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McAuliffe emphasizes health care with pitch for Medicaid buy-in plan
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McAuliffe emphasizes health care with pitch for Medicaid buy-in plan

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RICHMOND — Former Gov. Terry McAuliffe wants to offer another health insurance option to Virginians who earn too much to qualify for Medicaid but can’t afford the out-of-pocket costs of coverage they can buy now in the marketplace.

McAuliffe pitched his Medicaid “buy-in” plan at appearances in Charlottesville and Harrisonburg on Tuesday as part of an opening policy salvo in his race for another term as Virginia governor against Republican nominee Glenn Youngkin, who has criticized the state’s decision to expand Medicaid under the Affordable Care Act.

McAuliffe proposes to offer a Medicaid insurance option for people to buy on the new state marketplace if they earn more than $17,775 a year individually or $30,305 for a family of three so they wouldn’t be eligible for Medicaid. He did not specify how much they could earn and still qualify to purchase the optional plan.

The former governor was unable to overcome Republican opposition to Medicaid expansion during his term, but the General Assembly took the step the year after he left office under a bipartisan deal that took effect Jan. 1, 2019, and now provides health insurance coverage for more than 555,000 Virginians.

“Terry was a brick wall against extreme Republican attacks on health care during his administration, and he will be ready on day one to fight for affordable health care as Virginia’s next governor,” his campaign stated in a news release that played off a vow by former House Speaker Bill Howell to wield his Republican majority in the House as “a firewall” against Medicaid expansion.

Virginia Republican Party spokesman Devin O’Malley fired back that McAuliffe had acknowledged “after eight years of the McAuliffe-Northam regime, more than 700,000 people in Virginia still do not have health insurance.”

The Virginia Health Care Foundation estimates that 648,000 Virginians below the age of 65 lacked health insurance in 2019, the first year after Medicaid expansion. The foundation also estimates that the state has reduced the number of uninsured by 354,000 adults and children from 2010 to 2019.

Deborah Oswalt, executive director of the foundation, believes the actual number of uninsured Virginians is lower, but is awaiting updated data.

Oswalt had no comment on McAuliffe’s proposal because she hadn’t seen it, but she said it would appear to address what she called a “churn population” of mostly hourly, seasonal workers whose income — and Medicaid eligibility — fluctuates.

“It makes these people very vulnerable if they don’t have coverage,” she said.

The proposed Medicaid buy-in plan is a new wrinkle in McAuliffe’s strategy to make affordable health care central his campaign to return to the Executive Mansion.

He supports Virginia’s plan to create a state-run marketplace by 2024 and a reinsurance program to lower health insurance premiums, both approved last year by the General Assembly and Gov. Ralph Northam. The reinsurance program requires federal approval to pay for the highest cost patient care separately and lower premiums for healthier Virginians.

Health insurance affordability has been a contentious issue in Virginia primarily for families that previously earned too much money to qualify for either Medicaid or federal subsidies on health plans offered in either the commercial market or the health exchange the federal government currently runs.

However, the American Rescue Plan Act President Joe Biden signed in March expanded eligibility for federal subsidies of insurance premiums for people who earn above 400% of the federal poverty level, or about $51,000 for an individual, and also made about 390,000 Virginians eligible for “zero-dollar plans” with little or no premiums, based on income. As a result of the law’s changes, the State Corporation Commission has delayed the opening of the Virginia insurance exchange from 2023 to 2024.

McAuliffe’s health care campaign package also includes proposals to increase oversight of pharmaceutical practices and drug prices, including a plan to require Virginia’s Medicaid office to directly administer pharmacy benefits separately from health plans administered by managed care insurance companies the state hires to control costs.

He also proposes to expand home health services to elderly Virginians and address staffing shortages at long-term care facilities, which bore the brunt of deaths from COVID-19 during the pandemic. His proposals include free training for caregivers at Virginia community colleges and higher wages for home health workers.

Matt Wolking, a spokesman for Youngkin, said in a statement: “Glenn Youngkin will work hard to fix the problems that exist in our health care system. Virginians deserve better access, better choices and better care, and Glenn will focus on lowering costs, increasing price transparency, and creating more competition so that patients are better served.”

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