Mary Linn Bergstrom was in Boston over Memorial Day when she got a really bad, eyes-swollen-shut case of poison ivy. “I had to wait to go to the doctor until I had enough money in the bank,” says the 38-year-old Nia instructor.
Bergstrom is one of almost 5,000 people in Charlottesville and Albemarle who will qualify for Medicaid under the biennial budget Governor Ralph Northam signed June 7 that expanded health insurance coverage for nearly 400,000 Virginians who make too little to qualify under the Affordable Care Act or too much—or are too healthy—to qualify for Medicaid.
Her doctor’s visit and medication cost almost $400. “I think it’s pretty common to not have that amount of cash on hand,” she says.
And being in Massachusetts, which passed an individual health care mandate in 2006, people found it hard to believe she didn’t have insurance. “Everyone was arguing with me that of course you have health insurance, you must have forgotten your card,” she says.
Bergstrom makes around $7,000 or $8,000 a year, depending on how many classes she teaches. “My last wellness checkup was 11 or 12 years ago,” she says, and the last time she checked, health insurance would cost her around $500 a month. She lives in a household of three working adults who pay all their bills. “Health insurance is the only bill we cannot afford, or even imagine affording,” she says.
To House Minority Leader David Toscano, Medicaid expansion is a “really big deal” and one he’s worked on for the past five years.
Former Governor Terry McAuliffe made it a lynchpin of his administration, but he left office with no success in the face of a recalcitrant Republican-controlled General Assembly.
That all changed with the 2017 elections that swept 15 Democrats into the House of Delegates. “I began to see the possibilities after the election last fall,” says Toscano. Native son Northam won by nine points—“the widest margin of any statewide candidate. There’s always a number of reasons why, but of all of them I think the election was the biggest.”
Toscano represents all of Charlottesville and parts of Albemarle, and 3,400 people in his 57th District could be eligible for coverage, according to the Commonwealth Institute for Fiscal Analysis. And Toscano says as many as 10,000 could be eligible in the region, a “not inconsequential” number.
Virginia’s Medicaid program is one of the most restrictive in the country, with disabled individuals making more than $9,700 a year ineligible, as were poor, able-bodied, childless adults. The expansion allows people making 138 percent of the federal poverty level—$16,643—to be covered, with the federal government picking up 90 percent of the cost.
The expansion has a work requirement, which Tory Brown, spokesperson for Progress Virginia, says will lessen the gains in coverage and require an expensive bureaucracy to manage. “The work requirement was a bit of face saving for Republicans,” she says. “It’s not really that people are too lazy to work.” For people who have to work to get care but need care to be able to work, she calls it a “catch 22.”
Lena Seville, who ran for City Council in 2015 and has no health insurance, is worried that the work requirement could affect her eligibility for Medicaid coverage. “I’m in the middle of starting my own business,” she says, and whether she can get health insurance will depend on how the work requirements are written.
She says she’d hate to have to give up her volunteer work and new business to search for jobs, “which I already do and it’s hard to get a good fit.” Says Seville, “I was excited, but now I’m cautious. I may not have health insurance when it’s done.”
Virginia Organizing board member Emma Hale points out that a lot of people work full-time and don’t have health insurance. “We have a lot of places that don’t pay a living wage—the university is one of the worst offenders.”
People without insurance often delay treatment, she says, and Medicaid expansion could “prevent people from dying.”
Pam Sutton-Wallace, CEO of UVA Medical Center, doesn’t expect “measurably significant” changes from Medicaid expansion because nearly 30 percent of the hospital’s patients already are either on Medicaid, self pay or are indigent. “What we’re likely to see are more self-pay patients using Medicaid,” she says.
Her concern is whether the newly eligible will have access to primary care. “Some doctors aren’t accepting new patients,” she says. That, and whether emergency rooms will see a drop in the number of patients who wait until the last minute to seek care are “areas ripe for study.”
“I want to take preventive action so I don’t run into problems later on,” says Bergstrom. “We would gladly add in the cost of health care for me if it was a number remotely in reach, but we cannot spend nearly 80 percent of my income on one budget line item.”
The Commonwealth Institute for Fiscal Analysis estimated the number of people who would be eligible for health insurance coverage under Medicaid expansion by legislative district and locality. Here are the numbers for the districts of the four delegates who represent Charlottesville and Albemarle, and how they voted.
2,000 eligible in Western Albemarle, Augusta and Rockingham counties
Delegate Steve Landes voted no on expansion
3,400 eligible in Charlottesville and parts of Albemarle
Delegate David Toscano voted yes
3,100 eligible in parts of Albemarle, Fluvanna, Greene and Rockingham counties
Delegate Rob Bell voted no
3,300 eligible in southern Albemarle, parts of Appomattox, Buckingham, Campbell and Nelson counties
Delegate Matt Fariss voted no
Correction June 14: Emma Hale’s name was misspelled in the original version.