Thank God for Medicaid Expansion

By Peter Galuszka

For years after the Affordable Care Act, “Obamacare,” made millions of federal dollars available for states to expand Medicaid health coverage, Virginia Republicans steadfastly blocked Virginia from using the money.

Led by former House Speaker Bill Howell and Sen. Tommy Norment, the GOP claimed that expanding Medicaid to nearly 400,000 people would be too expensive and would blow out state funding.

This skinflint approach was finally put to rest after Democrat Ralph Northam became governor in 2018, foreshadowing a Democratic sweep of the General Assembly in elections last year.

Thank God the Democrats prevailed.

Virginia’s formerly robust economy has been shattered by the COVID 19 pandemic. Last week, some 110,000 Virginians filed for unemployment support. It was 46,277 the week before.

Who covers them is an open question but many would qualify for Medicaid. Expansion has boosted lower-income Virginians so that they may be able to better ride out the pandemic.

According to Nashville public radio station WPLN, a recent study in Health Affairs supports expansion .

“What researchers from Vanderbilt University School of Medicine and Harvard Medical School found is that people in southern states that expanded Medicaid – like Arkansas, Virginia and Louisiana – are experiencing slower declines in physical health but also in mental health. The benefits are so notable among a historically vulnerable group that the authors say that expansion could substantially boost a state’s overall health ranking.”

The report continues: “The lead author of the study, Vanderbilt health policy professor John Graves, says the findings could influence debates in state legislatures still considering expansion.

“Health care policy experts and physicians have suspected this for a while but with our study, we now have the actual evidence showing that non-expanding Southern states could materially improve population health if they accept expansion funds,” Graves says.

It is fortuitous that the Howell’s and Norment’s of this state, along with a number of notable Bacon’s Rebellion commenters, failed to keep block Medicaid expansion.

Besides their bogus “it will cost too much argument,” their resistance was rooted in a Pavlov dog-like opposition to anything that former President Barack Obama tried to do.

They made the useful but somewhat flawed Obamacare plan a kind of right-wing touchstone.

Their ideas don’t have legs. COVID 19 is changing attitudes towards healthcare. When the pandemic ends, that will translate into more modern policies for healthcare. There is nothing the conservatives can do about it.

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31 responses to “Thank God for Medicaid Expansion

  1. I’d wait for the final results from the socialized medical systems in the UK, Spain and Italy before jumping on the Medicare for All bandwagon. Our government, at all levels, has botched the COVID-19 response. Why would expect better results if those same government entities were put in charge of all healthcare?

  2. I didn’t exactly call for an enormous single payer system. All i said was that expanding medicaid was a good idea.

    • When we do that, let’s also take note of South Korea and Germany – and as Peter says – universal is not single payer. There is not a single Govt Doctor in the Medical providers of Medicare much less Medicaid.

      • YES, YES, YES!
        Why do people equate public payment for public ownership?
        But even still, two of the most highly rated medical systems in this country, as rated by the patients in those systems, are the VA and the military. And those are publicly owned.

  3. Medicaid expansion is baked into the cake now. Once an entitlement is granted, it can’t be taken away. Maybe we can turn our attention now to reforming the health care system in order to halt runaway cost increases and improve the quality of medical outcomes — something we should have been doing all along.

  4. Jim. Reasonable observation

  5. Pretty freaking obvious. I post something negative about the administration, hop in the shower, and when I come back you’ve posted something positive about the same folks that has the added advantage of pushing my story off the top, down “below the fold” in the parlance of our trade. That was intentional, Peter. Would have said so first in line but had to go to store. (Good news, 600 fuel points. Bad news: only bought six gallons. Sorry, VDOT…..)

    As all the Republicans are aware, it was votes from their Caucus and the decisions by Kirk Cox and Chris Jones that changed the course. They paid a deep price within the party for doing what they perceived as the right thing. Partisan Peter won’t mention that, ever. Or Larry.

  6. re: the “right thing”. for who and who judged whether it was the “right thing”? I’d posit that the GOP did the “right thing” according to their own party orthodoxy – and the voters decided that was not what they wanted.

