By Happy Carlock

Janet Bowles worked her entire life until two years ago, when she began receiving Social Security Disability Benefits.

On top of her deteriorating arthritis, Barrett’s esophagus, spine curvature and pulmonary trouble, Bowles is helping raise her 15-year-old grandson. She qualifies for Medicare. But her daughter does not have medical coverage.

“It’s tight enough on Medicare and disability check,” she said. “Then, you try to raise a teenager, and his mother still does not have medical coverage, and she’s not working.”

But if Virginia’s General Assembly votes to expand Medicaid this year, Bowles’ daughter could receive health care coverage. The General Assembly failed to expand Medicaid or pass a budget March 8, the last day of its 60-day session. But it could take up Medicaid expansion again during a special session, which will convene March 24. Medicaid expansion has been one of Gov. Terry McAuliffe’s top priorities this year, but the Republican-controlled House of Delegates continues to oppose it.

Janet Bowles and Rose Salgle support Medicaid expansion in Virginia. They both currently qualify for Medicare. Photo by Happy Carlock

The federal Medicaid assistance program provides health coverage to low-income Americans. Under the Affordable Care Act, citizens under 65 with family incomes up to 133 percent of the federal poverty level will qualify for Medicaid if states agree to an expansion. Only 25 states have done so.

Right now, between 2,800 and 3,000 adults in the Rockbridge Area live around or below the national poverty line and are uninsured, Suzanne Sheridan said.

Sheridan is the executive director of the Rockbridge Area Health Center, which officially opened as a federally qualified health center on Feb. 24. The Health Center accepts patients who are uninsured, as well as those covered by Medicaid. Sheridan said the poorest people in Virginia are the ones suffering the most because they do not qualify for tax subsidies under Obamacare.

“They’re left without any insurance because they have no subsidies to help them with the payment, and they can’t afford the insurance premiums,” she said. “Without Medicaid expansion in Virginia, our poorest people still have no coverage.”

The Affordable Care Act was written with the assumption that everybody living below 133 percent of the poverty line would receive Medicaid. The law did not provide a subsidy for people below the poverty line, assuming they would receive Medicaid. But when the Supreme Court decided in 2012 that states do not have to expand Medicaid under Obamacare, people living below 100 percent of the poverty line were not eligible for subsidies, Washington and Lee Shepherd Poverty Professor Harlan Beckley said.

Many Rockbridge Area residents are uninsured and rely on local hospitals for their medical care through the emergency room. But Sheridan said that would change if the state decides to expand Medicaid.

“Having coverage with Medicaid, they can perhaps find a primary care provider either through a private practice in the area, or through the Rockbridge Area Health Center,” she said. “And they would have the opportunity to have routine preventive health care that they haven’t had in the past.”

Beckley said Virginia hospitals are suffering from the failure to expand Medicaid because they currently have to provide uncompensated care to the poor.

“Should they do it? Sure they should,” he said. “It makes economic sense, and a lot more states are going to do it because the hospitals and others are going to put pressure on them.”

But Buena Vista resident Irene Berselli does not support Medicaid expansion in the state. She is covered by her husband’s private health insurance, and he is a retired federal government worker.

“I think they should focus more effort on prevention than after the fact,” Berselli said.

Irene Berselli attends a dinner at the Community Table. She is covered by private health insurance and is against Medicaid expansion in Virginia. Photo by Happy Carlock

Timothy Jost is a Washington and Lee University law professor and an expert on health care and health insurance reform. He said between 300,000 and 400,000 Virginia residents would qualify for expanded Medicaid.

Jost worries that if Medicaid is not expanded, then many residents will not receive assistance, and two people who have the same job might not have access to the same benefits.

“One of them has a family, and therefore, the poverty level is higher,” he said. “One of them is single, and therefore, the poverty level is lower. The single person would qualify for premium tax credits. The person with the family would not qualify for anything, and that just seems to me to be wrong.”

Jost sees Medicaid expansion as a moral and economic issue.

“We’re talking about billions of tax dollars that are going to be flowing out of Virginia to fund Medicaid expansion in other states and not coming back to Virginia,” he said. “We’re talking about 30,000 jobs.”

Virginia House Majority Leader Kirk Cox said public opinion agrees with the Republican majority that the General Assembly should pass a budget before debating Medicaid, the Associated Press reported.

“That is an argument we think we’re going to win,” Cox said.  “Momentum is certainly on our side.”

But Jost sees the failure to expand as a Republican political tactic.

“The only argument that I’ve heard against expansion is political,” Jost said. “‘We don’t like President Obama, and we’re not going to do it.’ I don’t think that’s enough.”

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