Virginia Bureau Fabricates Quote To Attack Medicaid Expansion

››› ››› DANIEL ANGSTER Virginia Bureau fabricated a quote attributed to the National Center for Policy Analysis (NCPA) to attack Medicaid expansion in the state while peddling other anti-expansion myths. Pushed NCPA Claim That Uninsured Virginians Buy Private Insurance NCPA Study Conclusion Suggests Uninsured Should Simply Buy Insurance. According to a September 20 article, the National Center for Policy Analysis (NCPA) promoted the idea that private health insurance would be available to those who will remain uninsured if Medicaid is not expanded in Virginia (emphasis added):

"There are about 1.7 million individuals living in Virginia with incomes under 139 percent of the federal poverty level, although only about 486,000 of them lack health coverage," said the study by the National Center for Policy Analysis.

"Uninsured Virginians earning just above the poverty level can enroll in private coverage superior to what they would get from Medicaid. Freeing them to seek private insurance will result in better quality and access to care, while expanding Medicaid will impose heavy costs on Virginia taxpayers," the study concluded. [, 9/20/13]

But NCPA's Report Doesn't Include Section Quoted By

NCPA Conclusion: Health Care Benefits "Should Reflect The Preferences And Priorities Of Virginia Taxpayers." The NCPA report does not include the quote attributed to it, but instead says that there are several options for changes to the Medicaid program. The full NCPA conclusion reads:

Conclusion. Medicaid comprises nearly one of every four dollars spent by the state of Virginia, with about one-third of general revenue dollars going towards Medicaid, and is growing at an unsustainable rate. Virginia would be better served to free those earning above 100 percent of the federal poverty level to seek subsidized coverage in the health insurance exchange. For families earning less than 100 percent of poverty, Virginia could tailor its Medicaid program in ways that make sense and meet Virginia residents' specific needs. These services might include selectively covering some optional populations but not others. The program might also involve providing limited benefits rather than an open-ended entitlement to whatever health care is available. In any case, some of this spending would still qualify for federal matching funds - albeit at a rate of about 64 percent, rather than 90 percent. The amount of benefits - and the populations covered - should reflect the preferences and priorities of Virginia taxpayers. [National Center for Policy Analysis, 9/19/13]

Medicaid Eligible Virginians Would Find It Difficult To Afford Private Insurance

Kaiser Health News: Many Who Would Be Covered By Medicaid Expansion In Virginia May Not Be Able To Afford Private Insurance. According to Kaiser Health News, those people who make just enough to be ineligible for Medicaid often do not make enough to cover the cost of private health insurance:

Those who miss the cut for Medicaid face sharply higher costs in a private insurance plan. "You have a very steep cliff," says Judith Solomon, a senior fellow at the Center on Budget and Policy Priorities in Washington. Many might have to choose between insurance and necessities like rent and food, say experts such as Richard Curtis, president of the Institute for Health Policy Solutions in Washington. [Kaiser Health News, 1/5/10] Medicaid Patients See Worse Health Care Outcomes Medicaid Patients "Fare Worse In Terms Of Health Outcomes" Than Those On Private Insurance. According to the article, NCPA senior fellow, Devon Herrick and director of the Health Policy Center at the Independence Institute, Linda Gorman concluded that studies have shown that "Medicaid enrollees fare worse in terms of health outcomes than do similar patients with private insurance." [, 9/20/13]

Medicaid Helps Improve Several Health Factors For Patients

New England Journal Of Medicine: Medicaid Can Help Improve Detection Of Disease And Lower Rates Of Depression. According to a New England Journal of Medicine study of Oregon's 2008 Medicaid expansion, when compared to the uninsured, Medicaid recipients see results in several areas:

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain. [The New England Journal of Medicine, 5/2/13]

Dr. John Lumpkin: "Coverage Alone Will Not Necessarily Lead To Good Health" But There Are Other Benefits Of Expanding Medicaid. In a May 2 Health Affairs blog post, Dr. John Lumpkin, former director of the Illinois Department of Public Health, added that the study found that "expanding Medicaid was shown to substantially reduce depression":

The study in NEJM highlighted the latest data from the experiment. It showed that enrollment in Medicaid, after about two years, profoundly increased patients' use of needed medical services, and vastly reduced the financial strain that previously limited their care.

The use of physician services, prescription drugs and hospitalizations increased by about 35 percent when patients had Medicaid. The probability of having a consistent place to get care, and to receive preventive services and screenings, increased by 50 percent or more.

Having Medicaid had a big impact on family finances. It virtually eliminated out-of-pocket catastrophic medical expenditures for enrolled individuals. It alleviated other measures of financial strain, such as reducing by more than 50 percent the probability of having to borrow money, or having to skip paying other bills because of medical expenses.

One of the most significant findings is that expanding Medicaid was shown to substantially reduce depression. Those who received Medicaid in the Oregon lottery reduced rates of depression by a noteworthy 30 percent compared to those who did not have coverage. This is important, because improving mental health is a powerful gateway to improving overall health.

Each of these factors demonstrates the value of health insurance coverage, but the study's findings show that coverage alone will not necessarily lead to good health. Over two years, those who received Medicaid through the lottery were more likely to be diagnosed with diabetes than those who were uninsured, but their blood sugar levels remained about the same. The same was true for their blood pressure and cholesterol levels. [Health Affairs Blog, 5/2/13]

Oregon's Medicaid Program Expanded Care, Worked Effectively As A Health Insurance Program. According to The Washington Post's Ezra Klein, the study proved that Medicaid "works as health insurance" because Oregon residents who won the Medicaid lottery "got much more health care ... than the residents who lost it":

Here's what we can say with certainty: Medicaid works as health insurance.

