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Both sides speak out at Medicaid expansion hearing

RICHMOND—Opponents and proponents of Medicaid eligibility expansion packed a General Assembly committee room Tuesday for the only public hearing planned by the legislative panel that will decide whether Virginia expands the program.

Sen. Emmett Hanger, R–Augusta, chairman of the Medicaid Innovation and Reform Commission, said 178 people signed up to speak, and many more filled the committee room.

The commission was set up by the General Assembly last winter to review the state’s efforts to get federal permission for various reforms to the Medicaid program and decide whether, based on those reforms, Virginia should move forward with expanding Medicaid eligibility under the Affordable Care Act.

Last year’s U.S. Supreme Court ruling that upheld the ACA as constitutional also said that a key part of it, expansion of Medicaid to cover more people, was optional for states.

As of September, 24 states and the District of Columbia had expanded Medicaid, according to the Kaiser Family Foundation. Virginia is among the 26 states that up to now has not decided to expand the program to cover people with incomes up to 133 percent of the federal poverty level.

Supporters of the expansion argue that it would provide coverage and better health care access for up to 400,000 more Virginians. They say Virginia would receive federal tax dollars to help pay for the expansion that will otherwise go to other states, and that Virginia taxpayers might as well recoup some of their tax dollars.

“These numbers represent real people who need health care,” said Judy Hodges with National Patient Advocate Foundation in the Richmond area. “I don’t think the people opposing Medicaid expansion realize the cost of non-group health insurance.”

Opponents distrust the federal government’s promise to pay the bulk of the cost of the expansion, and say those federal dollars are still taxpayer dollars, thus costing everyone.

They say Medicaid is a bloated program that needs reforms before any expansion should be considered, and said the low government reimbursements for Medicaid patients already are driving some doctors not to accept patients using the program. Many of those who spoke Tuesday also opposed the idea of expanding an entitlement program.

Dave Schwartz, the Virginia director of Americans for Prosperity—a national group that has intensely worked against the expansion—said 1 in 4 doctors don’t accept Medicaid, and that expansion would do nothing to help people if they can’t see doctors.

“Everyone needs coverage. Coverage means nothing if you don’t have care,” Schwartz said. “I don’t know anybody that wants to be part of this program.”

Dr. Chris Lillis, a Fredericksburg doctor, is on the side of expansion and came to Richmond to say so to the commission members.

“This is an historic opportunity to eliminate the problem of the uninsured,” he said before the meeting began.

He said free clinics treat the “poorest of the poor” and that relying on such clinics is not a reliable, integrated way for people to get regular health care.

Virginia’s free clinic system serves about 80,000 people statewide, and some 75 percent of those could be eligible for Medicaid if the eligibility was expanded, said Linda Wilkinson, the CEO of the Virginia Association of Free and Charitable Clinics.

Some supporters of expansion said they would benefit from it.

Rosalie Rodriguez said both she and her husband work several jobs, but have no insurance coverage. Their children are covered under the FAMIS program, but monthly premiums for their family would cost her husband’s entire paycheck, she said.

“I fear there are so many people like us who need Obamacare,” Rodriguez said. “We fall between the cracks.”

Representatives of several health insurers in Virginia also lined up to urge the expansion, saying they have the resources to treat the newly eligible. Several said that the ACA cuts several payments to hospitals and that hospitals accepted those cuts under the assumption that more people would have coverage, which would lessen their costs of caring for people who have no insurance.

Some opponents said those health insurance providers have plenty of money, but that taxpayers do not.

Clarence Thompson, a pastor at Life Church in Mechanicsville, said the expansion would be a “huge financial burden” for the state.

“The poor should be helped. But it should be done in a responsible way that doesn’t overburden other people,” Thompson said.

Other opponents said the state government can’t afford to cover its share of the expansion once the federal contribution is cut back to 90 percent. Medicaid has been a major driver of increased state budgets, and some speakers said they fear if the state must pay even more for the program, it will have to take that money from other programs.

At least two teachers spoke to say they fear the costs of Medicaid expansion would drain further dollars from the public education system.

The commission will hold its next regular meeting next Monday in Richmond.

Chelyen Davis: 540/368-5028