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Virginia health insurance

Old Dominion State adds a carrier, still without Medicaid expansion

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 – for example, a lack of Medicaid expansion.

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. The state’s scorecard (click on Virginia) includes details on how the rankings are determined.

The 2014 edition of America’s Health Rankings placed Virginia slightly higher at 21st – the state moved up several rankings from 26th in 2013. Virginia’s strengths include low rates of children in poverty, violent crime, and drug deaths. But the state’s ranking is negatively affected by a high prevalence of infant mortality and low immunization coverage among children and teens.

For more details on overall public health and specific diseases in Virginia, check out the 2015 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.

The state elected to default to an HHS-run exchange rather than create its own. Governor Terry McAuliffe, a strong supporter of the ACA, took office in 2014 and has very focused on Medicaid expansion. However, 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. In December 2014, McAuliffe included Medicaid expansion in his 2015 budget, but lawmakers did not vote to expand it in 2015.

How did Obamacare 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 has been only a small reduction in that number.

A Gallup Well-Being poll showed that 12.5 percent of Virginians were uninsured in the first half of 2015, compared with 13.3 percent uninsured in 2013. This number is in line with predictions of a 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 qualified health plans

HHS estimated that 470,998 Virginians were eligible for exchange plans in 2015 and that 355,017 of them were eligible for premium subsidies. By the end of 2015 open enrollment, 385,154 people had finalized their enrollment in qualified health plans through Virginia’s exchange, the sixth highest total enrollment among the 34 states where HHS is running the exchange. 84 percent of them received subsidies to lower the cost of their coverage (nationwide, the average was 87 percent). However, not all of these enrollees paid their initial premiums or kept their plans. As of March 2015, 335,033 Virginians had exchange-based private health plans—this number dropped to 327,026 in June. Of these enrollees, 83.8 percent are receiving premium subsidies.

In 2016, there will be 11 carriers offering health insurance plans through Virginia’s exchange. They include:

  • Innovation Health Insurance
  • Aetna
  • Coventry
  • Optima Health Plan
  • Kaiser Foundation Health Plan of the Mid-Atlantic
  • UnitedHealthcare of the Mid-Atlantic
  • Group Hospitalization and Medical Services
  • Care First Blue Choice
  • Health Keepers (Anthem)
  • Peidmont Community Healthcare
  • Piedmont HMO

The state’s overall weighted average rate increase is 8.5 percent for 2016 health plans.

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. As of September 2015, Virginia remains among the 19 states that have not yet expanded Medicaid — expansion is currently being discussed in Utah.

While Virginia’s governor introduced a 2015 budget that included Medicaid expansion, lawmakers rejected it in the 2015 legislative session. The issue will be revisited during the 2016 legislative session.

For Virginia applicants, 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 2014. From July 2013 through February 2015, Virginia’s Medicaid enrollment increased by less than 1 percent.

An estimated 171,000 people fall into 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 2015, there is no financial assistance available for people with incomes below the poverty level that do not qualify for Medicaid under the state’s existing guidelines.

Medicare in the state of Virginia

Virginia Medicare enrollment trends slightly lower than the total U.S. population enrolled in Medicare – 14 percent of its total population, as of 2009, compared with 16 percent nationwide. The state has also seen a gradual increase in annual spending per beneficiary throughout the past two decades and ranks 14th in the nation in terms of total spending.

Virginians who qualify for Medicare can purchase a Medicare Advantage plan instead of traditional Medicare. These private plans offer additional benefits, and 15 percent of Virginia Medicare recipients selected a Medicare Advantage plan in 2014. About 48 percent of Virginia enrollees have Medicare Part D prescription drug coverage.

State-based health reform legislation

The following is a summary of recent state-level bills related to health reform: