Hospitals eye another chance for Medicaid expansion in state elections

Posted at 8:19 PM, Nov 02, 2015
and last updated 2015-11-02 20:19:36-05

RICHMOND, Va. — As voters in Virginia cast their votes on Tuesday, the outcome of the General Assembly election could determine whether Gov. Terry McAuliffe gives a push for Medicaid expansion another chance.

Both the House and Senate rejected McAuliffe’s proposal to expand Medicaid earlier this year, eliminating the plan from the state budget. The proposal would have expanded Medicaid through an optional provision in the Affordable Care Act, something that some Virginia health organizations believe could benefit local hospitals feeling the financial strain of providing discounted care to uninsured patients.

“Not only does it hurt their health, but it hurts our rural hospitals and our rural health clinics and our community health centers,” said Beth O’Connor, executive director at the Virginia Rural Hospital Association, about the failed attempt to expand the program. “They’re having to provide a service to that group of people, who should have insurance through Medicaid expansion, but don’t.”

The mixture of discounted care and lack of patients is a factor hurting rural acute care hospitals in Virginia, said O’Connor. In order to handle these budgetary struggles, hospitals are cutting corners by hiring fewer staff members and holding out on buying new equipment. Those kinds of cuts can negatively impact hospitals’ abilities to operate, O’Connor added.

According to the Virginia Hospital & Healthcare Association, 60 percent of hospital patients get subsidized care through federal programs like Medicaid. Seventeen of the 37 acute care hospitals in rural Virginia operated at a deficit in 2013, with one hospital closing.

Julian Walker, Virginia Hospital & Healthcare Association (VHHA) vice president of communications, said that the ACA’s original Medicare-specific cuts, along with an additional 2 percent cut for healthcare from sequestration, have added up for hospitals. According to VHHA, $627 million has been spent by Virginia hospitals on free or discounted care in 2013, which is a 57 percent increase since 2008.

“That’s burning the candle at both ends,” said Walker. Virginia was not originally a proponent of the Affordable Care Act, but as it’s been law for the past six years and has stood up to two Supreme Court rulings. The solution going forward seems to be compromise, said Walker.

“There is a real problem, that problem has far-reaching implications for Virginians throughout the Commonwealth, and we cannot continue to ignore the problem. It needs to be addressed, we need to find policy solutions. And we’re willing to work with anybody to get there,” added Walker.

But Craig DiSesa, director of legislation and accountability for The Middle Resolution PAC, does not agree that more Medicaid legislation is what is needed.

“Your large hospitals, who are doing just fine and make plenty of money, would be the major benefactors of Medicaid expansion. These hospital systems do not need the money. They would love the money, but they do not need it,” he said.

DiSesa points to hospitals’ funding models as part of the problem, saying that the money they used to be making off inpatient care is drying up as less patients decide to stay overnight. An even bigger part of the problem, DiSesa said, is less medical in nature. State legislators should be working on job creation, not Medicaid expansion.

“Focus on those rural hospitals and see how we can create jobs in the Southwest. That’s gonna solve a myriad of problems, if people have jobs,” DiSesa said.

The importance of the Medicaid debate in this election differs greatly between districts. Senatorial candidates Siobhan Dunnavant and Deborah Repp, both medical professionals running in the 12th district, have paid special attention to Virginia healthcare reform in their campaigns.

“The problem with Medicaid expansion is that the cost of Medicaid has escalated at an alarming rate. It’s costing so much that it’s edging out programs like education and could take money that should be going to programs like security and defense in the future,” Republican Dunnavant said.

Having served on the board of trustees for Henrico Doctor’s Hospital since 2009, Dunnavant said she understands the battle local Virginia hospitals face in making profits, but stressed that increased federal spending and influence is not the solution.

“It’s almost a coercion by the federal government to adopt a single solution and that single solution is fraud,” said Dunnavant. “In science we are really careful to create safe interventions before we adopt anything, and I feel we’re not using due process wisely.”

Her Democratic opponent Repp, a retired nurse, believes that failing to expand Medicaid would be more costly, with the impact being “a loss of a billion dollars to healthcare to Virginians, particularly in rural areas.”

“[Republicans] are coming from a strictly ideological point-of-view, not looking at issues based on legality or merit,” said Repp, who said that she’s “overwhelmed” that another physician like Dunnavant would be against Medicaid expansion.

“When we become doctors and nurses we take an oath where we say we will always provide care to anyone who asks us for it regardless of whether we benefit financially or not and my opponent is frankly breaking her oath,” added Repp.

It’s a sentiment that Dunnavant dismissed, saying it was “silly political rhetoric, and I don’t want to engage in political rhetoric.”

By Daniel Parker and Allison Simmons (Special to

EDITOR’S NOTE: has partnered with the iPadJournos mobile and social media journalism project at VCU’s Richard T. Robertson School of Media and Culture. This story was reported by the iPadJournos.