Millions and millions and millions of your federal tax dollars have been flushed down the Potomac only to be harvested by wiser state legislatures. What could have been a catalyst for not only broad medical service sector growth but also the survival of rural medical clinics and hospitals was set aside for base political posturing. This should have been a simple financial decision. Instead it was a cynical sacrifice of their voiceless, powerless constituents for the protection of their own political hides.
Let's consider the costs because they are not limited to those dollars passed on to other states. Some number amounting to just under 5% of Virginians are without healthcare coverage because Medicaid expansion has been denied. That doesn't mean they go without healthcare. In many cases it means they go without healthcare until there is a crisis and then an emergency room visit and expensive procedure are required. Who pays for that? You can make up all kinds of voodoo financial and economic formulas but the costs get passed to those who are covered in increased insurance premiums and/or copays and/or deductibles. And maybe more importantly, in scarcer medical service resources. Visit an emergency room for the Republican version of healthcare delivery in the unregulated free market. They simply don't understand that the risk pool is the risk pool. No one in America is denied care in an emergency and those emergencies are exponentially more costly than preventive care. Republican denial of coverage poisons the well that feeds the pool. Welcome to the Teapublican Utopia.
On the other hand, some number amounting to just under 5% of Virginians now have healthcare insurance through the Federal Marketplace established by the Patient Protection and Affordable Care Act. That hasn't solved every problem but it goes a long way in that direction. While some are subsidized, these policies are not some government giveaway. They are a way Americans can take responsibility for their financial exposure. Republicans talk about individual responsibility in a vacuum. They like to preach about it but don't want to facilitate it. The fact is that 60% of bankruptcies in the United States involve medical indebtedness. Healthcare insurance builds a firewall between personal financial survival and insolvency leading to financial disaster.
If the playing field had been level the law would never have come to pass. The sweeping changes reflect the institutionalized predatory practices that it ameliorates. In an effort to allow the market to adjust and adapt, there were provisions designed to allow consumers to maintain coverage they believed to be adequate. Of course, the problem has always been that you wouldn't know if coverage was adequate until you had to use it and then it was too late. It wasn't as though you could shop around after that revelation; who'd take you on when you were laying in an emergency room? But even the "grandfathered" policies are prohibited from practices insurance companies commonly used to defraud consumers and shelter margins:
That consternation, it turns out, was from unnecessary friction. Commonwealth Coordinated Care (CCC), a concept sanctioned by the Affordable Care Act (ACA), is an effort to improve health care delivery to Virginians who are eligible for both Medicare (entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D) and full Medicaid. Medicare and Medicaid were not designed to work together and do not function seamlessly. This and the socio-economic characteristics of the client base create gaps and overlaps in services inviting waste and fraud.
The goal of this initiative is to provide Virginians with high quality, person-centered health care that focuses on their needs and preferences.
Virginia's Department of Medical Assistance Services (DMAS) designed a demonstration that operationalizes a more effective, cost saving concept by establishing overarching Medicare-Medicaid Plans (MMPs). This should be an effort hailed across the political spectrum and embraced by health care providers, beneficiaries, and all citizens of the Commonwealth. But other than potential enrollees, most of us haven't even heard about this effort to improve health care for some 76,000 eligible Virginians living in designated regions.