The Future of Medicaid: Talking About Health Before Health Care

Although Tim Kaine, the Democratic US senator from Virginia, is a big proponent for the Affordable Care Act (ACA) and Medicaid expansion, his state remains one of the 19 that have yet to expand the federal program.

And he doesn’t foresee that changing any time soon, despite efforts by the state governor.

“I predict [the legislature] will stand in the way as long as there is a president named Obama in the White House,” Kaine said.

However, he believes when the next president takes office—Democrat or Republica—they will embrace Medicaid expansion.

Kaine spoke about Medicaid, the ACA, and politics at America’s Health Insurance Plans’ National Conference on Medicaid, held October 21-22 in Washington, DC.

Having previous served as the governor of Virginia and the mayor of Richmond, Kaine is no stranger to political division, and yet he was surprised when he joined the US Senate in January 2013. At the time, the mood was tense.

Republicans were all for “repeal or nothing” when it came to the ACA and Democrats wouldn’t even consider reforms to the legislation. Even as a proponent of the health care reform law, Kaine bluntly said that the ACA could use some improving, but it took a while before other senators came around to his way of thinking.

Today there are more people in both parties who are willing to reform parts of the legislation. With 2 Supreme Court cases and 2 victories for the ACA, and now 16 million people covered under the ACA, the Republicans realized repeal was not a likely option.

And after watching the troubled rollout and the realization that some provisions in the law weren’t perfect, the Democrats have been shaken out of their complacency.

As for Medicaid expansion, Kaine worries about Virginia being the last state to expand. He likened their current situation to Arizona.

When Medicaid was first created in 1965, the program itself was opt-in for the states, and Arizona was the last state to join—in 1982, 17 years later.

“It left all the citizens uncovered who could have been covered all those years,” Kaine said.

Being the last state took its toll on Arizona. And despite the fact that it remains dramatically Republican, the state has been an early adopter.

“They learned that being a caboose on something that’s good for your citizens is a terrible place to be,” he said.

States that make the argument that they won’t expand the program because of cost “infuriate” Kaine.

While states do have budgetary challenges to work around, reports have shown that states that embrace Medicaid expansion see the cost curve for their Medicaid expenditures grow more slowly than states that did not expand.

Furthermore, expanding Medicaid means healthier citizens, which means more productive citizens and saving money.

“I just think [expanding Medicaid] is so critical,” he said. “I hear states making the argument we’re not going to do it because of the cost, as if this is about just dollars and cents. We’re talking about human lives.”

As a legislator, he looks at continually reforming laws to make them better for the people they serve. But in order to make reforms to the ACA or Medicaid, all stakeholders have to be brought to the table, he said. And they have to realize not everyone will be happy with the outcome.

And there are reform possibilities out there. The big reform is to move the talk from health care to health.

“There’s no way to manage a society’s health care system so efficiently and in a high-quality way take care of an increasingly unhealthy population,” he said. “So we really need to focus on health before we focus on health care.”