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ACA in Virginia

The Affordable Care Act (ACA) has widely been debated in America with proponents
advocating for the application of ACA while opponents are opposed to the implementation of the
policy. The state of Virginia has made progress in implementing various healthcare reforms
geared towards improving healthcare delivery (Blumberg, Rfkin, & Wengle, 2017). One of the
main strengths of Virginia’s approach to ACA is the implementation of a health insurance
exchange. The state of Virginia has implemented strong policies that support health insurance
exchange (Blumberg, Rfkin, & Wengle, 2017). The state has formed various task forces that
have worked towards ensuring that the state implements healthcare reforms in line with the
provisions of the ACA. Every task force that has been created in Virginia has been given a
specific task. One of the key recommendations that have been implemented is the creation of a
health insurance exchange that has created a healthy competition in the market.
Another strength of Virginia’s approach to ACA is the application of information
technology. The state is actively involved in efforts towards improving the information
technology system in the country (Blumberg, Rfkin, & Wengle, 2017). State officials have
realized the need to update the state’s outdated technology that would hinder the implementation
of the various healthcare reforms. In the year 2012, the state released documents showing the
intended improvements to the current health care systems (Blumberg, Rfkin, & Wengle, 2017).
The improvements have ensured that the eligibility for various medical insurances has been
streamlined. The application of better information technology systems has resulted in the
enrollment of more individuals to the various health insurance schemes.
Virginia has enacted legislation that supports the enactment of certain provisions of the
ACA. The approach has been advantageous since it has ensured that the state realized the

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positive impact of the ACA on healthcare. The state passed legislation that gave the Bureau of
Insurance (BOI) with the mandate to enforce various structural changes in the provision of
medical insurance (Blumberg, Rfkin, & Wengle, 2017). Pieces of legislation passed in Virginia
have ensured that the company keeps up with the various market reforms. Legislation has
ensured that the dependent coverage has been expanded to age 26, thus ensuring that many
people are covered by health insurance.
One of the weaknesses of Virginia’s approach to ACA is the failure to endorse the
provisions of the ACA fully. The political leadership in Virginia has failed to support the ACA
fully. The lack of a political will has thus created various policy-related programs. While other
states expanded Medicaid, Virginia failed to expand Medicaid. The implication is that many
people were left out of the health insurance bracket (Rand Corporation, 2017). Another weakness
of Virginia’s approach to ACA is the lack of a common insurance market across the state. The
ACA has various incentives that work towards ensuring that it becomes the second lowest cost
plan. However, in Virginia, the lack of proper implementation has resulted in differences in
provider insurance markets. In some parts of Virginia, the health plans are aligned to specific
hospital systems (Rand Corporation, 2017). Another weakness lies in the state’s approach to
ACA is the lack of Medicaid expansion. Medicaid expansion would result in the coverage of
more people. Approximately 400,000 people would be enrolled in health insurance with an
expansion of Medicaid (Rand Corporation, 2017). While there are certain disadvantages
associated with the expansion of Medicaid, Virginia’s approach has meant that more people have
been locked out of Medicaid.
Virginia political leadership was less supportive of the ACA; hence, the state had not
expanded Medicaid as of September 2017. Transformation opportunities in the state’s health

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system had no support from the state government hence they occurred in the context of
privatization or restructuring Medicaid initiatives conducted through waivers by the federal
government as per the Medicaid rules. The approach of Virginia towards ACA had various
impacts on different stakeholders, both consumers, and providers. ACA expands the eligibility
for Medicaid programs and makes them accessible to many consumers through offering tax
credits for people to purchase private insurance. The number of uninsured people within the state
dropped, and the change was driven by a rise in coverage that was sponsored by employers.
More consumers enrolled for Medicaid in the fiscal year 2015 (Nikpay et al., 2016). There was
an increment by 5.4 percent compared to the lower numbers registered in 2013 (Nikpay et al.,
2016). The less political support on ACA did not affect enrollment because one of the
requirements of ACA was for citizens to acquire health insurance. A report by the Kaiser Family
Foundation revealed that by 2017, Medicaid enrollment in Virginian had amounted to one
million per month. Eighty-three percent of people that had enrolled for Medicaid in Virginia
were eligible for premium tax credits. Besides, sixty percent of the enrollees were eligible for a
reduction in their cost-sharing responsibilities; hence, they covered a little percentage of the costs
while the rest was covered by their plans. Average premiums for enrollees in Virginia increased
by seven percent per month.
The approach taken by the state of Virginian created uncertainties to the consumes. In
2018, they were not sure whether the political class would make legislative changes to the ACA,
and the impact that would have on them ((Findley et al., 2019). Also, there was uncertainty on
whether reimbursements aimed at reducing cost sharing would continue to be paid, and how that
will be enforced at an individual level. Further, uncertainty has been high on whether the strict
enrollment rules would impact the risk pool, especially the short period that had been opened for

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enrollment. Insurers were also uncertain on the continuity of the trend that had taken place from
2016 to 2017, where premium changes were determined by the underlying healthcare costs
((Findley et al., 2019). The federal reinsurance program came to an end, and this affected the
insurers in Virginia as the federal government had previously reimbursed insurers for high-cost
enrollees. Insurers in some cases have been Pressure on premiums has increased since as high-
cost enrollees have to cover more costs.
Overall, by October 2017, Virginia agreed to support ACA. In 2019, the premiums being
paid for individual plans rose by about nine percent (Findley et al., 2019). There is a single
provider in many counties within Virginia, thus making the rates competitive. There has been a
spike in the average premiums paid by individuals, and hence enrollees now pay higher
premiums that were the case when ACA was federally run within the state. However, stability is
slowly being achieved in the market, especially through the expansion of short-term plans and
the repeal of the individual mandate provided for by the Trump administration. Stabilization of
prices has been seen as a correction of prices as insurance companies earned very high profits in
2018 when premium rates spiked. Stability has also made ACA in Virginia more consumer
friendly.

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References

Blumberg, Rfkin, & Wengle. (2017, February 1). The Launch of the Affordable Care Act in
Selected States: Small Group Marketplaces. Retrieved from
https://www.urban.org/research/publication/launch-affordable-care-act-selected-states-
small-group-marketplaces
Findley, P. A., Wiener, R. C., Shen, C., Dwibedi, N., & Sambamoorthi, U. (2019). Health reform
under the patient protection and Affordable Care Act: characteristics of exchange-based
health insurance enrollees. Social Work in Health Care, 1-18.
Nikpay, S., Buchmueller, T., & Levy, H. G. (2016). Affordable Care Act Medicaid expansion
reduced uninsured hospital stays in 2014. Health Affairs, 35(1), 106-110.
Rand Corporation. (2017). Affordable Care Act. Retrieved from https://www.rand.org/health-
care/key-topics/health-policy/aca.html