One of the conceits of Virginia’s Medicaid debate is that expansion would pay for itself. Uncle Sam would pick up 90% of the cost, leaving Virginia to raise money for only 10%. The Commonwealth would save a few hundred million dollars through reduced funding for prison healthcare, mental health, indigent care funding, FAMIS pregnant women, and other programs. And hospitals would kick in more than $300 million from a provider assessment.
Now we read from Michael Martz with the Richmond Times-Dispatch, the only reporter providing meaningful follow-up to the biggest entitlement expansion in recent Virginia history, that “the work is far from done in expanding access to health care for 400,000 uninsured Virginians.”
It turns out, he writes, that lawmakers and state officials “didn’t include money in the two-year budget to raise Medicaid reimbursement rates for doctors and other front-line health care providers.”
Oops. And how much money might that be? Supposedly, about $47 million in the second year of the biennial budget to raise reimbursements for doctors to about 67 cents on the dollar to 88 cents.
I’ve been making this point throughout the debate — expanding Medicaid coverage is meaningless if the federally and state-funded health insurance program for the poor pays so little that many doctors won’t take money-losing Medicaid patients. At least, it appears, our legislators did understand the problem even if they didn’t openly acknowledge it. (If they did openly acknowledge it, no one in the media picked up on it.) But now that Medicaid expansion is a done deal, lawmakers and lobbyists are suddenly talking about previously undisclosed liabilities to taxpayers.
“Just because you get insurance doesn’t mean you have access to a doctor,” said Ralston King, vice president of government relations for the Medical Society of Virginia, stating an issue that should have been obvious to everyone but somehow flew under the media radar through months of debate. Finding a way to pay for it is the next challenge, King said. “Right now, we don’t have a funding mechanism.”
Then there’s this from Dr. Todd Parker, an emergency room physician at Riverside Shore Memorial Hospital on the Eastern Shore: “We are encouraged that along with this legislation, given the very low reimbursements that Medicaid provides providers, that legislators are considering ways to increase Medicaid reimbursements and otherwise help physicians who may see increased numbers of Medicaid patients.”
Bacon’s bottom line: So, Medicaid expansion isn’t complete, and ordinary Virginians aren’t finished paying for it. We’ll pay indirectly by means of a $300 million provider tax, some proportion of which will be passed on to patients, and we’ll pay again when legislators figure out where to find another $47 million a year to make Medicaid expansion meaningful by raising reimbursements to a level where physicians don’t treat patients at a loss.
Who even knows if that $47 million number is real? How long it will take to morph into something much bigger? Do the math: About 1.3 million Virginians currently receive Medicaid. Expansion will add another 400,000. Forty-seven million dollars spread over 1.7 million patients equals less than $27 per patient. Do you think $27 a year will raise physician reimbursements from 66% to 88% of the cost of treatment? I don’t.
If you feel hoodwinked by Medicaid expansion — politicians consistently low balling the cost and the fourth estate failing to probe what it would cost the public — you’re not alone. So do I.
