Tens of thousands of impoverished Virginians are stuck in a gap between state and federal health care rules — and Obamacare isn’t helping, Watchdog.org reports.
Medicaid covers state residents whose income is less than 51 percent of the poverty level. But Obamacare’s subsidized insurance exchanges don’t extend to anyone below the poverty line.
That leaves individuals in the $5,600-$11,000 income range in an uncovered gap. Ditto for families whose incomes are between $14,061 and $27,570.
“Congress wrote the law that way,” said Robert Graboyes, a senior research fellow at George Mason University’s Mercatus Center. It effectively tells Virginia: “Expand Medicaid or a big chunk of people will be out of the cold.”
The state’s Medicaid Innovation and Reform Commission will hear public testimony Tuesday in Richmond. Commissioners contacted by Watchdog say they’re keeping their options open.
“There has been talk about granting waivers to put (uncovered individuals) in various benefit and provider network structures,” said state Delegate Steve Landes, vice chairman of MIRC. The Verona Republican said he’s waiting to see what the “total fiscal impact will be.”
The state Department of Finance estimates Medicaid expansion will cost the state’s taxpayers $137 million through 2022. Officials caution the figure could be off by millions, depending on who rolls into the program.
Meantime, Medicaid costs have been soaring in Virginia — up 19.9 percent between fiscal 2011 and fiscal 2012.
Dr. Carrie Triepel, an orthopedic surgeon from Virginia Beach, said merely expanding the current system won’t improve health care because more doctors are turning away Medicaid patients.
“How does increasing the number of Medicaid patients by 250,000 to 400,000 help patients obtain health care?” she asked. “They get a Medicaid card with no clear access to care. Insurance is not assurance of care.”
Graboyes said current health care rules create “perverse circumstances.”
He notes, for example, that a family of four with a household income under $14,061 (51 percent of the poverty level) receives Medicaid. A like-sized family making $27,570 (at poverty) becomes eligible for Obamacare exchanges, with subsidized premiums as low as $480 a year.
But “gap” households between those incomes get neither. Graboyes envisions scenarios in which Medicaid recipients make calculated decisions not to increase their income, lest the higher earnings disqualify them.
“Virginia is in a terrible situation,” Graboyes told Watchdog. “There’s a temptation to surrender (to Medicaid expansion).”