JC Hernandez column: To improve health care, Virginia has better options than expanding Medicaid

Worst of all, those on Medicaid may be no better off than similar patients who are uninsured.

It’s past time to ask if we’re getting our money’s worth from a program with spending now approaching $600 billion a year. The answer is clear. We’re not.

Researchers from MIT, Harvard, and Dartmouth found that Medicaid recipients receive only about 20 to 40 cents of benefit for every dollar spent. Insurance companies, not low-income citizens, are the biggest winners of Medicaid expansion. Kaiser Health News recently reported that Medicaid insurer profits more than tripled in 34 states and the District of Columbia after Obamacare’s Medicaid expansion.

We agree with Gov. Ralph Northam that Virginians should have quality care at an affordable cost. But Democrats have become so invested in the single-minded pursuit of expanding Medicaid that they’re losing perspective. When a hospital in rural Virginia closed, Democrats opposed emergency legislation to speed its reopening in a failed effort to pressure some Republicans to vote for Medicaid expansion. Keep that in mind the next time you hear them talk about expanding access to health care.

If Northam and the General Assembly are serious about doing something to keep Virginians healthier, here are a couple ideas that work better than Medicaid and cost a whole lot less.

Virginia could join the 22 states (and neighboring D.C.) that have eliminated scope-of-practice restrictions blocking nurse practitioners and physician assistants from fully utilizing their medical training to take care of patients. Nationwide, 234,000 nurse practitioners provided primary care during 1 billion patient visits in 2016, according to the American Association of Nurse Practitioners. With the United States facing a doctor shortage, making better use of all medical professionals would expand the availability of quality care while driving down costs. And studies have shown that primary care provided by nurse practitioners and physician assistants is just as effective as that provided by M.D.s.

The commonwealth could also get rid of its certificate-of-need law, which requires health care providers to get state permission before offering new or expanded services. Justified as a way to avoid expensive duplication, in reality they fail patients by protecting the turf of existing providers and driving up costs. A study by Mercatus Center researchers Thomas Stratmann and Mathew Baker showed that patients in states with certificate-of-need-law restrictions on medical technology such as MRI, CT, and PET have fewer choices and are much more likely to have to travel out of state for their procedure. That means longer waits and higher costs. Certificate-of-need laws literally kill people.

Expanding Medicaid will leave Virginia taxpayers holding the bag or force us to retrench, as has happened in state after state after state. Massachusetts now spends 40 percent of its budget on Medicaid. Ohio’s costs for its expansion are double original estimates. And the federal share of these costs is going to decline over the next few years under Obamacare, even absent any other action by Congress to rein in costs, meaning states will pay more.

There are better ways to expand health care coverage. Northam and the Assembly ought to get busy expanding scope of practice and repealing the certificate of need law instead of wasting precious time and money chasing the fantasy of a Medicaid cure-all.