ARLINGTON, Va. -- The patient had been managing his high blood pressure with medicine prescribed by his doctor until he lost his job and his insurance. As a childless adult, he did not qualify for Medicaid under Virginia's formula, so he cut his medications in half to extend his supply.
What happened next is one example of why the legislature's upcoming vote on revising Medicaid qualifications matters so much to so many.
The patient “had a severe headache and was taken to the emergency room,” said Dr. Basim Khan. “He had suffered a stroke." The stroke left him paralyzed, thereby qualifying him for Medicaid. The state is now picking up half of his Medicaid tab.
Khan, a physician at Alexandria's Neighborhood Health Services, Inc. a clinic in Arlington, VA, said he sees many cases like this--people who make just enough money to be above Virginia's threshold to trigger Medicaid assistance, but not enough to afford health care insurance.
Khan says his clinic serves 13,000 patients a year, 80 percent of whom are uninsured. Another 150,000 uninsured patients attend clinics in nearby counties.
"By and large, these patients are the working poor. They work low-wage jobs, driving taxis, working in restaurants or fast food chains, working in department stores or other small businesses. They make a little bit of money but they don't get insurance and they certainly don't have the money to purchase it," Khan said.
Latino Virginians top the list of the state's uninsured, according to Deshundra Jefferson of Virginia New Majority. Although they represent only 8 percent of the state's population, Latinos represent 33 percent of its uninsured, followed by African and Asian Americans, each at 17 percent, and European Americans at 11 percent.
Jefferson and Khan argued the case for expanding Virginia's Medicaid formula at a recent convening of ethnic media hosted by the Virginia Interfaith Center for Public Policy. Estimates are that Medicaid expansion could put health care within reach of 400,000 uninsured Virginians.
Revising the Medicaid formula is now part of a larger partisan debate in the state legislature over multiple issues, including increased transportation funding and automatic restoration of voting rights for non-violent ex-felons.
The partisan vote count on Medicaid is shifting towards expansion but timing is crucial. The legislative session ends on Feb. 22. A few of the 20 Republican senators, including the influential Senate Finance chair, joined 20 Democrats to craft a bi-partisan budget amendment that passed Medicaid expansion by voice vote. The state's lieutenant governor, a Republican, also supports the expansion.
The newly proposed Senate budget would require Virginia to put in an initial $1.1 billion into next year's budget but get reimbursed by the federal government under the Affordable Care Act. The state would still have to cover $137 million in administrative costs spread over the next 10 years. Marco Grimaldo, CEO and president of the Virginia Interfaith Center for Public Policy, says the benefits Medicaid expansion would bring to the state are compelling -- including making health insurance available to the elderly, disabled and childless couples like the stroke victim.
"Virginia is stingy when it comes to helping low income people with Medicaid," says Grimaldo. Only six states have a more restrictive Medicaid formula according to data from the Kaiser Family Foundation.
Most of those who will benefit from Medicaid expansion in Virginia earn between 30 percent and 100 percent of the Federal Poverty Level (FPL). The FPL takes into account family size. For example, in Virginia, if the adults in a family of three collectively gross $5,800 a year, or just slightly more than 30 percent of FPL, the family is ineligible for Medicaid assistance. Up to a yearly gross income of $19,090, or 100 percent of FPL for a family of three, the state would still not provide Medicaid assistance.
If Virginia opts in for Medicaid expansion now, the federal government will pick up the full costs of covering those in the gap for three years, from 2014 through 2016. Thereafter, the state will never pay more than 10 percent of those costs, "a very good deal for Virginians," Grimaldo notes.
The governor had stripped the $1.1 billion out of his submitted budget, so Medicaid expansion advocates like Grimaldo, Khan and Jefferson are urging the entire legislature to restore those funds as the Senate has done. If it does, the governor could veto the budget, requiring another legislative vote to override.
Grimaldo is optimistic. "On really key votes on certain occasions," he says,"we have seen bipartisan agreement."