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Medical Center Hour on Medicaid expansion explores implications for Charlottesville and the state

Talk addresses new changes coverage expansion could bring, reminds students of their civic duty

<p>The talk hosted Del. David Toscano (D-Charlottesville), the minority leader of the Virginia House of Delegates; Carolyn Engelhard, an assistant professor of public health sciences and Dr. Chris Ghaemmaghami, the chief medical officer of the University Health System to discuss the implications of Medicaid expansion in Virginia. &nbsp;</p>

The talk hosted Del. David Toscano (D-Charlottesville), the minority leader of the Virginia House of Delegates; Carolyn Engelhard, an assistant professor of public health sciences and Dr. Chris Ghaemmaghami, the chief medical officer of the University Health System to discuss the implications of Medicaid expansion in Virginia.  

A recent Medical Center Hour, a program hosted by the Center for Biomedical Ethics and Humanities, focused on the recent approval of Medicaid expansion in Virginia to 400,000 low-income residents. The one-hour talk last Wednesday featured three speakers, including Del. David Toscano (D-Charlottesville), the minority leader of the Virginia House of Delegates, Carolyn Engelhard, an assistant professor of public health sciences and Chris Ghaemmaghami, the chief medical officer of the University Health System.

Medicaid is a jointly-funded federal and state public program that provides health insurance to low-income Americans. The program primarily benefits children, the elderly and the disabled, but some states also provide some coverage for childless adults as well. 

In May, Virginia became the 33rd state to expand Medicaid. The expansion will take effect on Jan. 1, 2019. Medical Center Hour hosted Toscano, Engelhard and Ghaemmaghami to discuss the new policy and its ramifications for the state and Charlottesville itself.

The talk begin with Engelhard discussing logistics of the expansion and how Virginia compared to other states’ Medicaid coverage. 

She explained that the current cutoff for Medicaid in Virginia for families with children was 30 percent of the Federal Poverty Line or $6,900 for a family of three. With the expansion, families and adults making up to 138 percent of the federal poverty level — $28,677 for a family of three—will be eligible for the program. While childless adults were previously ineligible for Medicaid coverage, they will now be eligible with an annual income at or below $16,754.

Engelhard also gave an overview of what she called the “promises and perils” of work requirements, which will accompany Virginia’s Medicaid expansion, and are supported by 70 percent of Americans, according to a Kaiser Family Foundation survey.

According to Engelhard, Arkansas — which has enacted Medicaid work requirements — removed 4,353 people from the program for failing to meet the requirements. However, Engelhard said that many of those removed cited a lack of access to documentation, lack of awareness of work requirements or an inability to access a computer, which was needed to log work hours. 

Toscano also addressed work requirements in his segment of the talk, referencing the fact that Democrats in the Virginia House of Delegates felt that they had to compromise and add work requirements in order to get Medicaid expansion passed.

“Would we rather have straight Medicaid expansion? Yes,” Toscano said. “Were we willing to do this in order to get Medicaid expansion? Yes. And that’s where the compromise was drawn.” 

During his section of the talk, Toscano discussed the timeline of passing Medicaid expansion, from its beginning in 2010 when the Affordable Care Act was passed under the Obama administration to the intermediate events and failures leading up to May’s successful passage. He said he thought expansion would pass in 2015 after Virginia Gov. Terry McAuliffe (D) was elected, but the measure was unable to get approval from Republicans in the General Assembly.

Ghaemmaghami went on to discuss the effects that Medicaid expansion could have locally for the University Hospital. He emphasized that many residents in southern and southwest Virginia have so little access to health care that they travel to the University Hospital for basic appointments. 

Under the Medicaid expansion, Ghaemmaghami said, those patients would have better access to healthcare and more access to mental health services and substance abuse treatment. However, he mentioned that there likely won’t be “some giant windfall” for the hospital after expansion is implemented, as it is a safety-net hospital. In other words, the University Hospital will remain financially stable while having the ability to deliver more complex care to patients. 

Marcia Childress, an associate Medical Education professor and director of Medical Center Hour, later expressed what she hoped the audience would take away from the talk — exercising their right to vote. 

“With one vote, [Toscano has] potentially changed the lives of 400,000 people who have not, in previous years, had healthcare coverage,” Childress said. 

Childress also spoke about the political responsibilities of physicians.

“I would hope that doctors feel now that it’s an important, fundamental part of their job — if you’re going to advocate for your patients, you need to do that in the world as well,” Childress said.

Fourth-year College student Rebecca Soistmann, who attended the talk and is on a pre-med track, said she agreed.

“I believe that doctors should be very aware of the policies that affect their patients, just as certain drugs may affect them,” Soistmann said. “When caring for another person, one must consider all contributing factors to this person's health, including stressors such as ability to pay for their healthcare.” 

According to Childress, this was one of the reasons Medical Center Hour was founded — to remind medical students of the big picture — “the patients and the world they’re going to serve.”

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