That might seem obvious. It's actually not. A big criticism of Medicaid is that it pays doctors so little that it's essentially worthless because no doctor will see you. But the Oregon residents who won the Medicaid lottery got much more health care -- including preventive health care -- than the residents who lost it. They also saw catastrophic health costs basically vanish.


So here's what happened in the first two years of the Oregon Medicaid experiment: Medicaid proved itself good health insurance. The people who got Medicaid used more health care, and seem to have done so smartly -- they got preventive care, they got their diabetes diagnosed and began managing it, treated their depression, and so on. But the health care itself didn't work as well as we hoped -- at least not in terms of cutting rates of hypertension and cholesterol. [The Washington Post5/2/13] Medicaid Expansion Will Force People Off Private Insurance Claimed Private Insurance Would Experience "Crowd-Out" If Medicaid Were Expanded.'s Virginia Bureau claimed that people would be pushed off of private insurance and moved on to the newly expanded Medicaid:

Devon Herrick, a senior fellow with NCPA, and Linda Gorman, director of the Health Policy Center at the Independence Institute, concluded:

  • States that expand Medicaid eligibility to non-disabled adults are likely to experience "crowd-out" - substitution of Medicaid for private insurance. [, 9/20/13]

States That Have Previously Expanded Medicaid Show Little Evidence Of "Crowd-Out"

Center On Budget And Policy Priorities: "Medicaid Expansion ... Not Likely To 'Crowd Out' Private Insurance." The Center on Budget and Policy Priorities (CBPP) reported that states that expanded Medicaid did not see "significantly lower rates of private coverage among" the population of low-income adults:

If critics' claims regarding the extent of crowd-out that will occur under health reform are correct, states that have expanded Medicaid coverage for low-income adults should have significantly lower rates of private coverage among that population than other states. An analysis of Census data finds that this is not the case.

In the 12 states that have expanded Medicaid to cover adults with incomes at or above the poverty line, an average of 23 percent of individuals with incomes eligible for Medicaid have private coverage. In the states that haven't expanded Medicaid, a nearly identical share -- 22 percent -- of the same population has private coverage. Moreover, relative to non-expansion states, the 12 expansion states have a much higher proportion of low-income residents enrolled in Medicaid (53 percent versus 40 percent) and a much lower proportion of low-income residents who are uninsured (21 percent compared to 30 percent). [Center on Budget and Policy Priorities, 6/22/10] "Expanding Medicaid Would Cripple Virginia" Predicted Medicaid Expansion's Cost Would Have A Negative Impact On Virginia.'s Virginia Bureau claimed Medicaid Expansion would ruin the state financially due to the cost-sharing pledge between federal and state government under the expansion:

Expanding Medicaid would cripple Virginia, according to new research that says the state would be better served by moving low-income residents into health-insurance exchanges. 


GOP gubernatorial candidate Ken Cuccinelli and others have expressed doubt the federal government will deliver on its cost-sharing pledges totaling roughly $2 billion per year.[,9/20/13]

Medicaid Expansion Would Cover 430,000 Uninsured, Reduce Health Care Costs And Create Jobs In Virginia

Fairfax County: Medicaid Expansion Would Provide Coverage To Thousands of Virginians. According to a white paper produced by Fairfax County, Medicaid expansion would cover nearly half a million uninsured and would help prevent uncompensated care saving hospitals and consumers money:

  • Beginning January 1, 2014, as many as 430,000 Virginians could gain Medicaid coverage, including 25,000 to 30,000 individuals in Fairfax County.
  • Primarily low income, working adults earning up to 133% FPL (individuals earning below $14,856 per year or families below $30,657 per year), this group also includes children transitioning from foster care and adults with disabilities not eligible for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).


Providing insurance coverage to uninsured Virginians could lower health care costs for all Virginians.

  • Commercial insurance enrollees already pay a "hidden tax" to cover uncompensated care provided for uninsured Virginians. With fewer uninsured, "hidden tax" currently borne by other commercial payers should shrink (potentially $17 million to $24 million annually).
  • Uninsured Virginians would likely receive more preventative and primary care, reducing more expensive emergency care and treatments for sicker individuals. These cost saving potentials have already been documented in a recently published MCV study. [Fairfax County, Accessed 9/23/13, emphasis original]

CBPP: Medicaid Expansion Would Greatly Increase The Number Of Virginians Covered With Only 5.2% Increase In State Medicaid Expenditure. According to the CBPP, Virginia would be able to cover a large number of uninsured for minimal increase in Medicaid spending:

Virginia will spend $1.3 billion more on Medicaid to cover additional enrollment of currently eligible children and parents through 2022 with or without the expansion. The expansion would increase state spending by $1.3 billion. Altogether, this additional spending is just 5.2 percent more than what Virginia would have spent on Medicaid in the absence of the ACA. [Center on Budget and Policy Priorities, Accessed 9/23/13]

Virginia Hospital & Healthcare Association: Medicaid Expansion Would Result In A $3.9 Billion Annual Positive Economic Impact In Virginia. According to a study by the Virginia Hospital & Healthcare Association, when taking indirect effects of expansion into account, Virginia would see an annual positive economic impact of $3.9 billion and add 30,821 jobs from 2014 to 2019:

The total economic impact (direct and ripple effects of healthcare, business, and household sectors) from opting in is an annual average $3.9 billion and 30,821 jobs from 2014 to 2019, more than four times the economic impact of opting out of the expansion. [Virginia Hospital & Healthcare Association, 12/7/12]

Posted In
Health Care, Health Care Reform
Show/Publication Virginia Bureau
State Media
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