Loudoun County area hospitals have joined a statewide lobbying effort launched by the hospital industry to urge the Virginia General Assembly to expand Medicaid eligibility in Virginia.

The hospitals face an uphill battle trying to persuade local lawmakers, nearly all of whom are Republicans. GOP members in the General Assembly have generally resisted the expansion of Medicaid eligibility in Virginia, citing problems with the program and potential long-term costs to Virginia taxpayers.

Hospital representatives say that expanding Medicaid would help them provide better care to low-income patients and allow hospitals to offset millions of dollars in Medicare payments they lost with the implementation of the Affordable Care Act.

Representatives of Inova and HCA Virginia Health Systems said they are actively lobbying for the expansion of Medicaid eligibility in Virginia. Inova has hospital campuses in Lansdowne and Leesburg, and HCA operates the StoneSpring Emergency Center in the Dulles area and Reston Hospital, which served about 29,000 Loudoun residents last year.

“We are 100 percent advocates for the Medicaid expansion,” said Don Harris of Inova Government Relations. “We see a significant amount of indigent patients at our hospitals in Northern Virginia and . . . a significant percentage of them would be eligible for Medicaid insurance under the expansion of Medicaid.”

Harris said that healthy adults are generally not eligible for Medicaid in Virginia. Most patients covered by Medicaid are children, adults older than 65 or people with disabilities. Pregnant women can also qualify to have some of the costs associated with childbirth covered, he said.

The hospitals support expanding Medicaid coverage to include adults with incomes up to 133 percent of the federal poverty level, many of whom do not have health insurance. This would allow them to be put into Medicaid managed-care plans, “where they would have a primary care physician and then they wouldn’t have to use our emergency rooms for every health-care need they presently have,” Harris said.

Tracey White, vice president of community and government relations for HCA Virginia Health Systems, said that the lack of insurance keeps some patients from seeking treatment until they are very sick.

“They wait until their health is in a precarious state, and they come . . . in a sicker state than they would have . . . had they had insurance coverage,” White said. “They don’t come for care until it’s an emergency . . . and then we are treating a person that is much sicker and therefore ends up costing the system more. If that population has access to coverage, they will use it and generally become healthier because of it.”

Hospitals are also facing a financial hit because of unintended consequences resulting from the rollout of the Affordable Care Act, Inova officials said.

When the Affordable Care Act was being formulated, Harris said, hospitals agreed to cuts in the Medicare payments they receive from the federal government, under the assumption that Medicaid would be expanded to cover indigent care. The Medicare payments help hospitals offset the costs of care they provide patients who are unable to pay. The Supreme Court decision that upheld the Affordable Care Act allowed the Medicare cuts to go forward but left the decision to expand Medicaid up to the states.

“So the grand bargain at the federal level fell apart at that point,” Harris said.

H. Patrick Walters, chief executive of Inova Loudoun Hospital, estimated that the loss of the Medicare payments will cost the hospital $4 million to $5 million next year.

“The hospitals are getting our payments reduced from Medicare pretty substantially, and the federal government’s justification when they set that in motion was the understanding that there would be an expansion of Medicaid to offset the costs in other areas,” Walters said.

“Right now, Virginians and Virginia businesses are paying taxes into the kitty at the federal government, and we have an opportunity to bring those dollars back to Virginia,” he said. “We’re leaving billions on the table that we’re putting in . . . but not taking back out.”

White said that HCA has been reaching out to the business community to explain the benefits of Medicaid expansion.

“If there are large numbers of uninsured coming into the emergency rooms in hospitals and coming into the charity care system, the cost of that has to be borne by somebody,” she said. “And the commercially insured are the ones who ultimately foot a higher bill, because they are paying for those without insurance.”

Del. James M. LeMunyon
(R-Fairfax) said that the hospital industry has “a valid concern about providing care to people who are not in a position to pay.” But he expressed concerns about the long-term costs to taxpayers that could result from Medicaid expansion.

“We need to be mindful that the current Medicaid program, without expansion, has grown 45 percent during the last six years, while the remainder of the General Fund . . . has declined 1 percent during the same period,” LeMunyon said. “Unless current Medicaid costs are controlled, expanding Medicaid will create more problems than it solves.”

Del. David A. LaRock
(R-Loudoun) was more emphatic, calling Medicaid expansion “out of the question” at this time. “Any arguments for the long-term economic viability of this expansion lean heavily on promises from the federal government, and those promises are of tenuous value at best,” he said.

Sen. Jennifer Wexton
(D-Loudoun), who was elected Jan. 21 to fill the Senate seat vacated by Attorney General Mark Herring, is the only Democrat in the General Assembly who represents a portion of Loudoun County. Wexton, who campaigned as a supporter of Medicaid expansion, was not available for comment.