Virginia should follow Maryland's Medicaid expansion example [Commentary]

The Potomac River has long been a symbolic divide between two states with divergent histories and politics. Today, the difference between Virginia and Maryland plays out in Medicaid coverage.

In Maryland, low-income workers — adults living alone making $15,552 a year or less, or a family of four earning less than $31,720 — are eligible for Medicaid. In Virginia, workers with these incomes or lower are most likely uninsured. That's because the Virginia legislature last month rejected Gov. Terry McAuliffe's appeal to expand Medicaid to cover this group. In contrast, Gov. Martin O'Malley and the Maryland legislature took advantage of the Medicaid expansion available under the Affordable Care Act and implemented it starting in January 2014.

While Medicaid coverage is not private insurance, which tends to offer more health care provider choices and better provider reimbursement, Medicaid coverage is far better than no insurance at all. As the Institute of Medicine concluded in its landmark 2001 report with the same name, "Coverage Matters." With Medicaid coverage, low-income workers have access to preventive services and medical care for acute and chronic conditions and prescribed medications. This improved access helps low income workers avoid costly hospital stays and shortens episodes of illness that would otherwise prevent them from working.

Unfortunately, when uninsured workers become ill, they often delay seeking care until they have enough money to pay a provider, or they wait until they are sick enough to go to a hospital emergency room where they cannot be refused treatment.

Medicaid expansion is not only beneficial for low-income workers but it also helps health care providers, insured patients and taxpayers. Without the expansion, health care providers must rely on a convoluted set of federal and state government subsidies and surcharges to insured patients to cover the cost of care for their uninsured patients. In Maryland, because of Medicaid expansion, Maryland hospitals reported treating 62 percent fewer charity care patients and 24 percent fewer self-pay patients in the first quarter of 2014. The Maryland Health Services Cost Review Commission estimates that uncompensated care will fall at least $162 million because 96,000 low-income adults formerly enrolled in the Maryland's Primary Adult Care (PAC) program now have Medicaid coverage. Adults in the PAC program had limited coverage for physician services but relied on charity care for hospital services. The cost of their care in 2013 was covered by surcharges on insured hospital patients; now the Medicaid program pays for their hospital care.

The financial benefit to insured Maryland patients is likely to grow, as more than 330,000 persons enrolled in Medicaid or private insurance through the Maryland Health Connection. Marylanders will see this financial benefit in slower growth in hospital prices and health insurance premiums. In addition, Maryland taxpayers are no longer paying for the PAC program.

The Virginia legislature's vote against expanding Medicaid not only denies 400,000 low-income Virginians improved access to medical care. The vote also insures that Virginia hospitals will continue to provide over $370 million in charity care and $670 million in indigent care. As a result, Virginians will continue to pay higher hospital prices and health insurance premiums to cover the costs of hospital uncompensated care.

Medicaid coverage is a more rational way to provide health care to low-income workers. It allows low-income workers to maintain the dignity of work and address their health concerns in a timely manner without relying on the charity of providers. Charity from health care providers, while admirable, does not provide the range of services patients need and often won't provide treatment to patients until they are so sick, they can't work. Also, health care providers must cover the costs of their charity and indigent care patients by charging their insured patients more.

Virginians should reconsider their decision to reject the Medicaid expansion. They pay the federal taxes anyway; they might as well get the benefits of their tax dollars — both in health and in lower costs.

Dr. Darrell J. Gaskin is the deputy director of the Johns Hopkins Center for Health Disparities Solutions and an associate professor of health. He is also the pastor of Beth Shalom A.M.E. Zion Church in Clinton, Md., and the vice chairman of the Maryland Health Benefit Exchange Board. This article is made in a personal capacity and is independent of his affiliations with Johns Hopkins University, the A.M.E Zion Church and the MHBE. His email is

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