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The Future of Medicaid

Medicaid is a federal-state partnership that covers health care for poorer children, the blind, aged and disabled. It has grown because fewer employers provide coverage, increased assistance for the severely disabled, and aging baby boomers--Medicaid covers two-thirds of our nursing home population. In Virginia, Medicaid is a 50-50 match and, at 22 percent, is the second largest spending category in the State budget after K-12 education. Despite this growth, Virginia is ranked 47th in the nation in Medicaid spending.

The Affordable Care Act (ACA), or Obamacare, covers 90 percent of the costs for poor single adults from 19-64 years of age. (At 65, Medicare provides coverage.) The Supreme Court unexpectedly decided that states were allowed to opt in. Nineteen states, including Virginia, chose not to accept the funds although Virginia taxpayers were not excluded from paying! A coverage gap now exists for people too poor to qualify for subsidized insurance on

Since 2014, Virginia has decided not accepted these new funds, preventing over 400,000 Virginians from receiving quality routine health care. In the 43rd district, over 1,600 people would gain coverage with expansion. Currently, uninsured people show up at the ER and the hospital is required to serve them, which is expensive and ultimately baked into your insurance premiums. Opposition to expansion is based on the fear that states would be eventually left holding the bag but we have already lost $10 billion and are losing $6.6 million every day.

You have read or listened to the debate about “repealing and replacing” the ACA. The future of Medicaid is a fundamental part of the “replace” promise and led to the defeat of the Trump Administration’s initial effort. There is a lot at stake in this debate. Virginia, and the other 18 resisting states, could lose future billions should the new block grants or per capita funding is sent directly back to the states based on historic spending levels in that state. We will be punished because of our fiscal restraint. I will report on Virginia impacts as the debate in Washington plays out.