Medical Care for the State's Most Vulnerable

By Desiree Parker Friday, April 09, 2010

This is the second of two stories about healthcare reform in Virginia.

Federal healthcare reform is but one way medical treatment will change for Virginians. The state's commitment to Medicaid and how it gets fulfilled over the next couple of years is also something to watch.

The federal legislation will force the state to re-think parts of its recently released budget, now awaiting the governor’s approval. In that budget, funding for Medicaid - the health assistance program for the poor and disabled with joint federal and state funds - has been cut, as have provider reimbursement rates.

Around 780,000 Virginians are enrolled in Medicaid; nearly 1 million more are without health insurance.

According to licensure data from the Department of Health Professionals, there are a sufficient number of primary care doctors in the Triangle accepting Medicaid – but the numbers accepting new Medicaid patients are considerably lower. This, local providers fear, will lead to increased visits to already cash-strapped free clinics like the Olde Towne Medical Center and Lackey Free Clinic in the Triangle.

“The availability of sufficient primary care providers participating in public health insurance programs will be pivotal under [the new] healthcare reform,” says Rene Cabral Daniels, Co-Interim Executive Director for the Williamsburg Community Health Foundation. The Triangle has a number of ways to help people get care, she points out, like the Project Care program spearheaded by Bon Secours, Riverside and Sentara, which aims to get low income locals access to specialty physicians. The Project Care program has helped 2,728 patients since spring of 2008.

Charity care by local hospitals shows the commitment of locals to get quality healthcare to everyone, Cabral-Daniels says. Sentara Regional Medical Center and Riverside Regional Medical Center (which also serve patients outside the Triangle) gave more than $39 million in 2008 for people with incomes up to 200 percent of the federal poverty level.

One stopgap measure that could help the state through the next few years is a federal extension of stimulus dollars that go straight to Medicaid. Virginia has received 1.4 billion in stimulus cash toward Medicaid during the recession.

Virginia spends little on Medicaid, ranking 48th out of 50 nationally in per-capita Medicaid spending, and has one of the most restrictive eligibility requirements for both Medicaid and the state’s insurance program for poor families, called Family Access to Medical Insurance Security.

According to Michael Cassidy, Executive Director at the Commonwealth Institute for Fiscal Analysis, the state “could dodge a bullet” if it receives the federal extension, but this will only allow the state to limp along until the end of 2011.

Cassidy says that even with an extension of federal stimulus aid, “there will be a gap in 2012 and 2013 we’ll have to grapple with in the state, while we maintain our level of effort [with Medicaid].”

By 2014, though, the majority of the healthcare reform should be in place. “Health insurance reform will provide Virginians – insured and uninsured - with almost immediate benefits,” Cassidy said in a statement released along with a report on healthcare reform from the Commonwealth Institute (read the report here).

According to a report from the Congressional Committee on Energy and Commerce, in Virginia’s 1st District (which includes the Historic Triangle) 12,000 residents will get coverage under the new federal bill. There are also 17,700 businesses eligible in the district to join an insurance health exchange, too, the report says.

“Individuals in Virginia continue to pay a higher percentage of the premium cost for employer-provided insurance than workers in any other state in the country,” according to the Commonwealth Institute report. “The percentage of Virginians who get health insurance at work has steadily declined over the last decade, and the trend is likely to continue without reform that will help make insurance more affordable for both workers and employers.”

The state has been bucking the idea of healthcare reform, with Attorney General Ken Cuccinelli pursuing a lawsuit claiming the new law is unconstitutional and that it would cost the state more than $1 billion in Medicaid costs.

Cassidy points out that $1 billion will be matched by more than $10 billion in federal funds. “This is one dollar [of state money] for every ten dollars [of federal],” he says. “It’s a tremendous match.”

The cost of the current and future uninsured populations would also be high, in missed work and acute care costs, he says. “Having insurance coverage has been proven to be very cost effective,” says Cassidy. “Health insurance plays an important role in keeping the workforce productive, and keeping children and people healthy.”

According to a 2008 report by Families USA, an estimated 10 working-age Virginians die each week because they lack health insurance, most from diseases that could have been treated easily if caught early. Between 2000 and 2006, more than 3,200 Virginians between ages of 25 and 64 died because they did not have health insurance.

Cabral-Daniels believes the Historic Triangle community is in a strong position to implement the proposed reforms, thanks to the many collaborations and programs involved with the health safety net in the area.

“There will still be some challenges,” she says. “The cost of delivery of health care services must be contained if any reform is to be successful.” This cost containment will take cooperation between providers and patients, she says.

The Triangle is also in a good position to handle the new insurance exchange idea, but this will also require collaboration. “There will be a need to continually convene community members to update them” on changes, according to Cabral-Daniels.

“The Williamsburg Community Health Foundation is well-positioned to not only assist the community in meeting health reform challenges, but to improve the community’s collaborative infrastructure so that the Historic Triangle community is positioned to capitalize on health reform benefits,” she says.

“The Foundation is confident that this community can prosper under health reform and looks forward to being a pivotal leader who will work with other leaders to make that happen.”