Del. Ken Plum: The Dismantling of Virginia’s Ability to Care for Its Citizens

by Del. Ken Plum July 6, 2017 at 10:15 am 32 Comments

This is a commentary from Del. Ken Plum (D-Fairfax), who represents Reston in Virginia’s House of Delegates. It does not reflect the opinion of Reston Now.

Proposals are now before the Congress to change the Affordable Care Act. While there have been years of rhetoric on changing the plan that got dubbed “Obamacare,” changing it in a way that would continue to extend care to the most vulnerable people in our country has proven elusive. The proposals that have come forward look more like tax cuts for the very rich than health care for the very poor.

Recently, the Board of Medical Assistance Services that provides oversight for the various health care programs in Virginia wrote to Gov. Terry McAuliffe with their concerns about the new federal proposals. Their letter (available here) was very frank in its assessment.

The proposals before Congress they wrote “will inflict a serious cost burden to the Commonwealth, will expose Virginia taxpayers to an increased tax burden, will significantly harm Virginia’s Medicaid program, will derail important medical innovation, and will hobble Virginia’s ability to care for our citizens most in need.”

Most of the letter is devoted to the technical changes proposed in the new legislation that would reduce coverage to Virginia residents while increasing costs to the state. Most of the potential damage stems from the proposed shift to per capita block grant funding, but other technical changes will cost the Commonwealth citizens in services and in money. Using 2016 as a baseline would be especially costly to Virginia.

That provision alone would exclude the new Addiction Recovery and Treatment Services (ARTS) program designed to address Virginia’s opioid epidemic, declared a public health emergency by Virginia’s Health Commissioner Marissa Levine, MD, MPH. Another example is that the per capita cap baseline would exclude Virginia’s $46 million developmental disability system investment that also begins this year.

In a tone that is unusual for a Board made up of professionals and citizens, the letter went on to conclude, “We have attempted to provide some high level examples of the financial damage that the AHCA would inflict on Virginia, but cannot lose sight of the reality of what that means. It is not just the impact on Virginia’s fiscal health, it is also the impact on the health of individual Virginians. That, in the end, is the purpose of Medicaid and of all the other health measures we take as citizens. One of our Board members provides a striking example. She would have to choose between no nursing care for her daughter who receives 12-16 hours per day via Medicaid (their primary insurance nursing benefit is only $500 per year) or pay more than $86,000 per year out of pocket for nursing care, in addition to having to pay for items such as durable medical equipment and medical enteral formula that would no longer be covered by Medicaid. There are thousands of such examples within our Commonwealth.

Finally, we wish to emphasize one more issue: providing help to our fellow Virginians in need, who cannot help themselves, is a moral imperative, a moral test that we cannot and should not fail. We, as the Board of Medical Assistance Services, strenuously and unanimously urge you to oppose the AHCA or any similar bill that inflicts such undeniable damage to our Commonwealth and her citizens.”

Thank you Board for telling it like it is. Hopefully members of Congress, especially members from Virginia, will hear your plea and respond appropriately!

  • The Constitutionalist
  • Chuck Morningwood

    ACHA solution’s to illness: Please die quicker.

    • The Constitutionalist

      Please look up the EMTLA, passed in 1986 by congress.

    • Mike M

      Reality’s bargain: In exchange for life, you are assured death. Have trouble with that? Me too, but I try to keep my head and live within my means.

  • GettingPlummyWitIT

    Kenny, that is a lot of big talk for a guy whose primary responsibility is to focus on Virginia’s 36 district, Reston.

  • Jenny G.

    Thank the lords for Hillary not becoming president, we narrowly escaped the largest fail in human history

    As for ACA and variants/derivatives they are engineered time bombs, we must take care of our own health and body in a loving but serious way. Our public servants better stay guarded as the system could easily vollapse and take many with them
    Take care, ♡

    • RestonAssurance

      The “loving but serious way” doesn’t typically cut it for a late stage cancer or metastasized cancer diagnosis, for most long term illnesses, or for congenital and potentially fatal birth defects just to name a few.

      • The Constitutionalist

        You are certainly correct, and the causes of those illnesses should be treated, not the symptoms.

        Health care in the United States is broken from the bottom to the top. A total re-think needs to be … thought.

        Pre-tax HSA from birth starting in x year until the current system dies. Oh wait, that can’t happen as our entire economy and literally everything the government does relies on the money we make from tomorrow to pay for our spending yesterday.

