Virginia health insurance
The state's health scorecard – and how it might improve under Obamacare
By Louise Norris
August 6, 2014
If you live in Virginia – or you might be moving there – you’re probably interested in issues that impact the overall health of the state’s residents. Numerous factors play into the health of a state’s residents and the availability of services to keep the population as healthy as possible.
We’ve put together a list of resources to help you get a clearer picture of the overall public health and attitudes towards healthcare reform in Virginia.
Virginia health ratings
Virginia was rated 24th among the 50 states and District of Columbia on The Commonwealth Fund’s Scorecard on State Health System Performance 2014 – up three spots from 27th in 2009. Virginia’s Scorecard includes details on how the rankings are determined.
The 2013 edition of America’s Health Rankings also put Virginia right in the middle of the pack, ranking it 26th out of the 50 states. Virginia’s strengths include low rates of poverty, violent crime, and drug deaths. But the state’s ranking is lowered by a high prevalence of diabetes and infant mortality, and a significant disparity in health outcomes based on education level.
For more details on overall public health and specific diseases in Virginia, check out the 2014 listing of Key Health Data About Virginia, compiled by Trust for America’s Health. You can also see county-by-county health rankings in this interactive map created by the Robert Wood Johnson Foundation.
Virginia and the Affordable Care Act
In 2010, Virginia’s U.S. Senators, Mark Warner and Jim Webb, both voted in favor of the ACA. But the state’s delegation to the U.S. House of Representatives was much more mixed: the six Democratic Representatives voted yes, while the five Republicans voted no.
At the state level, newly elected Governor Terry McAuliffe is a strong supporter of the ACA, and is very focused on Medicaid expansion. But the state legislature has a Republican majority (strong in the House, but a very narrow majority in the Senate) and the ACA has been a very contentious issue. The state also elected to default to an HHS-run exchange rather than creating its own.
How did the ACA help Virginia residents?
Prior to ACA implementation, the uninsured rate in Virginia was 14.91 percent. Since the state has not yet expanded Medicaid, there will be only a small reduction in that number in 2014.
Various studies are projecting an average post-Obamacare uninsured rate of 12.45 percent – a reduction of just under two and a half percentage points. Although the state’s uninsured rate will likely fall much more significantly if and when the state expands Medicaid, an uninsured rate of 12.45 percent will be above average, ranking 17th in the nation.
Virginia enrollment in QHPs
In 2013, the Kaiser Family Foundation estimated the potential market for the Virginia exchange to be 823,000 residents, and that 518,000 of them would qualify for premium subsidies. By mid-April, when the 2014 open enrollment period ended, 216,356 people had finalized their enrollment in the Virginia exchange, the eighth highest total enrollment among the 36 states where HHS is running the exchange. 82 percent of them received subsidies to lower the cost of their coverage (nationwide, the average was 87 percent for the first open enrollment period).
Five carriers are offering health insurance plans through the Virginia exchange in 2014, although most counties in the state have no more than three available carriers. Piedmont Community Health Plan will join the exchange in time for the 2015 open enrollment period that begins in November.
Virginia Medicaid/CHIP enrollment
The ACA was written with Medicaid expansion as a cornerstone, but the Supreme Court ruled in 2012 that states didn’t have to comply with this provision, and nearly half the states are still refusing to expand their Medicaid programs. Virginia is one of 22 states that is not expanding Medicaid in 2014, but the debate is far from over and Medicaid expansion will almost certainly be considered again in the 2015 legislative session.
Democratic Governor Terry McAuliffe took office in early 2014, and Medicaid expansion is one of his primary goals. He’s been wrangling with his Republican-led legislature throughout the year, and the issue nearly caused a government shut-down in Virginia when the two sides had trouble agreeing on a budget for the 2015 fiscal year.
For applicants in 2014, Medicaid is only available according to the pre-ACA guidelines: non-disabled childless adults are ineligible regardless of income, and parents with dependent children are only eligible if their household income does not exceed 49 percent of poverty.
Even with such strict eligibility rules, the Virginia exchange had enrolled 48,660 people in the state’s Medicaid program by mid-April. But another 190,840 people – a quarter of the state’s uninsured population – are estimated to be in the coverage gap, with no access to financial assistance with their health insurance. They would be eligible for Medicaid if the state used federal funds to expand Medicaid to cover everyone with household incomes up to 138 percent of poverty.
But at least for 2014, there is no financial assistance available for people with incomes below the poverty level who do not qualify for Medicaid under the state’s existing guidelines.
State-based health reform legislation
The following is a summary of recent Virginia bills related to healthcare reform: