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January 28, 2025

Protect Our Progress and Health Care Access for Over 630,000 People

Good health is critical to our well-being, and having access to health coverage shouldn’t depend on where you live or how much money you have. Virginia’s historic choice in 2018 to expand Medicaid has been a critical safety net for hundreds of thousands of people across the commonwealth since it was implemented the next year. The bad news: Advocates’ hard-won victory is now in jeopardy because of discussions at the federal level to cut Medicaid funding. The good news: State lawmakers have an opportunity to protect the coverage of over 630,000 people so that they do not automatically lose access to care. Lawmakers should act this legislative session to make sure people across the commonwealth are able to access care without the threat of disruption.

Years of community advocacy led to Virginia lawmakers expanding access to Medicaid, resulting in greater access to coverage for adults and children and increased financial security for those who enrolled since expansion went into effect. As of mid-January, 630,740 adults were enrolled under expansion eligibility, including 126,605 parents. Medicaid expansion played a critical role in removing barriers to care for people who are Black, Latino, and multiracial. And families in every locality across the commonwealth are able to access health care through Medicaid expansion, where it plays an especially critical role in rural areas of Virginia. Over 1 in 10 adults (11.1%*) aged 19 to 64 living in rural areas of Virginia have access to health coverage thanks to Medicaid expansion.

Part of what made Medicaid expansion a commonsense choice is that the federal government would pay 90% of the cost, with Virginia covering the remaining 10%. However, during legislative negotiations in 2018 to expand Medicaid, lawmakers added a caveat to the Virginia budget: If the federal government reduced its share below 90%, the state would automatically “disenroll and eliminate coverage” for all people who are enrolled in Medicaid through expansion. Virginia is one of nine states across the country with this “trigger language.” 

Some federal lawmakers have stated a desire to reduce Medicaid funding in one of the spending bills that Congress will pass in 2025 during a special process known as reconciliation. This effort is part of a wide array of proposals to reduce access to critical social safety net programs, which would hurt working families, while continuing to favor the wealthy through harmful tax cuts. If they succeed in reducing Medicaid funding, specifically the money used to help states that have expanded Medicaid, then Virginia will be one of the states hardest hit.

a Black woman wearing a doctor's coat leans across the corner of a desk towards a patient, who is a white woman wearing a pale pink shirt. Her face rests in her hand with her elbow resting on the desk

Disenrollment language in the Virginia budget threatens the health coverage of 630,000 Virginia residents and could have harmful ripple effects across the commonwealth — including putting barriers to health and economic opportunity back in the path of many people of color and people in rural areas, given the critical role that Medicaid expansion plays. Research also shows that when parents go uninsured, their children are more likely to go uninsured, even though they may still be eligible for coverage. Eliminating health coverage for parents could cause new financial stressors to hundreds of thousands of families across Virginia and lead to declining health outcomes for parents and their children.

Medicaid advocates have two big opportunities to safeguard health coverage for the over 630,000 people in Virginia whose access to Medicaid is critical for their health and economic opportunity.

At the federal level, Virginia’s congressional delegation can fight to protect critical health care funding in the upcoming reconciliation negotiations. They can and should work to convince their legislative colleagues that the federal government should maintain Medicaid funding and make sure states are not forced to either terminate people’s health care plans or incur large unexpected costs, creating a significant strain on state budgets. 

At the state level, Virginia lawmakers have some tools available to make sure our neighbors are not abruptly left without health coverage if the federal government cuts Medicaid expansion funding. Lawmakers should strike the budget language that automatically ends Medicaid expansion if federal funds are reduced, as Senator Deeds and Senator Hashmi have proposed. Additionally, this language would kick off legislative action so that state legislators can consider their options and advance commonsense ideas to identify or raise new sustainable revenues to continue Medicaid expansion. One choice alone, a Fair Share Tax on annual taxable incomes over $1 million, would generate $3.1 billion in its first two years. 

Together, we made critical progress in 2018 to advance the health and well-being for so many in our communities. While that progress may be in jeopardy in the coming months, lawmakers can take action now to protect the health care of over 630,000 people in Virginia. Failing to do so would be a significant step back and one we cannot afford in our efforts to become a commonwealth where everyone can thrive.

*The percentage of adults in rural areas of Virginia who access health coverage through Medicaid expansion is likely higher. The Department of Medical Assistance Services suppresses Medicaid expansion enrollment data for smaller localities which undercounts enrolled individuals in rural areas. Enrollment is compared to the adult population in localities aged 18-64 due to data limitations.

Categories:
Budget & Revenue, Health Care

Freddy Mejia

freddy@thecommonwealthinstitute.org

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