Valley leaders clash over Medicaid expansion

By Katie Demeria

An estimated 400,000 Virginia residents would become eligible for Medicaid if the commonwealth decides to expand the program using federal funding. Around 30,000 of those individuals live in the Northern Shenandoah Valley.

Proponents of expansion, including Valley Health CEO Mark Merrill and Northwestern Community Services Executive Director Buddy Hall, say the benefits of providing those individuals with health care are too great to pass up on the opportunity.

Those opposing expansion, however, such as Del. C. Todd Gilbert, R-Woodstock, and Delegate Mark J. Berg, R-Winchester, believe the cost of Medicaid is too outrageous to consider. The burden, opponents claim, will fall on Virginia taxpayers.

The valley is torn over the issue.

Expansion explained

Under the Affordable Care Act, states have the option to expand their Medicaid programs. Expansion would allow adults under 138 percent of the federal poverty level to qualify for Medicaid.

Single adults making up to $16,105 a year would become eligible for the health care program.

26,867 residents in Warren, Shenandoah and Frederick counties, along with the City of Winchester, would qualify, according to the Commonwealth Institute for Fiscal Analysis.

Merrill calls it closing the coverage gap: Those that make enough money yearly not to qualify, but cannot afford private health care plans, will be covered with expansion.

High costs

The Affordable Care Act allows for covering the full cost of expansion in the first three years, and 90 percent of the cost after that.

Berg and Gilbert, though, say they are hesitant to take that deal because they do not trust the federal government to keep its promise.

“That’s just a game to get us on the hook, and once we’re on the hook, it’s going to be Virginia taxpayers who are paying the billions of dollars,” Gilbert said.

Berg said few individuals ever consider the administrative costs associated with expansion. He said an estimate predicted it would cost Virginia $40 million in startup costs that would not be covered by the federal government.

“It’s a budget breaker, and it’s going to come out of education and public safety and grant money to counties and cities that the state would have otherwise given,” he said.

A report detailing the impacts, both negative and positive, of Medicaid expansion in Frederick County stated that the county projects an approximate $1.3 million increase to personnel needs, including increasing staff for the Department of Social Services, which would have a significantly higher caseload with expansion.

“Some people make the argument that it’s causing employment,” Berg said. “What it’s doing is it’s increasing the bureaucracy and the number of people they need in social services.”

Berg added that, though health systems like Valley Health would benefit from expansion, the size of those systems should not entitle them to financial help.

Valley Health could gain $12 million in 2015 with expansion, and $24 million after that.

Without expansion, it would lose $28 million.

“If they’re that big, and they’re becoming a monopoly, maybe we need more competition,” Berg said. “It does not follow that because they’re big, that because they say they’re hurting a little bit, that they should get more compensation from the taxpayers in a program that is not worthwhile.”

According to the Virginia Employment Commission’s latest community profile on the Shenandoah Valley, Valley Health is the largest employer in the area.

In early January of this year, the health system had to cut 33 jobs. At the time, Merrill said the decision not to expand Medicaid in the commonwealth had a significant impact on Valley Health’s revenues.

“We’re talking about people who would really benefit from having access to health care, and the entire state would become healthier overall as a result, saving even more money down the line,” Merrill said. “I’m continuing to make the point that it would be good for the commonwealth.”

Increasing Services

For Hall, expanding Medicare would also allow Northwestern Community Services to hire more individuals to serve the mental health needs of the valley.

Right now, Hall said, few of the patients in need of Northwestern’s support pay their full invoices. He said it causes the organization to take a financial loss.

With expansion, more individuals would be able to pay for their services. Hall said Northwestern would then be able to hire more staff members.

“It would benefit us, but more importantly it would benefit those kids and adults that are right out of the poverty level, are maybe a dollar above it, and don’t qualify,” Hall said.

Medicaid expansion would mean St. Luke Community Clinic, the free clinic in Warren County would be left with only 25 percent of its original patient base — 75 percent would likely qualify for Medicaid.

According to Executive Director Glenn Burdick, the clinic cannot provide service to individuals with insurance.

Despite that prospect, though, Burdick said the clinic is in favor of expansion.

“Initially it could be difficult for us in terms of finances,” Burdick said. “But our stance is that we would favor Medicaid expansion because in the long run I think those patients would be well-served.”

Medicaid expansion may allow the clinic to free up some of its resources and serve the county in other, needed areas, Burdick added, such as dental and mental health.


Ultimately, the Medicaid argument comes down to a difference in principles.

“Many think the Medicaid population is lazy, not motivated, that they’re on entitled programs,” Merrill said. “In reality, 70 percent of the uninsured live in households in which one person works at least part-time or full-time.”

“These are not dead beats that just want to sit at home and not take care of themselves,” he added.

For Hall, providing health care to more individuals will result in a healthier society overall.

“We need to look at it from a humane perspective, and I think we do need to take care of these folks that don’t have the ability, physically, mentally or financially, to take care of themselves,” Hall said.

Berg, though, makes the opposite argument.

“In principle, I’m against redistributing wealth to people that are able-bodied, that are healthy, that are 19 to 65 years old, that are working — when everyone else is struggling in this economy and the area,” Berg said. “To do this when everybody’s hurting, is absolutely wrong in principle.”

“[Liberals] talk about charity by taking, by having the government take someone else’s money,” he continued. “But to say I’m charitable because I want to take somebody else’s money, somebody that has more than I think they need, and give it to someone that I think needs it more, the charity cases I want to give it to — that makes me some special person? That’s wrong.”

“Charity is a personal thing,” he added. “This country was not set up to be just government charity.”

Contact staff writer Katie Demeria at 540-465-5137 ext. 155, or kdemeria@nvdaily.com