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When the U.S. Supreme Court upheld the constitutionality of most of the Affordable Care Act, it was left up to the states whether or not to expand Medicaid eligibility.
Virginia lawmakers must consider which other costs could be avoided by expanding Medicaid coverage, the price for not expanding it, and the additional resources that might be needed.
Legislative Fiscal Analyst Joe Flores told the Senate Finance Committee that the makeup of who would be covered would change significantly under the broader coverage.
"You're going to pick up a lot of adults without children, and some single adults who are not currently covered under Medicaid," says Flores. "Men-women, about even, and then you're going to pick up a slightly younger population — under 35, you're talking about 52 percent being under the age of 35."
State costs for the 2016-2018 biennial budget would likely be $233 million, excluding administration. Flores says the expansion has potential cost savings, but there also could be a downside. For example, local government staff will have higher caseloads, there will be a greater demand on the healthcare workforce, and there's uncertainty about whether the cash-strapped federal government can pay its share.
The Commonwealth Institute for Fiscal Analysis says if the state does not expand Medicaid, it could forego billions in federal funds and leave many people without coverage.