V
irginia
C
apitol
C
onnections
, S
pring
2014
6
Closing the coverage gap
with Marketplace Virginia
By Senator John C. Watkins
At the Medicaid Innovation and Reform
Commission April 7th, I was pleased to
hear about how the Commonwealth will
save $225 million over the next biennium
through streamlining and other reforms to its
Medicaid program.
There was no doubt in my mind that
the commission’s goals—to ensure our
taxpayer dollars are spent wisely, effectively,
and for their intended purpose—are being
met. This was good news for the thousands
of Virginians who depend on Medicaid for their healthcare needs.
For the Virginia citizens with income above the traditional
Medicaid threshold but less than 138 percent of poverty, however, this
good news had little meaning. They neither qualify for Medicaid, nor
can they afford healthcare insurance.
That is the impetus behind Marketplace Virginia, the Senate’s
proposed plan that will provide access to healthcare for 359,000
uninsured Virginians in that “coverage gap,” so they can take
responsibility for their own health care decisions.
Not an expansion of Medicaid, Marketplace Virginia is a private
sector, managed-care model that will put a pro-business stamp on
coverage, creating the Virginia Taxpayer Recovery Fund to recapture
no less than $1.7 billion each year from revenues flowing toWashington
D.C., fromVirginia businesses and citizens. These monies will be used
to pay insurers for coverage.
While providing premium assistance, MarketplaceVirginia is not a
give-away initiative. It will require participants to contribute up to five
percent of their household income, so as to encourage use of primary
care and prevention, and discourage inappropriate use of emergency
room care.
As designed, Marketplace Virginia returns control to the
Commonwealth and provides a proven managed care delivery system
at a fixed, monthly cost. Other features of the program include
commercial-like health insurance benefits similar to those available
through the federal health insurance marketplace; provide incentives
for job search; include monitoring and oversight; and a failsafe feature
for the Commonwealth—termination of the program if revenues to the
Taxpayer Recovery Fund are reduced below commitments in federal
program.
Skeptics say that a waiver from the federal Department of Health
and Human Services would be required to establish Marketplace
Virginia. That would depend on what the state ultimately would choose
to include in the plan.
The elements included in how Marketplace Virginia would work
are comparable to current programs in Virginia and have already been
included in other states’ applications.
And according to Deborah Bachrach, a former NewYork Medicaid
director who has consulted with members of the state commission
before, “I do not think your hands are tied on new products. You won’t
know until you ask.”She went on to say that waivers are by definition
time-limited, but most of them are routinely extended.
The federal government has cooperated with these types of efforts,
issuing waivers to states with reasonable coverage plans, and I am
confident Virginia would be successful in its application for a cost-
effective managed care model.
If approved, the program could begin enrollment as early as the fall
of 2014, with coverage beginning on January 1, 2015.
If you would like to learn more about Marketplace Virginia, please
I am willing to say that Marketplace Virginia may not be “THE”
solution, but it is a solution. The Senate would be more than willing to
consider other pro-business, cost-saving approaches, but doing nothing
is not an option.
Virginians are paying $5M a day for healthcare as a result of
additional taxes associated with the Affordable Care Act. The “do
nothing” option would result in Virginia having to appropriate
additional monies out of its general fund to pay for indigent healthcare
instead of obtaining access to the federal dollars we have already paid.
I believe it is time to make use of what is, after-all, our money
to help some our most vulnerable citizens to have a chance to take
responsibility for their own health care decisions. It will be good for
them; good for their families; and in the long run, good for all of us.
There are two issues facing the Virginia
General Assembly: Medicaid expansion
and the passage of the state budget. As a
practicing physician who serves on the
House Appropriations Committee and a
state budget conferee, I have worked closely
on these two issues during the 2014 session.
Unfortunately, Governor McAuliffe
and the State Senate have made the passage
of the state budget contingent upon the expansion of Medicaid in
Virginia. I think this is a mistake for two reasons.
First, by linking these two issues, the Governor and the Senate
have prevented the General Assembly from completing its most
important obligation—passing the state budget. In the simplest
terms, the proponents of Medicaid expansion have taken the state
budget hostage. This is, fundamentally, the wrong way to govern.
We have seen in Washington the effects of threatening government
shutdowns and playing on the edge of “fiscal cliffs.” It is not pretty
and the voters do not like it.
That is why I and other members of the House of Delegates
have called for a clean budget. We know that the issue of Medicaid
expansion under the Affordable Care Act is controversial. We know
that Republicans and Democrats disagree. But a disagreement over a
single issue should not delay the entire state budget, which funds our
schools, roads, law enforcement, local governments and more.
Second, the merits of expanding Medicaid is worthy of a separate
and stand-alone debate. The key points to consider in that debate
would be how to provide quality care to those who need it most in a
way that is efficient and cost effective for Virginia taxpayers.
In my experience as a doctor, Medicaid does not provide very
efficient care, primarily because of the restrictions and obligations
placed on Medicaid by the federal government. Medicaid is also
growing at an unsustainable rate—nearly 8 percent per year and 1600
percent over the last 30 years. Medicaid expansion would only add
to that growth. It would also add a new population of beneficiaries—
able-bodied working adults—that would limit access for the most
vulnerable—children, the poorest of the poor and the disabled.
I recognize that good people might disagree with me on these
points. This is a vigorous and ongoing debate. But the debate
over Medicaid expansion cannot happen with the threat of a state
government shutdown looming. That is why I believe we should pass
a clean budget and continue the debate over Medicaid expansion in a
separate special session.
Doctor and Delegate John O’Bannon reflects on the
Medicaid debate
By Delegate John O’Bannon
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