Sunday, March 30, 2014

THE HUMAN IMPACT OF MEDICAID EXPANSION IN VIRGINIA

As the left and right draw battle lines about Medicaid expansion, perhaps Virginians should be concerned about the impact of hundreds of thousands of new patients on health care facilities in the Commonwealth.

Currently, Virginia has about one million citizens receiving Medicaid benefits.  The proposed expansion plan would dramatically increase the number of individuals receiving Medicaid.  If expansion should occur, 400,000 new patients would flood Virginia's health care system and facilities.

Virginia's hospitals and primary care offices are in many cases struggling to keep up with overall patient load.  This includes patients on private insurance and individuals receiving government benefits, like Medicare, Tricare and Medicaid. So, the influx of new patients should be a concern for all Virginians, and not just those on Medicaid or Medicare.

Will Virginia have the capacity to serve current patients and 400,000 new Medicaid patients?  Lets quickly examine some underlying challenges:
  • Facilities:  One must consider how the slow economy has kept many hospitals from expanding bed capacity and purchasing equipment to keep pace with growth.  In addition, many medical laboratories are barely maintaining the ability to service patient test results.
  • Health providers:  Many see the constant call to hire nurses and other specialists.  The demand for physicians is escalating too.  Coupled with a increase in physician retirement and a decrease in medical school residency, the trend is not healthy for having enough care providers to deliver quality health care.
  • Fiscal threat:  These are perilous times for hospital and primary care administrators.  The financial impact of the Affordable Care Act is squeezing the ability of many to stay in business.  This is primarily due to significant cuts in reimbursement from Medicare and Medicare Advantage.  Lee County had to close their hospital due to financial failure.  And, there are other facilities looking for a financial life line.  For instance, Culpeper Regional Hospital is looking for a partnership with the University of Virginia Health System to save their bottom line.
Now, consider what will happen to 400,000 new Medicaid patients.  Will they receive the same choice and quality care as current Virginians?  The short answer is unfortunately - no.  
  • Loss of Choice:  New Medicaid patient's choice of physician will likely be deterred.  Currently, only 1 in 4 Virginia physicians will accept new Medicaid patients.  In addition, only 1 in 3 medical specialists will accept new patients.  This is due to cuts in federal reimbursement to doctors.  
  • Questionable Quality of Care:  Indigent patients traditionally use hospital emergency rooms for their point of access.  Statistics reveal a large majority of Medicaid patients do not use primary physicians to receive preventative care.  They continue to use emergency rooms for all level of care.  Thus, placing them at risk for repeated occurrence of urgent medical visits, which also places an increasing burden on hospital capacity and profitability.
In summary, Virginia's health care capacity is strained with current patients.  The addition of so many new Medicaid patients will severely impact the level of care for all Virginians, including individuals with private insurance and those with government benefits.  Perhaps it is time for the General Assembly to seriously address reforms to Medicaid to assure patients receive the care promised.  Then, consider whether medical facilities have the capacity, personnel and fiscal ability to provide quality health care for Virginians.

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