In the wake of the 2016 presidential election, a time when the nation is questioning the future of Obamacare, people are enrolling in individual health insurance plans at higher rates than a year ago at the same time. Virginia is no exception. In the first month of 2017 open enrollment, which began November 1, more than 92,000 Virginians signed up for coverage.
Virginia is not among the states that have embraced the Affordable Care Act, opting to participate in the federal exchange and holding out on Medicaid expansion. However, the state’s exchange had the seventh-highest enrollment in the country as of March 2016—that enrollment reflected a 13 percent increase over March 2015.
If the ACA were repealed, there would be 685,000 fewer insured Virginians in 2019, according to a new Urban Institute estimate. Currently, there are about 863,000 uninsured; there would be about 1.5 million uninsured under a repeal as proposed by president-elect Donald J. Trump.
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.
2017 open enrollment rates VA
Consumers will notice changes to Virginia’s federally facilitated health insurance exchange for 2017, but these changes are not as substantial as they have been in some states. As a matter of fact, with 10 carriers offering coverage, Virginia’s exchange is more robust than many.
The ten carriers selling 2017 plans through Virginia’s exchange are as follows:
- Aetna (new plans, replacing Coventry)
- CareFirst Blue Choice
- Cigna (new plans)
- Group Hospitalization and Medical Services
- Health Keepers (Anthem)
- Innovation Health Insurance Company (An Aetna company)
- Kaiser Foundation Health Plan of the Mid-Atlantic
- Optima Health Plan
- Piedmont Community Healthcare (and Piedmont HMO)
- UnitedHealthcare of the Mid-Atlantic
The average benchmark plan premium in Virginia increased 10 percent in 2017, but that is less than half the 22 percent average increase nationwide.
How has Obamacare helped 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.
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: