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Virginia Legislators Ignore Health Care Reality

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We are no closer to expanding health care coverage in Virginia than we have ever been. Governor McAuliffe blames the tea party but that is too kind to the legislators who do not support expansion. They are either math challenged or corrupt, morally and/or ethically. The tea party provides obfuscation.

“There still is a House of Delegates which remains unmoved and unmoving on this issue.” – Reverend John Peterson speaking at an Organizing Virginia vigil for Medicaid expansion just prior to the Senate joining the forces of obstruction

Hospitals and patients in Virginia have to live within the reality of the law whether or not one agrees or disagrees with the Affordable Care Act, explained John Peterson, Chairman of the Board of Augusta Health. So it is in all our best interests to find a solution that makes the law as workable as possible for as many patients and those who serve them as possible. $300 million in annual payments to Virginia hospitals were eliminated under the Affordable Care Act including disproportionate share hospital payments for treating the uninsured and cuts to Medicare reimbursement rates. Those Medicare reductions were to be offset by Medicaid expansion in the states.

Peterson outlined the effects of failing to expand Medicaid. Augusta Health provided some $25 million in uncompensated care last year and an additional $5 million in community benefits related to care.

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Community benefits at risk:

  • Free tests for free clinic patients
  • Community screenings
  • Subsidies for mental and behavioral health services
  • Other community health activities

If Medicaid expansion or something comparable doesn’t happen, Augusta Health is going to have a difficult time maintaining that level of support for free clinics and other charitable care organizations. More importantly, the Augusta Health system will have to assess whether it can remain community owned and independent. Augusta Health is one of only five independent community owned care systems in the state. Many others have had to merge with larger systems because of the financial pressures they face. Absorbing these cuts without the offset in Medicaid expansion will force Augusta Health to reduce services to remain financially viable.

Quality of care cuts:

  • Service lines that lose money but are important to have within a community
  • The current low fee structure (one of the lowest in the state of Virginia)
  • Hesitance to expand services because of risk to returns on investment

These are painful choices that are forced because our money that is sent to Washington is not being claimed by the General Assembly which has the means to bring it back.

Augusta Health is a large employer; over 2,100 employees. Without Medicaid expansion or a private market-based alternative, then hard decisions will be forced over compensation and staffing that will have adverse consequences for the community. Augusta Health has responsibility to serve the entire community, not just those who can afford it. There is no option to opt out of the cuts under the Affordable Care Act.

The General Assembly has the opportunity to opt into a system which better provides for the needs of patients who are our neighbors and to sustain the quality of care being provided as a community-owned institution.

Medicaid in not a magic bullet for the financial challenges. Augusta Health currently loses about 40 cents of every dollar spent on Medicaid patients. But it loses 100% of all those without coverage. Far from a bonanza to the bottom line, expansion does mean that this organization can remain community owned, operated, and independent.

Peterson simply hopes that the General Assembly will take the opportunity it has to bring our dollars back to Virginia to provide better care of Virginians. If that doesn’t happen, we end up paying twice: once to send the money to Washington which we are required to pay under the Affordable Care Act and then to pay for those in the systems who do not have insurance and receive uncompensated care. It is paid in higher insurance rates and reduced services at a time when it need not be paid at all. All that the General Assembly has to do to preclude that is to do the right thing, ignoring personal benefit and interests.