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DEMOGRAPHY
The Patient Protection and Percent of Population in Virginia per Race / Ethnic Group2
Affordable Care Act (ACA) was
enacted on March 23, 2010.
Successful implementation
5.4
requires cooperation between key
stakeholders, federal and state 6.8
agencies, and reform advocacy
organizations. Because the fifty White (Non Hispanic)
states vary greatly, each state’s
19.9 Black
implementation process will be
unique. Hispanic
67.0 Other*
In 2009, Virginia had the 12th
largest population in the United
States, estimated to be
7,882,590.1 Virginia is also very
diverse, which presents a special
challenge to those trying to
implement health reform in the * Others include American Indian, Alaska Native, Asian, Native Hawaiian, and other
Pacific Islanders.
state.
VIRGINIA AND THE UNINSURED: HOW WILL THE AFFORDABLE CARE ACT HELP?
While 86.2% of all Virginians have health insurance, over 1 million individuals remain uninsured,3
including 9.3% of Virginia’s children4 and 15.8% of the state’s working population.5
ACA is designed to address these concerns by providing affordable access to health insurance to those
individuals who would otherwise be unable to obtain coverage. In addition, ACA extends current
benefits and services provided by Medicaid (a federal and state funded public insurance program that
provides health insurance coverage for low‐income and disabled individuals and families).
NEW BENEFITS UNDER ACA AND ITS EFFECT IN VIRGINIA
ACA establishes new requirements for private health insurers in order to make health care
Insurance plans more accessible to the public. These requirements include the following:
Coverage Effective Immediately: Plans must cover certain preventive health services, such as
vaccines and screenings, without a co‐pay.
Health Care Facts: Virginia Page 1 of 3
National Coalition on Health Care August 2010
Effective September 2010:
o Insurers will not be allowed to drop any insured person because he/she gets
sick or develops a chronic health condition. In addition, ACA allows individuals
to renew health insurance coverage regardless of their health status.
o Individuals up to the age of 26 can choose to be covered under their parents’
insurance plan.
Effective January 2014:
o Under the “guaranteed issue” provision, an insurer must accept every employer
and individual in the state that applies for coverage.
o Insurers cannot exclude people from coverage if they have a pre‐existing
condition (e.g., asthma, diabetes, or any other long‐term condition) or past
illness.
o All insurers will be required to offer a coverage package that offers essential
benefits.
Effective Immediately: ACA makes tax credits available to qualifying small businesses to
Small
help them afford coverage for their employees. These tax credits could total up to 50% of
Business
a business’ health insurance premiums. In 2008, Virginia had over 130,000 small
Assistance
employers,6 which represented over 72% of the state’s employers.7
Effective January 2014: ACA requires that states create an insurance market “exchange” –
Health
a marketplace where people will be able to compare and shop for health insurance. This
Insurance
will make access to health plans easier and more efficient. U.S. citizens, legal immigrants,
Exchanges
and small businesses will be able to purchase insurance through these exchanges.
Effective July 2010: High‐risk pools are designed to provide health insurance coverage to
people who were previously uninsurable due to a pre‐existing condition. Virginia does not
High‐Risk operate its own high‐risk insurance program and opted to let the federal government run
Insurance ACA's federally funded high‐risk pool.8 The Department of Health and Human Services
Pools (HHS) created the Pre‐Existing Condition Insurance Plan, a federally run program in
Virginia, providing a temporary insurance plan to Virginia residents who have a pre‐
existing condition and who have been uninsured for at least six months.
Effective January 2014: ACA contains provisions that would create new eligibility
Expansion requirements for Medicaid. For example, adults under the age of 65 earning less than
of 133% of the federal poverty level may be eligible to apply regardless of whether they have
Medicaid children. It is estimated that approximately 370,000 Virginians may be able eligible to join
Medicaid.9
IMPLEMENTATION CHALLENGES IN VIRGINIA
Successful implementation of ACA will require a joint effort among local, state, and federal agencies, as
well as many non‐governmental organizations. The State of Virginia will face several challenges:
State Lawsuit10 ‐ Virginia’s attorney general filed a lawsuit claiming that ACA is unconstitutional.
