This letter is in response to “Opportunities and Challenges - Implementing Obamacare in Alexandria” (Alexandria Gazette Packet, Oct. 25-31 2018). While the authors applauded Virginia’s Medicaid Expansion and advocated “to bring health and hope” to Alexandria’s low-income uninsured, they failed to use their bullhorn to message Virginia’s Medicaid Expansion planners. I’m as frustrated as many of Alexandria’s taxpayers are by the lack of transparency by our elected officials at the local, state and national level. I’m particularly frustrated with our state-level leaders by their radio-silence on their plans for this costly Expansion, despite repeated requests for information.
My frustration extends to the authors for not articulating what should be the primary goal of the Expansion — putting Patients First. What does that mean? In the article they accepted the low 40 percent increase in patients filling their diabetes prescriptions. That is totally unacceptable when we are talking about this multi-million dollar Expansion — it does not put Patients First! The use of affordable salaried coaches has demonstrated a 90 percent compliance in filling prescriptions, a huge savings in avoiding more costly treatments, long term care, etc.. This is something the authors need to advocate for — and demand!
A few months back I wrote our state delegate who was participating in the design of the Expansion, and challenged him to review the State of Mississippi’s Medicaid Program that provides over 35 specialty services at more than 200 hospitals. Their patient approval rate is 93.4 percent while their hospital administration approval rate is 87.5 percent. Mississippi capitalizes on information technology. I never heard anything back. The Gazette Packet article made no reference to the advocating for increased access to specialty care or expanded use of technology to better serve patients.
Absent also was their advocacy for lower drug prices. The FDA has aggressively approved 781 generic drugs so far in 2018. Huge cost-savings! Coupling the wider access to generics with the administration’s recent initiative to lower Medicare drug prices to match overseas prices and, as importantly, efforts in the House and Senate to reform the out-of-control Federal 340B Drug Program, will significantly lower drug prices — for all. The authors need to not only advocate for Virginia’s support of these ongoing improvements and initiatives, but demand it.
The access to healthcare professionals and their reimbursement rates is key to putting Patients First. Obamacare purposely did not expand the infrastructure to train an increased number of doctors to meet the growing number of patients. We are extremely lucky in the Alexandria area that our growing needs are being largely met through the immigration of foreign trained doctors. We recently went to India and saw first hand the exponential growth in income and opportunity there. It warned us that our window for the overseas supply of doctors is closing. As a result, the authors need to advocate for the State of Virginia to review their laws and regulations regarding Nurse Practitioners and Physician Assistants. Expanding Medicaid without ensuring access and the concomitant adequacy of reimbursement for services is not putting Patients First.
I’m hoping the authors and the taxpayers of Alexandria and those throughout the State of Virginia will view this letter constructively. There is a healthcare need, but currently, as demonstrated by the lack of specifics in the article, Virginia’s plans for Medicaid Expansion lacks transparency. Does it put Patients First? Your guess?