Virginia’s uninsured rate dropped after Medicaid expansion, new report finds

The rate of low-income Virginians without health insurance dropped more than seven percentage points since state lawmakers voted to expand Medicaid in 2018, according to a new report from the U.S. Department of Health and Human Services.

Virginia was one of five states, including Maine, Utah, Idaho and Nebraska, that extended Medicaid and subsequently recorded an increase in coverage among some of its poorest residents, researchers found.

Enrollment on the federal health exchange has also risen since 2020, leading to an all-time low in the national uninsured rate. Currently, only 8% of Americans are without health care coverage, according to the report. 

“No one should worry about whether they can pay for their doctor or choose between paying rent and filling a prescription,” President Joe Biden said in a Tuesday statement. “Today, we are closer than ever to making that principle a reality.”

The drop in the state’s low-income uninsured rate is just the latest sign that Virginia’s long fight to expand Medicaid is paying off. Before 2018, the state was known for having one of the most restrictive programs in the country, limiting coverage mostly to children and disabled adults. At the time, childless adults weren’t eligible, and working parents were only covered if they were making up to 30% of the federal poverty level — an income of roughly $5,727 a year, The New York Times reported.

The Affordable Care Act empowered states to extend Medicaid to adults earning up to 138% of the federal poverty level, or roughly $18,754 a year. But Virginia Republicans opposed the measure for years on the grounds that it would increase state spending. The vote to expand the program came only after a concerted lobbying effort by the Virginia Hospital and Healthcare Association and a near loss of the GOP’s majority in the state’s House of Delegates, with voters listing health care as a priority issue.

More than 400,000 Virginians became eligible for coverage after the decision, and statewide Medicaid enrollment swelled to more than 550,000 during the COVID-19 pandemic. It’s likely that number will decline with the expiration of federal waivers that prevented states from disenrolling residents during the public health emergency, but health advocates still describe the extension as one of Virginia’s most influential policy decisions.

“Medicaid expansion has been a godsend from the very beginning,” Virginia Health Care Foundation Executive Director Debbie Oswalt told the Mercury last summer. “I think it ranks at the top, by far, of any other health care initiative in the state.”

The federal report released this month calculated the decline in state-level uninsured rates using newly released data from the National Health Interview Survey — a series of household interviews collected by the Centers for Disease Control and Prevention — and statistics from the U.S. Census Bureau. Because the pandemic affected the quality of census data collected in 2020, researchers used publicly released estimates to calculate the change in coverage among a sample of more than 8,600 Virginians.

Other studies have also highlighted the importance of Medicaid expansion in Virginia. A recent survey of enrollees, for example, found that respondents were around one-third less likely to be worried about typical health care costs and a quarter less likely to be concerned about catastrophic health care events.

Since expanding Medicaid eligibility, Virginia policymakers have taken additional steps to strengthen the program, including extending coverage up to a year after childbirth. Virginia is also in the process of creating a state-run health marketplace and reinsurance pool for high-cost patients in an effort to lower premiums on the exchange.