  • Nigel P

    All very interesting. I’ve now lived in 4 countries – 3 with essentially single payer/state controlled health care systems (UK, France, Canada). I did a quick comparison between the last – Canada – and the current – the USA. Life expectancy – 82 vs 79 years (males 80 vs 76, females 84 vs 81), infant mortality – 4 per 1000 births vs 6 per 1000 births. 2015 data from the UN. It gets even worse once you start digging down into specific populations. Health care costs per year (per capita, in US$) – Canada $4509, USA $9024 (2016). I suspect the real question that should be asked is not why have insurance premiums gone up (again) but why with the highest health care expenditure per capita in the world (more than double other developed countries) does the USA rank last of all developed countries in almost every health care performance parameter? Even Cuba outperforms the USA.

    • Mike M

      When you look at specific populations it gets worse because those tend to be uneducated and poor and possibly rural. Conversely other US populations get better numbers. I think it’s also safe to say that the US subsidization aims higher and is far less efficient as a result. In Canada and the UK there are certain things you don’t expect in the quality of your healthcare. Note that many Canadians and Britons come to the US for high end health care. Finally, look at the ways in which the US wins the numbers game in other areas. There are trade offs. You raise a good question and I think you will find very similar ratios for some educational parameters (cost and effectiveness). But I would also tell you, anything ginned up by the UN will always have an anti-US bias.

      • Nigel P

        Not sure about the UN anti-US bias, these data are usually taken at source (in the case of the US from the CDC, where you will find exactly the same numbers) and then compiled. You’ll also find the same figures on lots of other independent sites, many US based. People move around to get healthcare, depending on availability and wait times. In general it tends to be a small number of people who are looking for treatments not available in their country and who have the ability to pay for what are experimental treatments with questionable outcomes. The point about the figures I used is that with double the per capita expenditure, the outcomes are the lowest of the developed countries. That’s 100% more for less (and of course that’s an over-simplification using population statistics). Which begs the question, where is all that money going? US health care is of course a business, with around 40% of the hospitals for profit according to the AMA, and where the ability to pay is extremely important. It’s also a system where expensive treatments such as cancer immunotherapeutics and chemotherapeutics often stops when insurance coverage ends and it becomes impossible to pay hospital costs. To those in this situation that’s far removed from being a “high end” healthcare system, it’s a “no care” system. The proposed cuts to Medicare will also have a major impact, given that’s currently around 50% of the health care business. Those countries with better health care outcomes than the US generally treat access to medical services as a fundamental right of its citizens and residents, irrespective of income. Or age. Or pre-existing conditions. Higher taxes all round of course, but you get what you pay for.

        • Mike M

          You get what you pay for and I would tell you, other countries get less. In the US there is a wider range. But there are many reasons in the US why there is no free market in healthcare, no genuine competition and the government is usually the problem. Few people go without healthcare here. They get it by means more expensive to everyone else. Also, in the US a huge percentage of our care goes to people’s last year. As another poster said. we need an overhaul top-to-bottom. But socializing medicine is also not the answer as I state below.

  • Chkitout1

    Let’s not forget the enlightening words of the former House Speaker, Nancy Pelosi:
    “We have to pass the bill,” she said, “so that you can find out what is in it — away from the fog of the controversy.”
    What’s good for one health bill is good for another health bill.

  • Reston Realist

    Mike, that was an excellent synopsis…

    • Mike M

      TY, RR.

  • drb

    Ok we have lies and damn lies to work with. I have no problem with the ACA and the Dems owning it. They have made health insurance the worst this country has ever had. It wasn’t going in a great direction before ACA but it did speed up the cost and lower the use of medical treatment.
    Now we have the Republicans ready to to what? Not do what they promised. They promised to do away with the ACA which would throw the whole thing back to the states where it was to start with. Still better than what we have now.
    Now they say they can better manage the Government controlled health insurance industry than their far left counter parts with less leftist policies but still leftist policies to make the left happy. And, themselves since most are closet leftist.
    I suspect they will understand soon enough that if we are to have left wing nut jobs running things then let it be the ones that admit they are left wing nut jobs.
    A famous quote is ” Inside a liberal is a totalitarian screaming to get
    out.”. I do not know who said this first but it seems to find it’s way into many quotes.


Subscribe to our mailing list