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Misinformation and the Ongoing Healthcare Debate in Virginia

By Mike Desjadon

Medicaid Expansion is now reality, but we have to resist the urge to put the healthcare fight behind us. Critical issues like gun violence, addiction and immigration must be confronted, and are part of this broader debate. We must continue to fight for a healthcare system that will actually lower costs and increase access to care across the Commonwealth and that involves calling out misinformation when we see it.

This blog published a Mason-Dixon Poll [1], commissioned by the VHHA, that attempts to show overwhelming (71 percent) public support for Medicaid Expansion, Certificate of Public Need (COPN), and unfairness that hospital systems alone are contributing to fund Medicaid Expansion.

I have three problems with this poll (and so should you):

-Number of people polled: 800 out of 5.6 million registered voters in Virginia.  71 percent of them means 568 people.  Total.

-Who commissioned the poll:  Virginia Health and Hospital Association, the association advocating for those benefiting most from and lobbying hardest for expansion and COPN.

-The Questions: “Do you support COPN.” I find it hard to believe a random sampling of 568 people understood COPN enough to know what they were supporting.

Expansion has been hotly debated, and with the way the assembly is likely to tilt it’s here to stay for now, so I won’t kick the dead horse. I’ll just say to those respondents who think it’s unfair that hospitals are footing the bill: trust me, you’ll get your opportunity to bail them out. If you expect they’ll continue to be the sole bearers of the $306 million tax to fund expansion, you weren’t paying attention in econ class. They’ll recoup that fee by raising prices on everyone else resulting in higher insurance premiums, increased costs to small businesses, and yes, taxes on … everyone. Every state that expanded Medicaid has blown out their budget so why would we be different?

I’ll bet Mason-Dixon didn’t describe COPN as a government protected monopoly on all health services available in a region, but that’s what it is. Under COPN, if anyone wants to construct a health facility in Virginia they have to apply for permission from Richmond. Richmond then decides if the people in that location “need” the service, after soliciting feedback from current services in that region for why they don’t want the competition – we know this as special interest lobbying. I know what you’re thinking …aren’t the same people that told us we had to expand Medicaid to INCREASE access to care restricting how much care is available? Sounds like other fan favorite Democratic hits like, “If you like your doctor, you can keep them.”

COPN was conceived of in New York in 1964 to protect access to unprofitable services and keep prices down, and now 34 states use it. So how are we looking after 55 years? Costs are through the roof everywhere, ironically higher in COPN states. Don’t take my word for it; George Mason’s Mercatus Center has great research on COPN here [2] and here [3]. We all want better access to quality care at lower costs. Competition increases access and lowers costs, and COPN prevents competition. The math isn’t complicated.

Virginia has great health options, just not enough of them (including mental health and rural centers).  In the beginning of this article I mentioned the danger of forgetting this debate as it directly ties to other major issues like gun violence, immigration, and addiction.

Gun Violence: Suicides account for 60 percent of all gun deaths; mass shootings are the most prominent aspects of gun violence discussed in the media. Both (suicides entirely and mass shootings partially) have a relationship to mental health and the availability of necessary care is woefully inadequate. The red flag laws gaining steam require review by a mental health professional as component of their implementation. How will this be possible if access to care is limited by fiat and there are only 980 psychiatrists in a state of 8M people?

Addiction: In 2018, addiction (not counting alcohol) claimed 1,400 Virginian lives, outpacing gun deaths and car accidents.

Immigration: Virginia expanded Medicaid to 300,000 residents, at a cost of $300M (to start). Democratic candidates say they intend to extend health benefits to undocumented residents. In 2018 Pew estimated there to be 275,000 undocumented residents in Virginia, double our expansion total.

We need more access to care and lower costs … so we need competition, not regulation.  Knowing all of this, would VHHA still have us believe 71 percent of Virginians support their agenda? I don’t buy it, and neither should you. I encourage those running for office this fall to take up these issues with vigor and fight hard. This poll makes it clear this debate is very much open and we’re no closer to working solutions.

Mike Desjadon is a Health Executive and former 6th District Congressional Candidate.