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!