Sen. Ryan McDougle: Republicans focus on lower health-care costs and help for those most in need

Created in 1965, Medicaid was intended to be a safety net to provide health care for impoverished children and mothers, the disabled, and some who needed long-term care. Obamacare extends the program to able-bodied adults as a substitute for health insurance, adding hundreds of thousands of Virginians to an entitlement program that continues growing at a fiscally unsustainable pace.

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The president and Congress have been working to repeal Obamacare, but haven’t done so — yet. Having successfully repealed the law’s individual mandate, which required people without insurance to pay a penalty, the Trump administration released its budget plan last week.

The plan proposed repealing federal funding for Obamacare’s Medicaid expansion. Clearly, Washington has not abandoned its desire to end one of Obamacare’s costliest components. The federal government has also been working to alleviate other restrictive Obamacare provisions, examining ways to give states greater flexibility to provide relief from its staggering premiums and exorbitant out-of-pocket expenses.

Gov. Ralph Northam and some legislators remain committed to fully implementing Obamacare regardless of the future of federal support. But, the rate of uninsured Virginians, less than one percentage point higher than the national average, is actually lower than in several states that expanded Medicaid.

Many of the states that opted to expand Medicaid found themselves in a fiscal quagmire, requiring special legislative sessions to close budgetary shortfalls caused by the program. Now that those states must provide funds from their own budgets to underwrite a portion of the cost of expansion, they are finding they have to reduce spending on other priorities.

These reasons alone should provide pause to those considering expansion. Making matters worse, a report issued last month by the United States Senate Committee on Homeland Security and Governmental Affairs paints a troubling picture.

Entitled “Drugs for Dollars: How Medicaid Helps Fuel the Opioid Epidemic,” the report noted that the number of criminal drug fraud cases related to Medicaid was 55 percent higher in the four years after Medicaid expansion than in the four-year period before.

Worse, four-out-of-five of the opioid cases pursued by investigators were in states that expanded Medicaid. But most disturbing of all, deaths from drug overdoses — which are actually lowering average life expectancy in the United States — are increasing “nearly twice as fast in expansion states as non-expansion states.”

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Adopting Obamacare’s Medicaid expansion will do nothing to cut health insurance premiums, reduce out-of-pocket expenses, or lower the costs of medical treatment for Virginians. For those who already have coverage, or who lost their coverage when their existing plans were cancelled because of Obamacare’s mandates, Medicaid expansion will do absolutely nothing.

Who, then, is offering solutions that address the concerns of the overwhelming majority of Virginians? Senate Republicans are.

One day after the federal government announced its proposal to scale back Medicaid expansion funds, Senate Republicans approved a package of legislation to increase insurance choice for areas with only one carrier, expand the low-cost catastrophic care coverage option, and increase the number of waivers for the intellectually and developmentally disabled.

Senate Bill 844, sponsored by Sen. Siobhan S. Dunnavant (R-Henrico) and incorporating a proposal by Sen. Bryce E. Reeves (R-Spotsylvania), would allow Virginians to purchase less expensive “short-term” health-care coverage plans.

Senate Bill 935, sponsored by Sens. Dunnavant and Frank W. Wagner (R-Virginia Beach), would expand the availability of group insurance plans, allowing more Virginians to participate in insurance “pools.” Again, this legislation would make more Virginians eligible to purchase more affordable health-care plans.

Senate Bill 964, sponsored by Sen. Glen H. Sturtevant, Jr. (R-Chesterfield) would allow catastrophic health coverage plans, which provide essential health benefits, to be offered to more Virginians. These plans, which are significantly less expensive than other plans offered under the terms of Obamacare, are currently available only to those under the age of 30. Senator Sturtevant’s legislation would remove this age limit and make the plans more widely available.

Senate Bill 915, sponsored by Senator Dunnavant, addresses funding for Virginians most in need of care, another group for whom Medicaid expansion would do nothing. The bill would prioritize the funding of waivers for Intellectually and Developmentally Disabled Virginians. Senate Republicans have long made funding for these waivers, for which there is a current backlog exceeding 3,000, a top priority. The Dunnavant bill also prioritizes funding for increased mental health and substance abuse treatment.

The Senate approved the Senate Republican health-care package without a single dissenting vote. With Washington considering severe reductions in federal funding for Medicaid expansion, these proposals constitute a sensible — and fiscally sustainable — approach to addressing the health care needs of Virginians.