Since the federal marketplace for health insurance became available though the Affordable Care Act, more than 216,000 Virginia residents have selected a plan. But that's only a small fraction of the 1,030,000 Virginians who currently don't have health insurance.
So what is the state of the uninsured in Virginia?
That's difficult to answer, partly because some key statistics are not yet known and the politics of the Affordable Care Act are still unfolding. About 400,000 of those who do not have health insurance are awaiting the conclusion of the budget showdown currently underway in Richmond, where Republicans and Democrats are split about the wisdom of accepting federal money to expand Medicaid, a program that offers health insurance to those who live in poverty or with disabilities. State officials say 470,000 of those without health insurance are eligible for the marketplace, although it's unclear how many of the 216,000 who have signed up for a marketplace plan already had insurance and were just looking for a better deal.
The most recent data from the Department of Health and Human Services suggests that 87 percent of enrollees were uninsured before signing up. But federal officials only collect information about existing coverage when the recipients qualify for a subsidy or tax credit. As a result, some say the states that run their own exchanges have better information because they ask for the information in a variety of ways, creating a balanced range of responses. By that measure, the percentage of people who sign up for marketplace health insurance had no previous insurance about 70 percent to 75 percent of the time.
"That is still way over half of them being previously uninsured, which is a good thing by my lights," said Len Nichols, director at the Center for Health Policy Research and Ethics at George Mason University. "Of course, the number that would be covered who were previously uninsured would more than double that if Virginia would expand Medicaid."
ESTIMATES FROM the Census Bureau show that parts of Northern Virginia have some of the highest concentration of adults and children without health insurance. Manassas Park City, for example, has the highest concentration of uninsured adults in Virginia, 28 percent. Manassas Park City also has the third highest rate of uninsured children in Virginia, 11 percent. Meanwhile, information compiled by the Urban Institute shows that Fairfax County has 136,000 residents who lack health insurance.
"If you look at the rate of people without health insurance in Fairfax County, it doesn't look that high," said Deborah Oswalt, executive director of the Virginia Health Care Foundation. "But if you look at the raw number of people without health insurance, that's a lot of people."
Supporters of the Affordable Care Act say the law has already started making progress for the uninsured in Virginia. For example, people can no longer be denied coverage because they have a preexisting condition. And the mandate that employers offer health insurance to their workers have removed people from the rolls of the uninsured. Plus allowing adult children to stay on their parents’ plans until the age of 26 has already helped many people keep insurance they would have lost. By some estimates, without the Affordable Care Act about 1.3 million Virginians would lack health insurance.
"It's an excellent first step," said Del. Scott Surovell (D-44). "It takes time for people to fully understand what's out there and what's available. We're talking about people who are struggling with medical expenses and jobs and don't have lots of time."
ALTHOUGH THE NEW statistics show some progress in Virginians without insurance selecting a plan through the federal marketplace, most of the attention in recent weeks has focused on the political fight over expanding Medicaid. For the first two years, the federal government would pick up 100 percent of the cost for that program. After 2020, though, Virginia would be on the hook for providing 10 percent of the cost of the program.
"That's $240 million in today's dollars, but by 2020 that's going to be about $400 million because of Medicaid inflation," said Del. Dave Albo (R-42). "It took me 15 years to get money for roads, and every time we had a surplus almost all of it got eaten up by Medicaid. So there's a lot of us that don't want to obligate Virginia to something we can't afford in the future."
Supporters of expanding Medicaid say Virginia can't afford turning down the deal, in part because money from taxpayers will be taken regardless of whether it's spent in the commonwealth or not. That means Virginia taxpayers will be funding Medicaid expansion in New York and California while low-income people in Virginia continue to suffer. By one estimate, that means about $2 billion would be collected here in Virginia and diverted to help expand Medicaid in other states.
"What is happening to the uninsured in Virginia really sits in the House of Delegates," said Nichols. "Will they agree with the Senate and the governor and accept large infusions of federal money to expand Medicaid coverage for the commonwealth or not? At the moment, the choice and fate of the uninsured is up to them. At some point, again, it will be up to the voters."