Local hospitals stand to lose millions in federal funding for uncompensated care when the
In Virginia, according to a study commissioned by the Virginia Hospital & Healthcare Association, expansion would extend coverage to an estimated 400,000 of the state's 1 million uninsured and would bring in $10 billion in federal funds over five years.
However, if Virginia chooses not to expand Medicaid coverage — an option made possible by the 2012
Reform can only happen, he explained, in conjunction with expansion of the program. "If we don't expand, then we won't have flexibility to experiment with pilots," he said, citing the federal 1115 waiver that allows states to tailor Medicaid plans to their state's health care goals. "Reform has got to happen no matter what. The money will help cushion the transition. … If you leave $10 billion on the table, it's gone. You don't get it back. Those dollars get spread out among other states."
Potential reforms include providing greater access to primary and home care to patients to manage their health and keep them out of more expensive in-patient care, and a dual-eligible (Medicare and Medicaid) system of managed care to participate in shared savings. Virginia Secretary of Health Bill Hazel has indicated support for these reforms, along with seeking flexibility in benefits, improvements in care coordination and personal lifestyle responsibility. "These would 'bend the cost curve' so costs are not going up as fast or are coming down," Kerner said.