Some thoughts on expanding Medicaid
http://www.fairfaxtimes.com/article/20140423/OPINION/140429391/1065/some-thoughts-on-expanding-medicaid&template=fairfaxTimes

There are two policy issues involved in whether Virginia should expand Medicaid: first, is whether the budget should be the vehicle through which a major new government entitlement program is determined; and second, whether expanding Medicaid is a sound policy overall.

Holding the budget hostage to this debate is serious business. Our elected officials need to decide whether this is the most responsible way to confront this issue, or whether funding schools, police, roads, etc should be approved and then a major debate held on whether to expand, or how to expand, this federal/state program.

Let’s look at some of the issues that a detailed policy debate could focus on if the General Assembly would decouple this Medicaid expansion issue from the state budget.

We are not faced with a health crisis. Those not covered under Medicaid today have access to hospitals and doctors. Emergency rooms are there and many doctors do “charity” work whenever possible. Let’s determine who actually isn’t covered with health care today, who really needs to be covered who are not, what reforms to the current system could be tried so that the many problems with the Medicaid program today aren’t merely increased with any expansion.

The hospitals seem to be faced with a financing headache and it is one that needs to be better understood. Why is that funding headache there in the first place? Federal government cutbacks in Medicare reimbursements? Structural problems within the hospital management system? Insurance rates due to our legal system? Bad business decisions within the hospitals themselves that have impacted the bottom line? Let’s have a full and open accounting so that all of us understand why the hospitals are so adamant to expand Medicaid which is program many doctors are not participating in because it doesn’t cover their costs.

Our Governor suggested a two year pilot program. Most pilot programs are “tests” to see if an idea works or not. Most don’t bring the whole shebang – all 400,000 new people in this case – into a test. Let’s consider some limited pilot programs that can be instituted and tried and see what works best here in Virginia. This requires a serious discussion with experts in the field who have knowledge of how reforms could be instituted here in Virginia. But reforms must be part of this discussion – reforms that are proven; reforms that can resolve the fraud problems within the current program; reforms that will help provide good health care; reforms to the Medicaid long term care system.

Some say expanding Medicaid will reduce emergency room visits thus saving a great deal of money. However, it is my understanding that in Oregon when Medicaid was expanded the emergency room visits increased substantially. Let’s find out why and make sure we don’t expand the Medicaid program here in Virginia thinking emergency room visits will decrease when that may well not happen.

We are told that the Senate program will save Virginia hundreds of millions of dollars. But a similar program in Arkansas – which the Virginia Senate seems to rely on – ended up not saving money. That program is already over budget. And as I understand it, the federal government changed the waivers that Arkansas wanted in this program. So what was proposed and what was allowed by the feds was not the same. Let’s find out the facts. Let’s bring in the folks from Arkansas and find out.

Florida has experimented on Medicaid reforms on the local level, doing it in a business-sort-of-way by focusing on limited numbers of people before anything is expanded statewide. How have those reform ideas worked? What kind of savings were found? What role does the federal government have in such reforms and the expansion of these reforms?

Indiana, under former Governor Mitch Daniels, reformed its health care and covered more people as I understand it. But that program is now in doubt because of the federal government may not continue its waivers that allowed this success to take place. Let’s find out what Indiana did. Maybe that is a better way to go than what is suggested by our State Senate. Why is the federal government creating problems with this program if it is successful?

We deserve a full and open discussion on this issue of reforming and possibly expanding Medicaid. It shouldn’t be something forced down our throats with the threat of closing the state government.

A serious discussion and policy debate on expanding Medicaid needs to be held. There is a system set up by the General Assembly last year to do this. Let’s continue that process. Let’s fund our schools, our police, our roads, our parks, etc and let’s tackle the Medicaid issue in a more responsible manner.


Michael Thompson is Chairman of the Springfield-based Thomas Jefferson Institute for Public Policy, a non-partisan, Virginia-focused foundation dealing with the issues of improving education, government reform, economic development and environmental stewardship.

"We are not faced with a health crisis. Those not covered under Medicaid today have access to hospitals and doctors. Emergency rooms are there and many doctors do “charity” work whenever possible."

Those days are largely past. Yes there are the rare instances where medical personnel provide volunteer services through periodic free clinics. That is not what we are talking about here. People who do not have health insurance today are not provided charity care. They are provided care that is mandated by law to patients regardless of ability to pay. It is the equivalent of you being told that you need to show up at work and put in an 8 or 10 hour day even if your employer is broke and cannot pay you. Doctors and hospitals try to recoup some of the costs through collections efforts, but most of the cost is past on to paying customers.

This is what is really in dispute: Are we going to try to keep down increasing costs of medical care for paying patients by shifting the cost of mandated health care plus additional necessary medical care to the government which mandates the care...or are we going to continue sticking it to paying patients and their insurance companies?

I do agree with Mr. Thompson on one point. The decision of whether to expand Medicaid should not be make as part of the budget process.

Theres nothing to discuss. People dont have health care. Its the law. Its time to cover them. Nothing is being shoved down anyones throat.

Its your own fault if your party cant seem to justify insuring the uninsured. Thatnis your own fault not anyone elses. Your party has decided to politicize this issue and bank on its failure not anyone else.

So take some responsibility and man up and actually run on making peoples lives better not trying to exploit the economic divisions and classes and races of people.

Those are some of my thoughts on Medicaid Expansion.

I see three doctors regularly. None of them accept Medicaid patients.

So, what is the point?

My thoughts on expanding Medicaid: DON'T DO IT LIBTARDS!!!!!

And one other thing. It must be nice to say people that are uninsured being able to see a potentially life saving doctor is being shoved down your throat, a person that probably already has health care. Must be nice to sit there and say that the basic right of health care for those less fortunate is something you should be able to decide if you're comfortable with or not.

God forbid one day for whatever reason you end up without healthcare. For some reason you might make a mistake and lose your job or all the money and investments you have. Will you still this way? Its easy taking a position against others having health care isnt?

The irony is some of these selfish self absorbed Republicans are Medicare recipients. Doing anything is shoving something down their throat. They'd rather we did nothing while everyone else works for their exclusive health care and social security costs until they die of course. A day that will never come.

These Republicans are desperate counter productive garbage and bad for the country and the state.

Bring back our federal tax dollars, insure our citizens, strengthen our hopitals, move Virginia forward stronger.

If Arizona and Kentucky and Ohio, Ohio has complete Republican control. If these states can looks past politics and see it within their states interests to expand medicaid I think we should be able to as well.

Our Gubernatorial election was based on this very issue. Ken Cuccinelli was one of the first people to sue to the Supreme Court over the Affordable Care Act. He lost there and he lost in this election as well.

How many times do Republicans have to lose in the Commonwealth with this issue central before they respect the will of the people.?

Its been done again and again. Politically speaking, you failed at the supreme court, you failed in the battle of public opinion, and you're failing to insure the uninsured. Those are three arguments you could make to pass medicaid expansion.

sheldon adelson said no. nuff said.

Hell yes we should expand it, and every other social welfare program. We can afford to do everything and fix every problem in the universe. Why do we even bother arguing anymore? Whatever we can't afford now we can just pay for it later. Or not. Who cares? Let's just fix it all now and then no one will ever be in need ever again.