By Sen. Barbara Favola
Affordable healthcare is essential to the vibrancy of Arlington. It’s essential to giving everyone a fair shot at a decent living, along with other key elements such as education, jobs and housing.
Yet not all Arlingtonians have access to high quality, affordable health care. Today, 6.7% of Arlingtonians under 65 do not have health insurance, generally because they cannot afford it. By making healthcare more affordable and more focused on wellness, families would have more income to pay for housing and other necessities.
That is why in the General Assembly, I have been working toward a public option insurance plan. Under a public option plan, state lawmakers could require that essential health benefits such as primary and preventive care and mental health services be covered. Hospitalization and rehabilitation benefits would also be included. In short, we could create a required benefits package that promotes health.
A public option health insurance plan would expand insurance opportunities using private-sector insurance partners rather than replacing existing sources of coverage (e.g., employer-sponsored plans, the marketplaces, Medicare and Medicaid). There are also cost savings opportunities with public option plans. For example, a public option insurance plan could negotiate reasonable (not excessive) provider payment rates because providers would want to avail themselves of such a large share of the patient market.
It would also be possible to tie reimbursement rates to health outcomes, providing an incentive to keep individuals healthy rather than rewarding multiple visits to a provider. Such leverage would help lower premiums in the private market and encourage healthy behaviors.
If Virginia implemented a public option insurance plan and used federal and state funds to subsidize the premiums for those between 138% and 500% of poverty, I believe that the 6.7% of Arlingtonians who do not have health insurance could afford coverage.
Why Do Some Families Have Trouble Paying for Health Care Insurance Now?
Families with incomes below 138% of the federal poverty level ($36,156 for family of 4) qualify for Medicaid or Medicaid expansion, so they are covered now. However it is households with incomes between 138% and 500% of the federal poverty level ($131,000 for a family of 4) that face difficulty purchasing health insurance. In Arlington, approximately 40% of households are earning between $35,000 and $125,000 annually.
With the removal of an enforceable mandate under the Patient Protection and Affordable Care Act (ACA), younger and healthier individuals are not buying insurance. This has created an environment where the cost of care is being distributed among a smaller and sicker pool of insured individuals. The result is a continual increase in health insurance premiums. For many who want to put in place a plan to pay for their health care, the expense of paying increasingly high health insurance from their disposable income is too burdensome.
Other Tools to Rein in Health Care Costs
Last year, my bill to end what’s known as “surprise medical billing” in Virginia passed. No longer will patients who receive out-of-network care in an emergency room or from a specialist during a planned procedure, be responsible for more than their usual co-pay or deductible. This new law sets up a process for insurance companies and providers to negotiate a fair reimbursement without the involvement of the patient.
For the 2021 session, I am submitting a bill to require the state to cover the costs of certain excessive insurance claims in an effort to slow the rate of increases in insurance premiums. This is called a reinsurance program. Several states have implemented such a program and have seen success in stabilizing the insurance market and premium costs. Gov. Ralph Northam’s team is evaluating this proposal and various ways of paying for the reinsurance fund.
Virginians Want and Need Affordable Healthcare
While much of the opportunity to make healthcare affordable requires federal policy reform, I
am working diligently to ensure that the laws of the Commonwealth are helping as much as possible to provide every Virginian with access to quality, affordable healthcare. I think we can all agree that access to healthcare is one of the building blocks for achieving a fair shot at a decent life. Together, we can make this a reality.
Sen. Barbara A. Favola represents Virginia’s 31st Senate district, which includes parts of Arlington and Fairfax counties, and a portion of Loudoun County. She is the Chair of the Senate Rehabilitation and Social Services Committee. Favola has championed many health, education and childcare improvements, such as the expansion of subsidies to improve access to quality early childhood education.