Medicaid expansion’s positive ripples come as no surprise

August 4, 2022 12:02 am

(Prapass Pulsub / Getty Images)

Veteran newspaper people in Detroit taught me the saying, “No (rhymes with spit), Sherlock,” when I was a young journalist back in the early 1980s.

The profane phrase – I can’t do it justice in a family publication – was used to refer to a headline or story stating something so obvious, so predictable, that it called into question why an editor assigned it. (Think “Gunfire leaves neighborhood shaken” or “Blizzard keeps residents home.” You get my drift.)

Such articles, though, occasionally are defensible. They prove that what politicians or community activists had predicted all along indeed came to fruition.

Which brings me to the recent Virginia Mercury story on how the expansion of Medicaid in the commonwealth under Obamacare – after years of spiteful, obstinate Republican opposition – provided financial security for adult enrollees.

The article was based on research published in the journal Health Affairs. It covered a study by lead author Hannah Shadowen, a medical student at Virginia Commonwealth University. The study was prepared for the Virginia Department of Medical Assistance Services.

This research found that new Medicaid enrollees were more likely to use a doctor’s office than more expensive emergency rooms for their usual source of care. Stress decreased for nonmedical costs, including groceries and rent.

“Non-Hispanic Blacks reported a larger decrease in worries about the cost of normal healthcare after enrolling in Medicaid compared to non-Hispanic Whites,” the study found, “suggesting that Medicaid expansion was particularly meaningful for this group.”

Also, “rural members had a greater decrease in problems paying medical bills and unmet need for prescriptions in the year after enrolling in Medicaid, compared to non-rural members.”

In short, the lives of new Medicaid patients improved dramatically. That’s great for the individuals – and for the state’s image, too.

Well, duh. NSS.

Of course things got better for adults who hadn’t been in the program because of previous restrictions. Of course it’s preferable to have regular doctor visits and practice preventive care than to rush to high-priced ERs when a medical crisis hits.

The state says more than 677,000 adults have enrolled in Medicaid since expansion started in January 2019. Advocates initially believed, before the General Assembly changed course in 2018, that about 400,000 adults with incomes ranging up to 138% of the poverty line would sign up.

The issue is an indictment, too, of Republican state legislators who fought so hard, for so long, to deny access to health care to more adults. In this they were motivated by politics moreso than compassion for low-income Virginians: They were trying to prevent President Barack Obama and Democrats from notching a political victory while sacrificing the health of people who desperately needed it.

The approach was callous – as well as hypocritical, since many legislators participated in a low-premium, high-benefit state plan themselves. A 2014 news account noted the state even covered more than 200 of these lawmakers’ dependents.

Obamacare, also known as the Affordable Care Act, allowed states to expand Medicaid beginning in 2014, and it required the federal government to pay at least 90% of the cost. Republican opponents claimed the feds could renege on paying its share in later years.

That argument was always dubious. For one, states rarely refuse federal funding based on the possibility Washington might cut off the spigot later.

It’s akin to telling an ailing patient that you won’t give him medicine now because it might lose potency in the future. So suffer in the meantime.

The GOP’s craven stance was revealed fully after Republicans nearly lost control of the state House in the fall 2017 elections. Polls at the time showed strong support for Medicaid expansion among Virginians.

The result: Many Republicans broke ranks in the state House in 2018. And four Republicans in the Senate did so, voting 23-17 for expansion. As I noted in a column that year in The Virginian-Pilot, Republicans “surmised the will of the people was finally worth following.”

This week, I tried to reach a couple of state senators who opposed expansion, including Tommy Norment, R-James City, who was Senate majority leader in 2018. Had they revised their opinions now that more of their constituents likely had health coverage?

My messages weren’t returned.

Some 38 states and the District of Columbia have accepted federal funding to expand Medicaid under Obamacare. The dozen holdouts are primarily in the South, including Alabama, Florida, Texas and Mississippi.

The latter is the country’s poorest state, based on its 18.7% poverty rate. A private foundation, the Commonwealth Fund, contends expansion in Mississippi “is a better fiscal deal than ever before, in addition to significantly increasing insurance coverage.”

As you’d expect, Republicans control the governor’s seat and both chambers of the state legislature.

In Virginia, as in the rest of the U.S., annual eligibility reviews of people on Medicaid were suspended during the pandemic. Reviews could resume as soon as October. Once they do, folks could lose coverage if their annual income exceeds limits, though some might have gained health insurance elsewhere.

What we know, for now, is more poor people in Virginia since 2019 have had better health care. They’ve had less stress. They’ve been able to use their precious dollars for other necessities. All because Medicaid was expanded.

NSS? That should now be obvious – even to the legislators who opposed changes to Medicaid.

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Roger Chesley
Roger Chesley

Longtime columnist and editorial writer Roger Chesley worked at the (Newport News) Daily Press and The (Norfolk) Virginian-Pilot from 1997 through 2018. He previously worked at newspapers in Cherry Hill, N.J., and Detroit. Reach him at [email protected]