As Lawmakers Discuss Medicaid Expansion, Reforms Also on the Table

Feb 1, 2018

Republicans in Richmond have opened the door to negotiations on Medicaid expansion, and they say they want recipients to work. But work requirements aren’t the only reforms that could be part of an expansion deal.



Virginia Gov. Ralph Northam waves to the crowd as House Speaker Kirk Cox, R-Colonial Heights, top, applauds as he delivers his State of the Commonwealth address. Cox and Northam have begun a public negotiation on Medicaid expansion and reform.
Credit AP Photo / Steve Helber

While work requirements are his top priority, Republican Speaker of the House Kirk Cox says he’s open to other ideas.

“I think there are a lot of possibilities. Obviously healthcare savings account, which of course gave you a stake. A low premium, maybe 2-percent, things like copays,” Cox said in an interview with RADIOIQ this week.

Those reforms are all meant to increase personal responsibility.  Doctor Hal Sherz of the right-leaning Docs 4 Patient Care, says copayments and health savings accounts can encourage Medicaid recipients to be smarter consumers.

“And that means going to their primary care doctor for their care rather than utilizing high acuity sources like Emergency Rooms or Urgent Care centers,” says Scherz.

A study in the New England Journal of Medicine found that Emergency Room visits went up by 65-percent when Medicaid was expanded in other states. To help keep people out of the ER, some states give financial rewards to Medicaid recipients who get routine preventative care.


Related: Medicaid Expansion is on the Table, But Work Requirements Could be a Sticking Point

Those reforms are meant to provide better health outcomes and save the state money. Virginia spends, on average, upwards of 7,000 dollars per Medicaid recipient.

In Virginia, reforms like this are being championed by a Democrat. Delegate Mark Sickles is calling for Medicaid expansion -- but not without copays, wellness incentives, and some kind of work program.

And in a letter to Republicans this week, Governor Ralph Northam says he’s ready to discuss ways to make the program more efficient and effective.

But Republican Kirk Cox still sees another problem.

“Which no one wants to talk about if you expand,” Cox said. “There are over one third of doctors right now that don’t take Medicaid -- and that will only get worse.”

That’s because Medicaid pays doctors significantly less than regular insurance. In an interview last week, Governor Ralph Northam says he’d like to increase payments to providers.

“Look at ways that we can better incentive reimburse hospitals and providers to make sure that they’re willing to take care of Medicaid recipients,” Northam said.

But, Northam added, his top concern is expansion -- and providing healthcare to the more than 400,000 Virginians who remain uninsured.

 This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.