The legislature also acted, passing a law, exempting state residents from ACA’s insurance coverage
Health Care Facts: Virginia Page 2 of 3
National Coalition on Health Care August 2010
mandate. On August 2, 2010, Judge Henry Hudson ruled that Virginia has standing to sue;
therefore, the District Court will hear the merits of the case on October 18, 2010. Ultimately, both
sides predict that the United States Supreme Court will decide the case.
Budget11–Virginia's $77.6 billion budget for the upcoming two years incorporates over $400 million
from an anticipated extension of enhanced Medicaid funding by Congress. However, if Congress
fails to pass the extension, Virginia's legislature may cut several programs. The limited budget for
Virginia's 2010‐2011 fiscal year will be a challenge for implementation, specifically where ACA calls
for the expansion of services.
Health Care Workforce12 – With the potential increase of Virginia's insured population, it is
important that primary care physicians and other necessary health care professionals are engaged
in health care reform. ACA provides grants and loan forgiveness to health care professionals; this
will help Virginia ensure that it has an appropriate supply of doctors, nurses, social workers, and
other professionals to cover the increased demand.
Diverse Population – Virginia's diverse population presents a special challenge to those
implementing ACA in the state. A key concern for Virginia’s residents is access to care. Providers
must be sensitive to the state’s language, economic, and cultural diversity. This means that access
to care and the ability to understand one’s treatment should not be threatened by one’s ethnicity,
language, culture, or economic status.
1
U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS (2010), available at http://quickfacts.census.gov/qfd/states/51000.html (last accessed
June 2010). These figures are from 2009.
2
Ibid. These figures are from 2008.
3
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Health Insurance Coverage of the Total Population, states (2007‐2008), U.S. (2008),
Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008
and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements), available at
http://www.statehealthfacts.org:/comparetable.jsp?ind=125&cat=3 (last accessed June 2010).
4
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Health Insurance Coverage of Children 0‐18, states (2007‐2008), U.S. (2008), Data
Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and
2009 Current Population Survey (CPS: Annual Social and Economic Supplements), available at
http://www.statehealthfacts.org:/comparetable.jsp?ind=127&cat=3 (last accessed June 2010).
5
COVER THE UNINSURED, ROBERT WOOD JOHNSON FOUNDATION, U.S. UNINSURED WORKERS, available at
http://covertheuninsured.org/uninsured_workers#map (last accessed June 2010). These figures are from 2006‐2007.
6
Small businesses include employers with fewer than 50 employees.
7
U.S. DEP’T OF HEALTH & HUMAN SERVS. MEDICAL EXPENDITURE PANEL SURVEY (2008), available at
http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/state/series_2/2008/ic08_iia_f.pdf. These figures are from 2008.
8
Anita Kumar, McDonnell: Virginia Will Leave High‐Risk Insurance Pools to Feds, WASH. POST (April 30, 2010), available at
http://voices.washingtonpost.com/virginiapolitics/2010/04/mcdonnell_high‐risk_insurance.html (last accessed June 2010).
9
JOHN HOLAHAN & IRENE HEADEN, KAISER COMMISSION ON MEDICAID AND THE UNINSURED, MEDICAID COVERAGE AND SPENDING IN HEALTH REFORM: NATIONAL
AND STATE‐BY‐STATE RESULTS FOR ADULTS AT OR BELOW 133% FPL 41 (2010), available at http://www.kff.org/healthreform/upload/Medicaid‐
Coverage‐and‐Spending‐in‐Health‐Reform‐National‐and‐State‐By‐State‐Results‐for‐Adults‐at‐or‐Below‐133‐FPL.pdf (last accessed June
2010).
10
Andrew Harris and William McQuillen, Virginia's Challenge to Obama Health‐Care Overhaul May Proceed, Judge Says, BLOOMBERG, (Aug
2, 2010), available at http://www.bloomberg.com/news/2010‐08‐02/virginia‐challenge‐to‐obama‐health‐care‐overhaul‐may‐proceed‐
judge‐says.html (last accessed August 2010).
11
Michael Sluss, Virginia Braces or Cuts to Medicaid, ROANOKE NEWS, (June 20, 2010), available at
http://www.roanoke.com/news/roanoke/wb/250953 (last accessed June 2010).
12
Adam Rhew, Virginia Seeing Doctor Shortage, NBC29.COM, (June 11, 2010), available at
http://www.nbc29.com/Global/story.asp?S=12563111 (last accessed June 2010).
Health Care Facts: Virginia Page 3 of 3
National Coalition on Health Care August 2010