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Medicaid Expansion Passed by Virginia General Assembly

Posted by Chip Block on June 4, 2018 9:30 AM EDT
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Despite a vigorous debate for many months, absolute support from the newly elected Virginia governor and much political gamesmanship....

...Virginia has become the 33rd state in the U.S. to accept the benefit of federal tax dollars to expand Medicaid coverage to an additional estimated 400,000 newly-qualified.  So, what does that mean...and how does someone like me who has written on this topic many times in this blog space feel about it now?

My answer to both questions is a resounding "I'm not sure"....

Here's what I mean.  I have not been a blind supporter of Medicaid expansion for Medicaid expansion's sake.  It has always felt like it was important to do.  At least it's important from the humanitarian perspective.  It seemed wrong to tax citizens an incremental tax at the federal level and not provide a benefit back to the state, in this case, Virginia.  And having seen Medicaid taken away for a large percentage of the population it's always seemed to me to be fair to give it back.

But what I am not sure about is what really changes.  Most of the editorials I have read, even two fine ones that were published in The Virginian-Pilot last Sunday (Sunday, June 3rd Opinions section of The Virginian-Pilot included a fine editorial board lead editorial and an equally fine offering in the Other Views section as an op-ed piece by Gordon Morse) have stopped short of acknowledging that there will be changes that will forward better health care at lower costs, better access and that will lead to better health for the  Medicaid-insured population than would be the case without it.

So, until I read about or hear about the fine print requirements that were effective enough changes to Medicaid that it could garner solid support from enough Republicans that the bill would pass, then I remain "unsure" about the impact Medicaid expansion will have on improving the general population's health in Virginia-and reduce the health care cost burden of the specific Medicaid expansion's beneficiaries.

I'm hoping that the expansion will look more like the managed services portion of Medicaid.  That it will require healthy living plans, compliance, accountability and transparency for the beneficiaries of Medicaid.  I'd like to see that this population becomes a kind of control group for an innovative and expandable/repeatable solution that can be expanded to Medicare and to the broader population as well.  

For you see, I don't see insurance as a way to drive fundamental improvement in population health.  Nor do I see it as a trigger for a fundamental change in the cost and quality of health care itself.  Until those two things are dealt with in powerfully new ways...and in ways that can be sustained and rapidly adopted across the entire country, then I will continue to answer "I'm not sure" if my advocacy for Medicaid expansion will really be positively satisfied.  And on the topic of transformational change, one question I can answer that "I'm sure" about is this one:  "can there be a dramatic improvement in population health?"  By a leap of faith and evidence of other solutions that may seem equally more difficult, I say "I'm sure" it can happen....but now sure when, and how and by whom. 

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