    I call that Democracy in action.

    And this pandemic has proven just how critical it is for anyone who might be affected might well decide to NOT seek medical help because they could not afford it. That’s WHY Northam acted to assure anyone on Medicaid to go to the doctor right away if they felt infected.

    This is one more thing that is not readily noticed that is going to check health care in Virginia and in a way that might please the free-market competition types and that is portable electronic medical records that no matter what provider the Medicaid folks go to – they can pull up their record.

    If that kind of a world, post-pandemic, it allows please to CHOOSE what providers to go to AND to “shop” for quality and cost.

    Medicaid is “portable” – no matter where the recipient works – between that and electronic medical records, it has the potential to change health care in good ways – in ways that those who opposed the expansion might even agree is a good thing!

    Now, I realize what was said above was horribly partisan.. tsk tsk

  7. A couple of three days ago, I published a comment with 3 maps; 1) a map of the States with Medicaid Expansion, 2) a map of Red/Blue States, and the Kaiser Family map (that one was unlabeled) showing the counties most at risk from this infection. With the exception of NYC and surrounding counties, the three maps were nearly identical.

  8. johnrandolphofroanoke

    658 days until Ralph turns back into a pumpkin.

  9. Get a grip, steve. I did not post this to knock you down. You didn’t enter my mind. Given that you are new to blogging. It is the way it works. Somebody gets an idea and posts it. In now way does the sequence if my post diminish your work

    • Two years of steady activity now, and my practice is to wait a while and give somebody else’s piece time to marinate before taking over the top. No good deed goes unpunished.

  10. Well, bully for you! I have been blogging for 15 years or so including stints at BNET, CBS news snd the Post. What you describe is NOT how it works. I got my idea this morning snd put it up. I have too many other things going on in my life worry about a batting order

  11. Jim is right that Medicaid expansion is baked into the cake now. There are still 28 million non-elderly uninsured. Many policy people were worried about how the uninsured would react if they had symptoms. Not get tested? Ignore symptoms and hope???
    Then Friday the Feds announced that hospitals cannot refuse uninsured virus patients and the Feds would reimburse providers at Medicare rates.

    My policy choice goes further than Peter’s … not a single payer system right now, but Medicare for anyone who wants it. A choice that is not predicated on employment. The system we have is much too complicated and costs too much. Let’s talk about how to fix the medicine part … Big Pharma’s control has to go and we need a health directed system, not one that caters to what procedures have insurance coverage.

    • the arguments against this are getting weaker and weaker… We can and should keep the private provider system we have but everyone having some kind of insurance , portable medical records, and choice when getting services benefit everyone and lower costs for everyone and we move away from cost-shifting and the rationale for COPN.

    • Medicare for everyone who wants it. And what about us who are eligible for Medicare Part B and don’t take it because when you do your own cost/benefit analysis, many find that sticking with just the federal employee insurance for retired employees is a much better deal unless one is willing to use an in-network plan? I have a doctor who I have been seeing since 2010, who is not a FEP Blue member. With what we have, I get partial reimbursement. If I switched, I wouldn’t.

      And the bottom line is ever since Obama and many other Democrats lied about the ability to keep your own doctor under Obamacare, I don’t trust anything the Democratic Party says about health care. They will lie and steal just to get an open plan where they gave give free health care (except for federal taxpayers) to everybody who can cross the border without papers and permission.

      • TMT – I guess you do realize that many retired govt employees have BOTH Medicare AND their FEHB insurance and the FEHB insurance often covers what Medicare did not cover.

        For Medicare Advantage – you cannot keep your FEHB insurance.

        • Yes, I have the same understanding as you. We did our own calculations that came to the conclusion that we should just use FEP Blue and not take Medicare Part B. My wife was given the same advice from an OPM counselor before she retired and both her and my financial advisors have drawn the same conclusion. We’d both need to suffer catastrophic problems that required us to pay the family out-of-pocket maximum each year to offset paying both sets of premiums (Part B and Insurance).

