A legislator's post- Mother's Day reflections on Virginia's healthcare debate

By Dave Ress

Del. Jennifer McClellan, D-Richmond, took some time today to talk about an aspect of the debate over expanding health insurance coverage for low income Virginians that doesn’t get a lot of attention –  moms and would-be moms.

At the moment, Virginia’s Medicaid system covers pregnant women until 60 days after birth. It also covers working parents who earn up to the about 30 percent of the federal poverty line – that’s $4,700 for a mom with a 61-day-old or older child. It does not cover childless, able-bodied adults.

If Virginia were to tap Affordable Care Act funds to expand coverage for the poor, McClellan strongly feels the state should do, she’s sure more women of child-bearing age would be getting and acting on the now standard advice to take vitamins with a daily dose of 400 micrograms of folic acid.

That dose in the first three to four weeks of pregnancy (when many women might not yet know they are pregnant, and so might not have yet signed up for Medicaid if eligible)  can prevent the kind of neural tube defects that cause stillbirth or such disabilities as anencephaly, spina bifida, and encephalocele.

The cost of those to the current Medicaid system which covers pregnant women and kids in households with income up to two times the federal poverty level ($31,460 for that mom with one kid) to say nothing of the human toll, is something McClellan wishes more of her fellow legislators would consider.

A single woman with no kids can’t get Medicaid now, unless she is disabled and has an income of less than $9,340 a year. If the state were to use Obamacare funds to expand coverage, single women (and men) with incomes of up to $16,050 could get coverage, whether disabled or not.

The coverage, unlike current Medicaid, would not be completely free to those men and women, under a state Senate proposal that so far the House of Delegates has rejected.

Under that state Senate proposal, a single mom (or single dad) with one kid at home and earning up to $21,700, would be covered. She (or he) would also have to pay some toward medical bills.

One other difference from current Medicaid when it comes to coverage of the roughly 98,000 parents who could be covered by the state Senate plan, is that the bill through 2016 falls entirely on the federal government. The state’s share from then gradually increases to a cap of 10 percent by 2022, compared to the 50 percent it pays for current Medicaid recipients – like, for instance, a child with spina bifida whose mom didn't have the money to go to the doctor to learn about folic acid.  

McClellan's point is that paying for early care can save big money later on, one of the key arguments made by advocates of expansion.

Republicans are skeptical about the argument, though.

Pregnant women with incomes up to 138 percent of the poverty level are covered by Medicaid, and so should be getting the prenatal care McClellan emphasized. Expanding coverage won't change their status, and the numbers of women who don't realize they are pregnant and already entitled to Medicaid might not be as large as McClellan thinks, said House GOP caucus spokesman Matt Moran.

Medicaid already covers nearly half of all births and Medicaid rolls are growing fast, even without expanding coverage, he said.

Soaring costs for the current Medicaid system mean it makes no sense to expand coverage without significant reforms to the current system, which is why House Republicans have rejected the state Senate proposal, he said.

A controversial study from Oregon found that state's 2008 expansion of Medicaid did not reduce use of emergency rooms, he said. In addition, Republicans are concerned there are not enough Virginia doctors willing to accept Medicaid to deal with an major expansion.