Virginia’s hospitals are required to treat anyone who comes to their emergency rooms, and they’re spending about $600 million a year on charity care. Meanwhile, state lawmakers refuse to expand Medicaid, and the federal government is cutting payments for Medicare. Unless something is done, some hospitals say they may be forced to close.
Patricia Springer owns a small business – Moonbeam Massage. She’s happy to help people who’ve suffered an injury or illness, but since the great recession began, business has been slow.
“It’s been dropping off ever since 2008 really. I used to work at a spa in Fredericksburg, and just every year a couple thousand less per year.”
Springer doesn’t have health insurance, so when she heard about the Affordable Care Act, she was excited. But it turned out she made too little money to buy a policy through Healthcare.gov. The new law assumed people like Pat would go into the Medicaid program, and Washington promised to pay the full cost to expand, but Republican lawmakers like Virginia’s Delegate Rob Bell refused to go along. Eventually, he says, the state will be paying 10% of the cost for new Medicaid patients, and if we don’t have the money, it’d be hard to deny people benefits.
“There are those who would say, ‘Let’s take the money now and reform as we go. I’m not trying to be skeptical, but these are very hard choices if you want to reform Medicaid growth. And they’re choices nobody wants to make, and I think it will not be easier but would be harder as the program grows.”
Senator Creigh Deeds, a Democrat, disagrees. He points to an estimated 400,000 people who could qualify and notes many of them need mental health care, which is also covered by Medicaid.
“77,000 people of 400,000 have serious mental illnesses. I can tell you first-hand what happens when people aren’t treated. Under federal law, for the first three years – we’ve missed the first year, so the next two years we’d get 100% of funding from the federal government. After that, federal funding will not reach below 90% of the cost of the program expansion. If it does, the program would shut down. Now some people might say that would be heartless to give these people some insurance and then take it away, but to that I respond at least we could give it to them for a few years. Then we can deal with any federal cuts that might come.”
He’s got a powerful ally in the state’s hospitals. They were counting on increased Medicaid money to offset lower payments for their Medicare patients – people over 65. Tom Riley is CFO of Augusta Health – a 255-bed community hospital in Fishersville.
“The American Hospital Association – all the hospitals agreed that we would forego some increases over a number of years, and so we were willing to do that anticipating that the Medicaid programs in the states would be expanded.”
At the Virginia Hospital Association, Chris Bailey says our system is penny wise but pound foolish – that we could actually save money by providing relatively low cost preventive care for everyone.
“When people cannot pay for the care they need, they defer care, often end up sicker and unfortunately requiring emergency treatment in our emergency rooms, and that’s often at the later stages of a disease when care is more expensive. State lawmakers generally have been looking in the rearview mirror + and historically Virginia healthcare systems have been relatively stable, but what Virginia legislators are not fully aware of is the future picture as these federal cuts come rolling down the pike.”
In our next report, we’ll look at the role healthcare plays in Virginia’s economy, what failure to expand Medicaid might mean for whole communities and how some lawmakers hope to sell Republicans on expansion.