          For federal retirees that were low on the totem pole or who believe all of their needs can be satisfied within a network may do OK buy keeping their employer insurance (an in-network plan only) and buying Part B. My wife was a successful government attorney and was a GS-15 for more than 25 years. I have a good friend who was SES and she and her husband follow the same strategy.

          I just want to be left alone. I don’t want any single payer or Medicare for All plans that would make us worse off. I’d love to confront Sanders about this face to face. I’d verbally cut him a new one.

          • was not aware that GS grade made any difference in FEHB insurance.

            But FEHB insurance, not even the high option pays everything and so Medicare Part B combined with FEHB high option covers more especially if you have a major illness.

            Most Medicare B premiums are around $134 a month unless you are in higher income bracket then it’s $300 + or so.

            There is no guarantee that FEHB nor Medicare will not go up.

            Medicare for all is a proposal from the left, It has no chance of being implemented. What is much more likely is public option for those who do not have insurance… in combination with ACA – Obmacare and MedicAid.

            Didn’t know if you knew – Medicare Part B is 25% premium share and the govt picks up the 75%.

            Medicare is just like FEHB when it comes to providers – they’re all private practice not govt.


          • TooManyTaxes

            Pay grades, like everything else that affects post-retirement income, has a significant impact on the cost for Medicare Part B. If an upper pay grade federal retiree has a good coverage health plan and also pays for Medicare Part B, the costs of the combined premiums would exceed the cost of the out-of-pocket insurance caps unless the insured(s) have major medical expenses.

            If the retiree can go completely in-network, the combined premium expenses for health insurance and Part B may work. But think about it, if you travel, even just in the U.S. and have an accident or sudden illness that requires an ER visit (which could be followed by hospitalization), the EMTs may well take one to an out-of-network hospital. Then it’s all out of pocket. That’s a big risk for retirees who remain active, especially when they travel.

            My problem with the Democrats is that they don’t attack those who demand single payer or Medicare for all. That tells me that they’d give up private insurance for those who have, especially if the could give free coverage to illegal immigrants. If I saw my Congresswoman Jennifer Wexton, who supported Sanders in the Virginia primary, I’d verbally cut her a new ===^^^^.

  12. First.. Medicaid isn’t insurance, it’s a welfare entitlement program.
    Unlike many I sacrificed and made good personal decisions, used cars, leftovers for lunch, no drugs smoking liquor gambling etc… you guys know the litany.. I was able to keep my concierge physician although I didn’t get the 2500 saving Obama knowingly lied about.
    Do we have a better system now.. NO.. the free market ALWAYS does a better job.. Glad I’m not in the mediocre medicaid system
    Now I get to help pay for all of the irresponsible.. who could have what I have but at this very moment are at their local convenience story buying lottery scratchers!!

    • Medicaid IS also a “single-payer” system with private sector providers.

      And there are things it “covers” and things it does and other things that require co-pays for those who have incomes.

      Medicaid is basic safety-net health care and it exists primarily because, like it or not, we all pay for the health care of those who do not have private sector insurance or Medicare or the ACA.

    • @Top-GUN – you may want to take a look at who is actually receiving Medicaid – it may not change your view but it might add some more info to the subject:

  13. Pingback: Thank God for Medicaid Expansion – Virus News Network

  14. Larry,,, you are a typical liberal,,, you can’t stay on point..
    The point is ,,,Medicaid is not insurance, it’s entitlement welfare. .,, and most of the folk you show getting this welfare are “poor” and don’t have insurance because they or their parents have made bad personal decisions about, spending, eating, drug use, lottery ticket purchases and any other bad habit you wish to name…
    Now I will add to this and point out that Medicaid, and a host of other federal welfare give away programs are UnConstitutional, many dating back to the days of FDR… And as I have mentioned, when you subsidise something you just get more of it…

    • Oh Tom, can you be more creative than just saying “liberal”?

      Medicaid is as much insurance as is Medicare and of that matter Employer provided.

      Do you not have any govt-provided insurance ?

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