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Governor urges Medicaid expansion
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Gov. Terry McAuliffe (right) makes a point during a discussion on health care and expanding Medicaid in Virginia on Tuesday at the Martinsville office of Piedmont Access to Health Services Inc. (PATHS). With him are (from left) Kay Crane, CEO of PATHS; Anjanette Farmer of PATHS; and state Secretary of Health and Human Resources William A. Hazel Jr., M.D. (Bulletin photo by Mike Wray)

Wednesday, March 19, 2014

By BEN R. WILLIAMS - Bulletin Staff Writer

Expanding Medicaid coverage in Virginia simply is “common sense,” according to Gov. Terry McAuliffe.

McAuliffe, along with Virginia Secretary of Health and Human Resources William Hazel Jr., stopped Tuesday at the Martinsville office of Piedmont Access to Health Services Inc. (PATHS) to discuss expanding Medicaid coverage in Virginia.

PATHS CEO Kay Crane told McAuliffe and Hazel that the organization, which has offices in Martinsville, Danville, Chatham and Boydton, has roughly 5,000 patients who potentially could qualify for health care coverage under an expanded Medicaid.

“Every day,” Crane said, “we see what happens when our patients don’t have any kind of health coverage. We have a patient who has end-stage liver failure. ... She can’t get on the transplant list because she doesn’t have insurance which will pay for the expensive drugs she’s going to need once she has the surgery. She came to us ... her son and her daughter-in-law sat in our office and just cried.”

Crane said the woman told her, “‘The General Assembly has signed my death certificate.’”

According to Associated Press (AP) reports, the Patient Protection and Affordable Care Act (“Obamacare”) expanded federal funding for Medicaid, and also expanded the eligibility guidelines.

However, states have the option of accepting the expanded guidelines, an issue that has divided the Democrat-controlled Senate and the Republican-controlled House of Delegates, with the House opposing the expansion.

McAuliffe campaigned in the November election in favor of expanding Medicaid, and he said at that time that he would not sign a state budget that did not include it.

According to AP reports, the Medicaid disagreement caused the General Assembly to adjourn a week ago without passing the $96 billion two-year state budget.

The House Republicans argue that states would have to foot the bill if the federal government doesn’t keep its funding promise. The Obama administration has pledged to pay for the first three years of expansion and no less than 90 percent after that.

Republicans also want to consider the issue separately from the state budget.

A special session of the General Assembly will be held Monday, and McAuliffe said he hopes the decision will be made to expand Medicaid eligibility.

“With your tax dollars over the next eight years,” McAuliffe said, “you’re going to ship $26 billion to Washington. Now we’ll probably get about $6 billion back through the exchanges, but the idea that we would leave $20 billion of our taxpayer money in Washington, not to come back to provide health care for up to 400,000 Virginians, makes no sense. It’s socially and morally wrong.”

According to McAuliffe, actuarial analysis by PricewaterhouseCoopers determined that expanding Medicaid in Virginia would not cost money, but would save $1.1 billion between now and 2022.

Any arguments against the expansion because of its ties to the Patient Protection and Affordable Care Act are irrelevant, McAuliffe said.

“Wherever you may be on the federal health care bill, it really doesn’t matter anymore, because it’s now the law of the land,” he said. “That argument is over. ... The United States Supreme Court decided that last year. We have to deal with the consequences, so let’s bring this money back.”

Failing to expand Medicaid and thereby close the “Medicaid gap,” McAuliffe said, could affect not only patients who need medical services but also hospitals, which often are among the largest employers in their counties.

“The secretary and I, this is our 12th hospital or clinic visit in the last week and a half, and we’re going to do more,” McAuliffe said. “(At) Bon Secours (Maryview Medical Center) in Portsmouth ... the chief medical officer said, ‘If we do not close the gap, this hospital will cease to exist.’”

Lee Regional Medical Center in Pennington Gap already has closed, McAuliffe said, putting an area in need of economic development in a tight spot.

“If you’re a CEO about to move your manufacturing facility,” McAuliffe said, “are you going to put your plant in a county that no longer has a hospital? Your employee’s got to ride 65 miles in an emergency vehicle.”

During the stop at PATHS, McAuliffe heard from two patients who Crane felt had fallen through the “Medicaid gap.”

Anjanette Farmer, who also works at PATHS, said her husband was in a car accident two years ago that left him unable to work.

“I had to make the hard decision to remain out of work completely so he could qualify for Medicaid to receive the care that he needed,” Farmer said. “I did that as long as I could. We survived off of food stamps and a TANF (Temporary Assistance for Needy Families) of about $269. I have two children in the household as well.”

“After that,” Farmer added, “I made the decision that I had to go back to work. But when I did that, that took us out of the area that he could qualify for Medicaid. So he lost the Medicaid.”

“You lost your coverage because you went back to work,” Hazel said.

“Because we had to live,” Farmer said.

Another patient, Gladys Moynahan, said her husband, who was a veteran, died in June. She quit her job to take care of him for the last 10 years of his life.

In November, she said, she went to the hospital and learned that her heart was functioning at only 10 percent of its capacity.

“They took me to (Memorial) Hospital, and I stayed there while they checked me all out, but they put me on oxygen for the rest of my life,” Moynahan said.

Even with the assistance of PATHS, which helps cover the cost of her medications, she still owes $50,000 for the medical attention she received.

She has no way of paying that debt, she said, as she does not currently qualify for the unexpanded Medicaid.

“Right now, my oxygen is over $250 a month,” Moynahan said. “Where do I draw the line? Do I not eat? Do I not buy a medication? Do I not pay a bill?

“Even if I could work, who’s going to hire a 63-year-old woman that’s got to pull this around?” she added, gesturing toward her oxygen tank.

McAuliffe suggested Moynahan contact her elected representatives to urge them to endorse the Medicaid expansion.

“We cannot politicize this issue, because to do so takes these patients hostage,” Crane said. “It affects their quality of life; it affects their ability to be with their families, and we need it now. We can’t wait.”

McAuliffe agreed.

“Keep the politics out of it,” he said. “Keep the partisan ideology out of it. Let’s do the common sense business thing that’s in the best interests of the citizens of the commonwealth of Virginia. That’s what we were elected to do. We were elected to serve, not bring partisan politics in. It hurts our constituents.”


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