My Alternative to Medicaid Expansion

  I URGENTLY NEED YOUR HELP!!  My HB 39, to provide an alternative to Medicaid expansion by providing free health care to the indigent through volunteer doctors is set to be killed in Committee tomorrow.  There are big money interests that want Medicaid expanded, and my bill would get in their way!

PLEASE CONTACT MEMBERS OF THE COURTS OF JUSTICE CIVIL LAWS SUBCOMMITTEE IMMEDIATELY AND ASK THEM TO SUPPORT HB 39!

When I received notice that HB 39 would be heard tomorrow, Delegate Landes and I asked for a short postponement as a courtesy to the doctors who need to rearrange their schedules in order to testify on behalf of my bill.  I was told by Subcommittee Chair Delegate Habeeb that I could reschedule.  Within an hour Del. Habeeb told me the bill would be heard tomorrow!

My bill is being opposed by the Trial Attorneys.  Under HB 39, if doctors donate four hours weekly of free care to the indigent in exchange for their service, the Attorney General’s office would defend them against lawsuits in their private and charity practices.  This would lessen the need for malpractice insurance.

Few doctors serve Medicaid recipients currently because of the high costs.  Adding 425,000 new Medicaid recipients to the present one million will further burden the system.

During the Governor’s race, Terry McAuliffe twice said he would not vote for a Budget unless Medicaid expansion was included.  My HB 39 is a true compromise in that the poor would get medical care, and the taxpayers would not have to suffer through more tax increases because of Medicaid expansion.

Remember, Republican leaders imposed the last three tax hikes on Virginians, including the 2013 road tax hike.  We cannot count on their “Alamo-like” resistance to Medicaid expansion unless the people make their voices heard.  My HB 39 would forestall the need to expand Medicaid, and that is why it is feared.

HB 39 will not cost a dime of tax money and will avoid Medicaid fraud because Medicaid would not be used.  No insurance billing bureaucracy would be needed to administer the program.  Doctors would keep regular patient medical records.

Thirty years ago filing insurance paperwork cost doctors 15-30% of their revenue.  Today it’s 60%+ with more to be needed for Obamacare paperwork. (Business Insider, 5/29/13). Virginia already self-insures 3,400 physicians for care they provide in free clinics with no law suits pending.

McAuliffe claims the Feds will cover 100% of Medicaid costs for three years and 90% thereafter.  Recall Obama and Mark Warner’s prior failed promises: “You can keep your own insurance,” and “you can keep your own doctor.”

The U.S. Centers for Disease Control found in their 2011 National Medical Care Survey that 31% of doctors would not take new Medicaid patients.  The 2012 Jackson Healthcare Physician Practice Trends Survey found that 36% of U.S. doctors will not take new Medicaid patients. A NEJM study (6/16/11) of Cook County, Illinois doctors found that “Overall, 66% of Medicaid-CHIP callers…were denied an appointment as compared with 11% of privately insured callers…” after women posing as mothers of pediatric patients with common health conditions made calls to identical clinic staff for appointments 30 days apart using the same script but identifying Medicaid or private insurance as payment.

So, a Medicaid card will not guarantee medical care for the poor.

Terry McAuliffe claims that “if we don’t accept money it will simply flow to other states.”  This is not true.  Virginia’s “share” of Medicaid expansion money (our federal taxes) is based on a formula.  For 2016, Congress allocated $372 Billion for Medicaid for all 50 states, with $1.5 billion for Virginia.  If every other state rejected expansion, Virginia would not get the entire $372 Billion.

McAuliffe has reappointed Governor McDonnell’s Secretary of Health, Dr. Bill Hazel, who has been working to expand Medicaid since passage of Obamacare in 2009.  McAuliffe said, “'I am confident that Secretary Hazel will be the best steward to help me carry my agenda forward and meet the challenges we face when it comes to health care in this commonwealth.”

The Obama Administration has cut from $500 million to $1 billion in reimbursements to VCU and UVA for hospital care for indigents.  The news of the VCU/UVA funding shortfall came from Health Secretary Hazel on the same day Terry McAuliffe announced he wanted Hazel to stay on as Health Secretary.  Terry McAuliffe would not be seeking to re-appoint Sec. Hazel if he were not also fighting for Medicaid expansion!

Medicaid expansion may not significantly improve health. In 2008, Oregon expanded Medicaid for low-income adults.  Two years later, The New England Journal of Medicine (NEJM) reported (5/2/13) “…Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services…”   Those words come from the authors of the article, not me.

Science magazine [1/2/14] further analyzed Medicaid usage of patients enrolled in the 2008 Oregon Medicaid expansion.  The author’s summary reported on 25,000 Medicaid lottery participants over an 18 month period.  “We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings. ...  A back-of-the-envelope calculation, using $435 as the average cost of an emergency room visit suggests that Medicaid increases annual spending in the emergency department by about $120 per covered individual.”

In other words, because it is harder and harder for patients to receive primary medical care in private doctor’s offices, Medicaid eligible patients are going to hospital ER’s for primary care at a rate 40% higher than non-Medicaid patients.

Because doctors fear lawsuits, many doctors practice “defensive” medicine which consists of ordering medical tests and treatments which shield a doctor from liability, but which may offer little or no benefit to the patient. This drives up general health care costs as well as tax-funded Medicaid and Medicare programs.

An AMA published survey, answered by 65% of 824 Pennsylvania doctors (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) found:  “... 93% reported practicing defensive medicine. ... such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%).  Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. ... Defensive practice correlated strongly with ... perceived burden of insurance premiums.”  JAMA. 2005 Jun 1;293(21):2609-17.

As more and more Doctors consider leaving the medical profession over Obamacare requirements, HB 39 can remove the burden of insurance claims for care provided by charity doctors, a significant factor increasing health care costs across the board. Relieved of that burden, doctors will be able to exercise their best clinical judgment, and not order tests to avoid litigation.  Doctors under HB 39 will have no incentive to encourage behavior that produces repeat pathologies, where voluntary behavior and not genetic history, social condition or accidents, is the major causative factor in illness or subpar health.

Doctors serving the poor through charity care will not waste time with Medicaid. Physicians who treat the poor without charge will have their reputations enhanced, and attract more paying patients. Non-profit groups or churches will be better able to direct only the truly needy to their affiliated clinic doctors resulting in true patient-centered care by physicians delivered in the local community.

The drawback for some politicians may be the absence of political payback votes.  In other words, instead of converting citizens into government dependents, the indigent will remain free men and women not beholden to anyone or expected to vote for a particular political benefactor.

HB 39 has the potential to take us back to a medical care delivery model that preceded Lyndon Johnson's so-called Great Society which bureaucratized Charity by creating government programs and agencies with employees who relied upon the indigent remaining so in order to keep their jobs. Thank you for your support!

P.S. Without your urgent calls, emails and contacts to the above committee members, we will certianly not be able to cut costs and serve those who are most vulnerable among us.