Medicaid Expansion

Medicaid (not Medicare) is the fastest-growing line item in the Virginia budget, growing from $3 Billion in 2002 to more than $7 billion in 2012 , a 133% increase, now 22% of the state budget, threatening to crowd out other key services such as education and transportation.  Expanding Medicaid would likely add 400,000 to the current 1.1+ Million recipients.  This expansion would likely require major cuts in current core services, and/or massive tax increases.  For this and other reasons I oppose expanding Medicaid.  But that does not mean that I am not concerned about providing medical care to the impoverished or disadvantaged, as you will read below.

Governor McAuliffe's claim, “if we don’t accept [Medicaid] money it will simply flow to other states," is not accurate.   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 ($1.5 billion for Virginia.)  If every other state rejected expansion, Virginia would not receive the entire $372 Billion.  Further, while Virginia would receive 90% federal funding for the first three years of expansion, after that the decrease in the federal match would require major state expenditures.

Governor McAuliffe points to a letter he received from the Obama Administration stating Virginia can expand and then back out of Medicaid years later. The letter did not cite the Affordable Care Act, any ACA regulations, or any legal opinion from the Department of Health and Human Services or Office of Social Security to provide legal authority for Virginia to later withdraw from Obamacare expansion of Medicaid. 

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…”   

An article in Science magazine [1/2/14] found that Oregon Medicaid patients went to hospital Emergency Rooms for primary care treatment 40% more than non-Medicaid participants.  This may happen because few doctors are willing to treat Medicaid patients due to the impact on their business, federal paperwork requirements and the like.  Also, if the pool of Medicaid beneficiaries increases there will be more patients waiting for appointments, creating more demand on the few private practice physicians who accept Medicaid.  Expanding Medicaid recipients may end up decreasing the quality of healthcare which current Medicaid patients receive, forcing more patients to use hospital emergency rooms for primary medical care.

A poll commissioned by the “American College of Emergency Physicians shows that 28% of 2,099 doctors surveyed nationally saw large increases in volume, while 47% saw slight increases. ... Still, seven in 10 doctors say their emergency departments aren't ready for continuing, and potentially significant, increases in volume.”  (USA Today, May 4, 2015)  Giving a Medicaid card to newly eligible Medicaid enrollees that indicates they have health insurance, does not assure access to physicians.  Emergency room visits were supposed to drop under Obamacare.  Instead, they have increased.

Defensive Medicine

An AMA published survey, answered by 65% of 824 Pennsylvania doctors found:  “... 93% reported practicing defensive medicine. ... such as ordering tests, performing diagnostic procedures, and referring patients for consultation…Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. ... .”  JAMA. 2005 Jun 1;293(21):2609-17.  Such defensive medicine practices raise the cost of healthcare for everyone.

Delegate Marshall’s Alternative

Would providing doctors with medical malpractice liability coverage be a sufficient incentive to encourage professional health care providers to volunteer their time to serve poor Virginians?   That question will be examined at my request by Virginia’s Joint Commission on Health Care.   The JCHC will conduct a study to examine how many Virginia physicians would treat indigent patients if the Attorney General would represent them in any civil liability matter (except for gross negligence or willful misconduct), as they currently do for doctors who work in Virginia’s free clinics for the disadvantaged.  This approach has the potential to reduce tax subsidized medical coverage (Medicaid) while expanding access to health care for lower income patients utilizing doctors from patients' own communities which would also cut down on patients having to travel long distances to visit a doctor who accepts Medicaid, and making more physicians available to see needy patients. 

ObamaCare Challenged

I wrote the 2010 law Attorney General Ken Cuccinelli used to sue Barack Obama’s misnamed Affordable Care Act.  I successfully amended a bill in the House of Delegates to curb abuses of the ObamaCare law.  The single greatest threat to health care and also to personal Liberty is President Obama’s so-called Affordable Care Act, also known as "ObamaCare." Unfortunately, the cost of health insurance has skyrocketed in most cases under Obamacare despite promises to the contrary.

I joined an Amicus Brief in the King vs. Burwell case before the U. S. Supreme Court  to challenge the Obama Administration’s awarding of subsidies in violation of  the Obamacare law.  

Obamacare has made healthcare more expensive and less available, and has exposed Americans to abuses at the hands of federal regulators.  Ultimately it will make government bureaucrats, not doctors, the final judge of what medical treatments are considered appropriate.