The need is self-evident. An Obama administration report, issued before passage of the Affordable Care Act, found children with access to Medicaid had shockingly low usage rates of basic, preventive and screening services. More recent reports suggest a significant improvement, although we believe the data isn’t definitive. The lack of usage is still dramatic.
McAuliffe tried for months to get about 400,000 people added to Medicaid. The General Assembly said no. Now he is aiming to add about 20,000. But, adopting the right mix of incentives — and enforcement — to spur those already covered to use Medicaid would produce a far greater expansion in usage, the supposed goal, than the General Assembly will pass this year.
Access v Usage: This is the key matrix. Without access, there can be no usage. But merely increasing access doesn’t guarantee more usage. Medicaid is now the single largest health insurance provider in America. Among the participants are the country’s neediest populations. But like the health-care industry generally, Medicaid is struggling to adapt to the 21st century.
As often happens in politics, complex policy debates get reduced to shorthand. “Medicaid expansion” — making more Virginians eligible for the program — is now the campaign litmus test. Democratic and Republican candidates are increasingly locked into campaign sound bites as primary season beckons.
However, access to care — “Medicaid Expansion” — is only a means to an end, not an end in itself.
Current data indicates 25 percent to 50 percent of children enrolled in Medicaid “are failing to get … preventive exams and screenings guaranteed by Medicaid,” according to a federal watchdog report.
We believe the statistical data actually understates the preventive care shortfall. Under any analysis, Virginia — while doing a better job than most states — still lags usage goals set years ago.
Bottom line: If we kept access eligibility as is but instead focused on becoming the first Southern state to be a national model for increased usage, the resulting statistical “expansion” would give the governor a noteworthy legacy.
We therefore propose the following bipartisan “usage” challenge. Richmond’s mayor is the state Democratic chairman. It is the largest Democratic city in the state. The mayor’s son sits on the Richmond School Board, as does a key aide to Attorney General Mark R. Herring (D).
Let’s establish a pilot program. Require all Richmond public school students — overwhelmingly from modest-incomes families already eligible for Medicaid — to show proof of an appropriate annual health exam when they show up for school in September. Former mayor Doug Wilder (D) suggested a variant of this proposal 10 years ago, only to be rebuffed.
If students haven’t been given such an exam, one would be provided free of charge. A similar (though smaller) pilot program in the Richmond Public Schools — praised by Education Secretary Arne Duncan, Richmond Mayor Dwight Clinton Jones, Republican health-care leader John O’Bannon and the previous school superintendent — using only private incentives revealed a shockingly high percentage of Medicaid-eligible students with undiagnosed serious health issues.
Three quarters of Virginia students fail basic health, fitness and learning standards. Yet dedicated medical professions remain eager to help, only to be thwarted by outmoded state laws the General Assembly hasn’t changed.
A Medicaid expansion debate singly focused on access will fail more than these unexamined children. Analysis suggests their families likely have similar medical exam histories. We don’t believe the governor should give in to gridlock on access, but focusing on improving usage for existing enrollees would open the door to a historic bipartisan effort and would do far more than merely expand the current Medicaid discussion.