State Sen. Bill Stanley made stops at Danville Regional Medical Center and Piedmont Access to Health Services on Monday to talk about Medicaid expansion — and how Virginia could help the uninsured without expanding the program.

During his gathering at PATHS, Stanley sought the input of staff and board members as he presented his solution to the debate. While visiting PATHS, Stanley said the issue of uncovering a solution to Medicaid expansion has become his passion.

Stanley explained to the PATHS staff and board members what the Medicaid expansion problems are. He said that the system is burdened by patients seeking care from emergency rooms for simple issues. He stated that preventative care is the main means of reducing that burden.

“It’s about 275,000, not 400,000 people,” Stanley said, that fall into the coverage gap and do not have insurance. On the other hand, many typically cite that 400,000 number. Stanley argued that the number is much lower because many Virginians have gotten cheaper forms of insurance from alternative sources, such as employers like Walmart.

The Affordable Care Act does not provide coverage to American citizens whose income is below the poverty level. Since Virginia has not expanded Medicaid, which was an assumed decision, those citizens are without coverage. Meanwhile, legal residents of less than five years are offered coverage.

Many of these uninsured patients come to PATHs or resort to using hospital emergency rooms as their primary care physician.

“Right now with the Medicaid program we have right now, it is 21 cents out of every tax dollar. So it is $19.6 billion every two years of our tax money that goes just to the existing program. We have 41,000 people on the waiting list. Without expansion, it grows at an annual rate of 8 percent per year.”

Stanley suggested that a Medicaid expansion would be unwise because the costs would only continue to grow. With Medicaid expansion, the state is offered payment coverage by the federal government for the first three years. After that, payment can be up to 90 percent. Currently Virginia operates under a 50 percent plan, Stanley said.

In order to ensure patients can afford preventative care, Stanley suggested that services like PATHS are ideal. PATHS reduces costs, provides preventative care and creates good outcomes, he said.

Due to constant need, PATHS is expanding its services. It is implementing dental, behavioral and high-risk patient pre-natal care at its four sites, which are located in Danville, Boydton, Martinsville and Chatham.

Stanley explained that the challenges faced by this district include a unique mix of urban, suburban and rural, and bad lifestyle choices such as poor nutrition and habits like smoking. PATHS nurses and doctors explained that the undereducated population can’t afford any coverage, even from the discounted services provided through centers like PATHS.

“The challenge that you face here is, of course, much different than what life is like in Northern Virginia, and it really is an economic issue when it all boils down,” PATHS COO Billy Crumpton said.

Stanley’s solution places the impetus on the state government to support its own medical needs. “We think we should increase funding in state involvement,” he said. Through regulations, Stanley hopes to emphasize the use of generic medicines.

A primary focus in funding will be increasing funding for community health care centers. PATHS and the rest of the 130 community health care centers receive $2.5 million altogether. Stanley was astonished that he voted for a state budget that did not provide more funds for facilities like PATHS.

Telehealth or telemedicine programs must be expanded, too, he said. Through those, many uninsured patients can receive care conveniently.

Through research of his new passion, Stanley has discovered that there is a health insurance monopoly at work in this economy. He suggested that Virginia should “allow health insurance to be purchased out of state, across state lines.”

The “controlled monopoly” offers customers only a few insurance companies, he said. “I think when you open up that kind of competition, you’re going to be opening up also lower premiums, boutique packages where you can pick and choose better health care for you.”

An extended idea for the entrepreneurial angle would be to encourage more community care centers like PATHS that will provide preventative care. Stanley sees the community-based centers as the “first line of defense.” He said a rural-based pilot program based off a South Carolina model would cost $3 million a year.

CEO Kay Crane stated after more than an hour of discussion that “one of the things they need to know is that this debate has taken so long, and it’s really taken our patients hostage, and we’re losing them. They’re dying, and they’ve got to realize this is a human issue. There are real people involved in this. It’s not numbers, politics.”



(Posted: Monday, August 4, 2014 at / Article by: Vicki Morrison)