Medicaid expansion may be the most important thing the General Assembly has done in a generation

November 20, 2019 12:01 am

Lawmakers and Virginia officials attended an event in Alexandria Wednesday to announce that 300,000 people signed up for Medicaid under expansion. (Katie O’Connor / Virginia Mercury)

Making policy is often pretty bland and frustrating. Long hours and detailed analyses often lead to an endless spool of problems to solve, and results that can take decades to fully grasp. A hundred years ago, Max Weber called it the “strong and slow boring of hard boards,” and that’s not because he was particularly riveted by carpentry.

But every once in a while, things move fast and results come quickly. Medicaid expansion could very well be one of those rare situations. As more data accumulates and more studies come together, it’s beginning to look like the expansion of Medicaid under the Affordable Care Act is one of the most important advances in public health in nearly a generation.

A new study in the National Bureau of Economic Research shows that, if every state had expanded Medicaid under the Affordable Care Act, more lives would have been saved in 2017 than were saved by seatbelts. In fact, just for people aged 55 to 64, Medicaid expansion in every state would have saved more than 13,000 lives in 2017. That same year, seatbelts, across all ages, saved just under 15,000 lives. We’re just a few years out, and we already have evidence that expanding Medicaid is as effective as one of the biggest public health victories in decades.

The most important way to measure good policy is in how many lives are saved, but it’s not the only area where experts are finding evidence that Medicaid expansion made a measurable difference in people’s lives. The nonpartisan Kaiser Family Foundation periodically conducts a literature review of the latest studies around Medicaid expansion. Their last one took place in mid-August of this year. Here are just a few things they found:

  • Not surprisingly, expanding Medicaid led to more people with health insurance. It also reduced the differences in health insurance between people who lived in cities and people who lived in rural areas, and the differences between people of different racial groups.

  • Expanding Medicaid led to more and earlier cancer detection, more people quitting smoking, and more people getting access to behavioral health care like treatment for addiction.

  • Expanding Medicaid helped hospitals’ financial stability, especially in rural areas. It also increased employment, reduced evictions and even brought down health insurance costs for people buying private coverage.

  • Notably, opponents of Medicaid expansion had complained that states would eventually be on the hook for health care costs that would outpace state budgets. But looking at states that have expanded so far, the evidence has shown that the savings from expanding Medicaid have more than covered any additional costs.

The fact that one simple policy change has touched so many different aspects in such a short time is astounding, and rare for a policy area with so many complex moving parts like health care. It proves that the General Assembly in 2018 may have made one of the most important decisions for Virginia’s health and well-being in a generation with the vote to finally expand Medicaid. And it provides a few lessons for future lawmakers.

First, universal health coverage is an important goal – not just for what it means for health care in Virginia, but what it means for economic stability and growth. More stable and affordable health care leads to healthier workers, to encouraging entrepreneurs to start new businesses and to helping vital regional employers like hospitals keep their lights on and their doors open.

Second, sometimes the most direct policy solution works best. Tens of millions of people across the country in 2010 lacked health insurance, and many of them simply couldn’t afford the premiums that private health insurance charged. Expanding public health insurance was a quick way to provide some coverage for those people, and the evidence shows it did that job and more.

Finally, concerns about fiscal responsibility are important, especially at the state level where the budget has to be balanced each year. But fiscal responsibility has to be weighed against the opportunity cost of inaction. For five years, hundreds of thousands of Virginians all across the Commonwealth were left uninsured with no way to get the chemo they needed, or the medication they needed to keep a chronic condition under control and thereby keep their job. For those five years, there was an option on the table, fully-paid by the federal government, that would have drastically improved their lives, and as a result, made Virginia’s economy and health care system stronger.

We’ll never get those years back, and we’ll never get back the lives lost while the state legislature dithered, but we can carry these lessons forward to make health care in Virginia better for the future. We can decide to use what we’ve learned, to take the lessons from the evidence we’ve gathered, and build on what the delegates and senators in the General Assembly accomplished in 2018.

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Brian Chiglinsky
Brian Chiglinsky

Brian Chiglinsky of Falls Church works in health care communications. A former director of speechwriting at the United States Department of Health and Human Services, he has worked in state, local and federal government. His views are his own and do not represent those of any other organization.