the region.

Merrill said the decision not to expand Medicaid throws a wrench in Valley Health plans.

Not only does the health care provider lose about $50 million annually by treating uninsured individuals, but hospitals nationwide agreed to cuts in funding they receive from the federal government to help pay for Medicare in order to help insure more people with Medicaid.

But now health care providers could take a double hit, losing out on some of that previous funding and not seeing a big jump in the number of insured individuals, Merrill said.

Merrill added that the state is missing “a big opportunity to deal with the chronic problem of the uninsured.”

There are about 12,309 uninsured individuals between the ages of 18 and 65 in the City of Winchester and Frederick and Clarke counties, according to County Health Rankings & Roadmaps, a project by the University of Wisconsin Population Health Institute.

Those earning up to 138 percent of the federal poverty level — an income of $31,000 for a family of four — would qualify for Medicaid if the program were expanded.

Virginia is currently one of the most restrictive states when it comes to the program, with only Colorado, Utah and Nevada spending less per capita.

Parents who earn roughly $7,000 a year or less are eligible to receive Medicaid in Virginia, but adults without children — unless they’re blind or disabled — don’t qualify at all, according to the Commonwealth Institute.

Currently, the state and the federal government split Virginia Medicaid costs, but under the new law the federal government would pick up 100 percent of the tab to burgeon the state’s system for the first three years.

Starting in 2017, Virginia would pick up a small portion of the cost, but would pay no more than 10 percent after 2020.

In June, the U.S. Supreme Court upheld the mandate of the Affordable Care Act that individuals either have insurance or pay a fine, but ruled that states can opt out of the expansion of Medicaid.

Subsequently, the Obama administration said that individuals will not be fined for not having insurance in states that turn down the expansion.

McDonnell, who will leave office in January of 2014, left open the possibility that Virginia could change course.

The General Assembly passed a law last year giving the governor control over the implementation of a state-based health insurance exchange — a marketplace to help consumers and small businesses pool their purchasing power and shop for coverage comparing prices, benefits and services.

McDonnell has not responded to recommendations made by his own advisory council a year ago on how to create the exchange, and he and House Speaker William Howell, R-Stafford, blocked legislative attempts this year to create a state exchange.

McDonnell joins six Republican governors in Texas, Florida, Mississippi, South Carolina, Louisiana and Georgia who have said they will not participate.

The Associated Press contributed to this report.

— Contact Conor Gallagher at