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Medicaid Expansion in Virginia: A Community Discussion

On Wednesday, November 6, the Office of Community Engagement hosted a discussion between students and experts in the medical field regarding the expansion of Medicaid in Virginia, the greater Williamsburg area, and for William & Mary students.

Dr. Alison Scott started the roundtable, delving into a quick history of Medicaid and the implications of its expansion related to benefits and definitions of eligibility. Catered to certain subsets of the poor, Medicaid and its continued development and evolution since its creation have contributed to an increasingly complex system with an “increasingly big price,” according to Dr. Scott.

Expansion of Medicaid programs improved care and access to services, reduced the number of uninsured in rural areas and within vulnerable groups, resulted in an increase in self-reported health, and created state budget savings as a result of the federal-state funding arrangement. As Dr. Scott put it, expansion was undoubtedly positive, but did little to mitigate the complexity of health coverage under Medicaid.It acts as the largest source of funding for medical and personal health services for the nation’s low-income population. For example, 62% of all nursing home care is covered by Medicaid, while nearly 45% of all births in the country are funded by the program. The Affordable Care Act (ACA, or ObamaCare) raised the income ceiling for eligibility, adding more than 400,000 Virginians to the pool who qualify for its services. Virginia finally agreed to expansion in 2018, and 300,000 of that newly eligible crowd had enrolled, a remarkable 75% enrollment rate.

Dr. William J. Mann, Jr., executive medical director at Olde Towne Medical & Dental Center located here in Williamsburg, then described what this expansion has meant locally. While he noted that patient traffic has increased in the last few years, he was careful to explain that after the ACA, the number of uninsured individuals coming in for care actually increased. Dr. Mann pointed to local residents’ reluctance to register their identities with the IRS because they make so little; under the ACA, those seeking Medicaid benefits must have IRS identities and pay taxes on their income. This relates directly to Dr. Scott’s assessment of increasing complexity following Medicaid expansion in Virginia, and regional clinics like Olde Towne are being forced to face that new reality.

Undergraduate Jonathon Lawton (’20) capped off the set of presentations by giving a legislative history of Medicaid expansion in Virginia. Due to heavy Republican opposition until the last year of Gov. Terry McAuliffe’s term, Medicaid expansion was not ratified in Virginia until 2018, nearly ten years after federal passage of the ACA. He also shifted discussion towards implications of the new category of eligibility known as the “Childless adult,” which nearly all William & Mary students are.

Despite the complex nature of Medicaid and health care in general in this country, ACA expansion opens some doors for many college-aged individuals. Taking the initiative to be informed about coverage options for yourself will be crucial going forward, and it certainly needs to be considered when evaluating options for life during and after college, too. Medicaid has now become a part of that evaluation where it once wasn’t, and ought to garner some serious consideration where employer, family, or private insurance falls short.

This discussion provided myself with new insight into a program I knew admittedly little about. It opened my eyes to the expanded possibilities of coverage and changed my perceptions about those who utilize Medicaid services. The timing of the event was particularly pertinent, too, given the day prior, where Democrats managed to flip the Virginia House of Delegates. What does this mean for healthcare policy in Virginia moving forward, and should the political realities of health care in Virginia specifically factor into decisions about which path for coverage to take? Its complexities are as interesting as they are frustrating and confusing; deciding what’s right for you will require equally complex evaluation.

For more information regarding the talk and Medicaid, please feel free to reach out to Dr. Alison Scott, Dr. William J. Mann, Jr., or Jonathon Lawton.

For information regarding the Office of Community Engagement, contact Rich Thompson.