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Del. Paul Krizek: Virginia Finally Did the Right Thing on Healthcare—Now, What’s Next?

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Guest post by Del. Paul Krizek (D- Mt. Vernon)

We did it!

Last week, the General Assembly voted 67-33 to pass an historic budget that expands Medicaid, bringing health care coverage to 400,000 low income Commonwealth residents who otherwise could not afford it. For the past five years Medicaid has been expanding – but in the most fiscally irresponsible way possible. Thousands were left without the healthcare they deserved, and Virginia forfeited 10 billion federal dollars that could have been used to address other areas in our budget.

Despite broad support by the electorate, it was not until after last year’s election of 15 new Democrats that Governor Ralph Northam and the Democratic leadership, working in tandem with Republicans, notably Speaker Kirk Cox and Appropriations Chairman Chris Jones along with Senators Emmett Hanger and Frank Wagner, put the interests of Virginians ahead of partisan politics. Now, we can all enjoy the satisfaction of knowing that many of our neighbors and fellow citizens have a better chance to get and stay healthier.

It was not just the right thing to do but the fiscally sound thing to do as leaving people without access to medical care is both wrong and expensive. Many living in low income households suffer from problems that can be prevented and managed with health care that will allow them to keep working, paying taxes and not burdening hospital emergency rooms. What’s more, we can now use Virginia’s Medicaid system to innovate through the federal Affordable Care Act (ACA), providing higher quality health care and increased health care value.

Expanding coverage, though important, isn’t the only thing that the ACA is designed to do. With its focus on quality and value, the ACA is intended to transform our health care system. According to the National Academy of Medicine, there are six determinants of high quality health care. It should be safe, effective, patient-centered, timely, efficient and equitable. The ACA has developed pilot programs in all six areas, testing the belief that increasing health care quality will improve clinical outcomes.

Americans receive much less value for their health care dollar than citizens of other first world nations. Per capita expenditure in the US is $10,348, vs. $5,169 in other OECD (The Organization for Economic and Cooperative Development) countries; and that difference has increased steadily for almost forty years. Despite this investment, life expectancy in the US is less (78.8 vs. 81.2 years) and infant mortality is greater (6.1% vs. 3.5%); these differences are even starker for black Americans. Similarly, 68% of US citizens 65 years and older have two or more serious chronic medical conditions vs. 37-56% in other OECD countries. Clearly, we are not getting our money’s worth, yet the amount we invest is so great – currently 17.9% of our GDP – that it threatens our ability to invest in other areas of importance to citizens of the Commonwealth such as my priorities: transportation and education. We must start now to do many things very differently.

This includes a substantial focus on preventative care, such as health screenings for cardiovascular diseases and cancer, smoking cessation assistance, healthy weight programs and immunizations. For example, one Northern Virginia business enrolled in a new ACA plan and found out they could save money if employees got a checkup and followed through on certain recommendations based on the result. Within a year, everyone was more fit and in control of their health, and the company got a break on their medical insurance premiums. At a time when 75% of US health care dollars go to chronic diseases, such steps are essential to achieving sustainability in government, employer and family health care spending.

Similarly, the ACA has begun to restructure payments to better align expenditures with outcomes and is trying to determine the proper place in real-world clinical practice for information technology, expanded role providers and personalized (genomic) medicine.

I am proud to have played a part in this historic effort, and I look forward to building on this accomplishment with your support. While this expansion gives us reason to hope for better times ahead and shows what can happen when we put aside our differences and work together, I want to sound a cautionary note. Despite broad public support, expansion only came about following the overwhelming Democratic victory in 2017. Virginians must become and remain knowledgeable about health care issues. We must go to the polls – both state and national – to give direction by our vote to our elected officials. We must remain vigilant and stay active.