Virginia health insurance

VA exchange one of few where UnitedHealthcare remains

  • By
  • Contributor
  • September 18, 2016

Virginia may not be among the states that have greatly accepted the Affordable Care Act, but its residents who qualify for ACA health insurance plans can choose from a more robust selection than most states.

A holdout on Medicaid expansion, the state has retained a slightly higher than average uninsured rate. How has Virginia’s health insurance landscape impacted its residents?

This quick guide to health insurance in Virginia will show how the state fares in popular public health rankings, its current legislative efforts, and its enrollment numbers since the ACA took effect.

Virginia health ratings

Virginia was rated 23rd among the 50 states and District of Columbia on The Commonwealth Fund’s Scorecard on State Health System Performance 2015. The state placed in the second quintile for four out of five categories – Access, Prevention & Treatment, Healthy Lives, and Equity. For Avoidable Hospital Use & Costs, it ranked 28th, placing it in the third quintile.

Virginia’s rank was helped by improvements in the percentage of adults who went without care due to cost and childhood vaccinations. Health factors that worsened in the past year included the percentage of adults who went without dental care and the rate of childhood obesity. View Virginia’s state scorecard for additional details.

The 2015 edition of America’s Health Rankings placed Virginia slightly higher at 21st. Low per capita public health funding was among Virginia’s biggest challenges, but its rating was positively impacted by relatively low uninsured rates, access to dentists, and the number of children who received vaccinations.

For more details on overall public health and specific diseases in Virginia, check out the 2016 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.

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.

Between 2013 and 2016, of all 50 states, Virginia had the smallest reduction in its percentage of uninsured. A Gallup Well-Being poll showed the number of uninsured Virginians dropped 0.7 percentage points from 13.3 percent in 2013 to 12.6 percent in late-2015 – the national uninsured rate fell from 17.3 percent to 11.7 percent in that time.

It is predicted that Virginia’s uninsured rate would fall more significantly if the state were to expand Medicaid.

2017 open enrollment rates VA

Consumers will notice changes to Virginia’s federally facilitated health insurance exchange for 2017, but these changes won’t be as substantial as they have been in some states.

Humana will leave Virginia’s individual market. Cigna will join the individual market, offering both on- and off-exchange plans. Coventry has rebranded as Aetna. And, Virginia is among the few in which UnitedHealthcare will continue to offer exchange plans – HMOs only, however.

In total, 10 carriers will offer 2017 exchange-based plans in Virginia. They include:

  • Aetna
  • CareFirst Blue Choice
  • Cigna
  • Group Hospitalization and Medical Services
  • Health Keepers
  • Innovation Health Insurance Company
  • Kaiser Foundation Health Plan of the Mid-Atlantic
  • Optima Health Plan
  • Piedmont Community Healthcare (and Piedmont HMO)
  • UnitedHealthcare of the Mid-Atlantic

Final rate and plan information will be available on or before 2017 open enrollment begins November 1, 2016.

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.

During the 2016 open enrollment period, the number of Virginia enrollees grew 9.5 percent over 2015 and reached 421,897. Of these enrollees, 37 percent were new to the exchange. By March 2016, effectuated enrollment was 378,838, and 84.2 percent of those individuals were receiving subsidies that averaged $276 per month.

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.

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 July 2016, Virginia remains among the 19 states that have not yet expanded Medicaid.

While Virginia’s governor introduced a 2015 budget that included Medicaid expansion, lawmakers rejected it in the 2015 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 June 2016, Virginia’s average monthly Medicaid enrollment increased by 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 now, there is no financial assistance available for Virginians with incomes below the poverty level that do not qualify for Medicaid under the state’s existing guidelines.

Medicare in the state of Virginia

In 2015, Virginia Medicare enrollment trended slightly lower than the total U.S. population enrolled in Medicare – 16 percent of its total population, compared with 17 percent nationwide. The state spends about $8,127 per enrollee, annually, also just below the national average of $8,970 per enrollee. As of 2009, the state 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 16 percent of Virginia Medicare recipients selected a Medicare Advantage plan in 2015. About 46 percent of Virginia enrollees chose 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: