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McAuliffe promotes Medicaid expansion

The day before the General Assembly’s budget deadline, Gov. Terry McAuliffe sat down with a patient at Mary Washington Hospital’s Lloyd F. Moss Free Clinic to talk about how Medicaid expansion would remedy her chronic health care bills.

The patient, 45-year-old Rachelle Benson of Spotsylvania County, said, “I would be dead if this place wasn’t here.”

Benson suffers from diabetes and mental health issues, which are all treated through the clinic. She has also sought dental care there.

She was married for 20 years and never thought to seek health insurance during her divorce. Now, unemployed and with mounting health problems, she is one of the thousands in the Fredericksburg area who would be covered under the expansion.

McAuliffe visited the clinic—which provides free care to the poor in House Speaker Bill Howell’s backyard—as part of a healthcare tour aimed at supporting Medicaid expansion.

The expansion is the sticking point in the state’s budget, which House Republicans refuse to pass if included.

The standoff is between Senate Democrats and House Republicans over whether the state will accept Medicaid funds from the federal government. It has brought the passage of the two-year, $96 billion budget to a standstill.

Howell, whose district covers Fredericksburg and part of Stafford County, leads the Medicaid opponents, even though Mary Washington Healthcare, the largest medical provider in his district, can’t survive another decade as an independent hospital system without with expansion, according to its chief executive officer, Fred Rankin.

During the visit, McAuliffe told hospital officials and community members who gathered at the free clinic that Virginia can’t “sit back and wait” any longer.

“We are getting this done,” McAuliffe said. “And we’re not going home until we figure this out.”

The day before the visit, McAuliffe rejected a Republican-backed initiative to extend the legislative session 30 days.

Instead, the governor plans on calling a special session March 24 to work out the budget.

With McAuliffe during the visit was William Hazel, secretary for health and human services.

Hazel relayed to hospital staff and community members that 3,400 people are uninsured in Fredericksburg and 1,600 of those would be eligible for coverage under the expansion.

In Stafford 10,400 are uninsured and more than 3,000 of those would be eligible, he said.

“For us, the math is significant,” Rankin told McAuliffe. “For us, closing the coverage gap means $13 [million] to $14 million locally.”

For the past two years, MWHC has been operating at a loss.

In 2012, the hospital system spent $22 million over budget.

That annual loss was decreased to $8 million in 2013, and the 2014 budget for MWHC is set to be an even $600 million. The health care provider won’t make any money in 2014, but Rankin said he hopes it won’t lose any, either.

Without the expansion, Rankin said costs would have to be reduced 10 to 15 percent over time and programs like the clinic would have to be cut to sustain essential services.

Rankin said he has worked with Howell on health care issues for two decades and has never seen the speaker refuse to compromise like he is with Medicaid expansion.

“I’m surprised,” Rankin said. “It is not how he is normally. But I still believe there is a compromise.”

Howell sent out a press release Friday questioning McAuliffe’s motives for visiting the hospital.

“On the eve of Virginia’s budget deadline, Governor McAuliffe should be in Richmond working to help pass a clean budget bill,” the release said. “Instead, he continues to grandstand, campaigning for ObamaCare expansion with a hospital CEO that earned nearly $900,000 in compensation last year. Despite having over $185 million in assets and balances, according to the most recent publicly available data, this hospital and its executives are asking for a bailout.”

Even though MWHC has $185 million in reserve funds, its debt tops $200 million, Rankin said.

The $185 million would cover 140 days of operation for MWHC.

According to Rankin, MWHC cannot survive as an independent hospital system at its current trajectory without new sources of income, such as Medicaid expansion.

“Our position on ObamaCare is clear,” stated Howell in the release. “We believe reforms should come first and we are skeptical of Washington’s ability and willingness to pay its share of the cost.”

McAuliffe said the release from Howell and House Republicans’ unwillingness to talk were “unfair.”

“Folks, we don’t have time for the political games,” McAuliffe said. “People are dying [without access to health care]. This is life and death.”

McAuliffe also met Stafford Dr. Patrick Neustatter, the medical director of the clinic, during a tour of the facility.

Neustatter had seen five patients by 2 p.m. and would see seven more by the end of the day.

On average, a practitioner sees 17 patients per day at the clinic.

Neustatter told McAuliffe the clinic, and patient care there, would benefit if all the patients who came through had Medicaid.

The clinic takes 15 to 20 new patients a week, but has to turn away between 50 and 100 every month, said executive director Karen Dulaney.

Much of its care is provided by doctors volunteering time and skills, which Dulaney said is not sustainable.

Care there isn’t free for the clinic, she said. Its annual budget is $2.1 million and 28 people are employed there full time.

“We have to prioritize care with patients,” she told McAuliffe.

Those the clinic can’t help end up in the emergency room.

“It’s a terrible, vicious cycle,” she said.

Lindley Estes: 540/735-1976

Medicaid expansion explained

Under the Affordable Care Act, states were to expand the Medicaid program to cover people earning up to 138 percent of the Federal Poverty Level ($15,856 for an individual or $26,951 for a family of three in 2013). The law requires the federal government to pay for 100 percent of expansion costs the first three years, then 90 percent thereafter.

But the U.S. Supreme Court struck down the Medicaid expansion provision in the law, saying it should be an option for states.

Twenty-five states and the District of Columbia have opted to expand Medicaid. Virginia is one of six states considering expansion, but so far has opted not to do so but has a legislative commission charged with looking into reforms including expansion. Lawmakers in the remaining 19 states have decided as of 2014 not to expand the program.

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