400,000. That is the number of Virginians that are estimated to be insured through Medicaid should the commonwealth decide to expand its Medicaid program. Lets put some numbers on that 400,000. These are people whose income levels are between 0 and 133% of poverty. In dollar terms that is $0 – $15,282 for a single individual and $0 – $31,322 for a family of four. Does anyone think that a single individual making $15,282 can afford any type of insurance? The answer is not only “no” but “Hell no”. Yet, it remains an ongoing discussion in this state. “Why” you may ask? Simple, its the most conservative element of Virginia’s General Assembly, the House of Delegates. It is somewhat amazing that the two rotating chairs are both from the Shenandoah Valley, Emmett Hanger from the Senate and Steve Landes from the House. Right now there is a split. The Senate is more inclined to reach some accommodation for expansion while the House is opposed. Think the US Senate and House. The House seems to be dominated by ideologues (or tea party types) while the Senate and its moderation is more of a traditional reflection of Virginia politics. How would you like to have the power to influence whether 400,000 needy Virginians got health insurance? The Staunton News Leader has stated that the failure to expand Medicaid is “immoral” yet Steve Landes has suggested that it will never be expanded! It seems that Landes’s major argument against expansion is that the Federal Government may decide not to foot as much of the bill as they have suggested they will. In other words, he is basing his opposition on “ifs” and “buts”. My response to this would be there is a chance if I leave my house everyday something could happen to me. However, that doesn’t prevent me from leaving my house. Medicaid expansion WILL create more jobs because it will provide reimbursements to hospitals and community-based centers that provide services to the uninsured that are used to getting very little or nothing in reimbursement. What happens when organizations, especially non-profits get more revenue? They hire more staff, give staff needed raises or purchase items and equipment that they need to become more efficient. That puts more money into our economy. More money into the economy means more jobs. Who cares if it is federal money, state money or private sector money? The result is the same. A New England Journal of Medicine study concluded that after two years, the expansion of Medicaid benefited the population – “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, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain”. Diabetes and diabetes related conditions account for almost 20% of all hospital admissions. Doesn’t it make sense to treat these people in primary care environments rather than as inpatients in a hospital? The Staunton News Leader is correct, it IS immoral not to expand Medicaid. Everyone who calls themselves a Christian and many that do not know the story of the Good Samaritan. Those who oppose Medicaid expansion are those that choose not to see the person in need along the road. They are not going to help. They are in a position to make the most significant and important decision of their legislative careers and instead they are going to be swayed by a minority of ideologues who never care about those less fortunate than themselves. Together, we can “heal the sick, feed the hungry, clothe the poor”.