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July 30, 2015

Medicaid at 50: Looking Good and Capable of So Much More


In 1945, in a special message to Congress recommending a comprehensive health program, Harry Truman wrote: “People with low or moderate incomes do not get the same medical attention as those with high incomes. The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities.”

Twenty years later, the nation adopted a fix called Medicaid. Today, Medicaid turns 50, and in its half century at work, the program has accomplished a lot. It provides quality health coverage for more than 68 million Americans so they can stay healthy and work while protecting their families from going bankrupt because of medical bills. In Virginia, Medicaid provides health coverage for more than 1 million people – mostly children, pregnant women, seniors, and the disabled.

But despite all the progress, President Truman’s description of health care disparity is stubbornly persistent in Virginia, and this is in large part because the state has chosen not to close the coverage gap as part of the Affordable Care Act. As effective as Medicaid is, it’s being prevented from reaching all the people who need it in Virginia.

Back in 2011, Remote Area Medical (RAM) visited Grundy – once called the sickest town in America – located in Buchanan County. Most of its patients were in dire need of dental care and waited in line before the crack of dawn to receive free dental care. Even in Arlington, often ranked one of the healthiest and wealthiest counties in the nation, about 100 people draw a lottery ticket each month at The Arlington Free Clinic hoping to become one of the handful of new patients to receive care. And most recently, more than 2,000 people stood in line to get health, dental, and vision care at the annual three-day clinic sponsored by RAM and The Health Wagon in rural Wise County.

The people served by these and other clinics are among the hundreds of thousands of Virginians who would benefit if the state took steps to close the coverage gap. But Virginia lawmakers’ stubborn refusal is keeping quality, affordable coverage out of reach for all but the most destitute, and then only if they have kids.

While Virginia’s current Medicaid program provides health care coverage for the elderly, disabled, children, and pregnant women, it remains extremely difficult for low-income adults to receive the care they need. Working parents in a family of three only qualify if they make less than about $10,300 a year, and that’s only if they live in the most expensive parts of the state, like Fairfax. In some parts of the state, working parents in a family of three don’t qualify if they make more than approximately $6,600. And childless adults aren’t eligible for Medicaid in Virginia at all. Closing the coverage gap would provide health insurance to single adults with income under about $16,200 a year, or adults in a family of three with less than about $27,700 a year. These hardworking families in Virginia need the security of quality coverage to get health care when they need it.

So far 30 states – including neighboring Kentucky and West Virginia – and the District of Columbia have closed their coverage gaps and used the available federal funding to do so.

With federal dollars covering 100 percent of the cost through 2016 and then gradually tapering to 90 percent by 2020, Virginia should take this opportunity, get health coverage to people who need it, save the state money on health care for low-income Virginians – like other states are doing – and give a boost to the economy.

Medicaid has done a lot to improve the health outcomes of people in Virginia and across the country in its 50 years. But it’s time for Virginia lawmakers to close the coverage gap so the state gets the boost it needs to do even more.

– Rebecca Park, Health Care Advocacy Coordinator

The Commonwealth Institute

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