RICHMOND, Va. - As the fight over Medicaid expansion continues, budget numbers from around the nation suggest expansion actually could be financially good for Virginia.

Critics of expanding the program to cover the working poor have argued it's a budget-buster. However, Michael Cassidy, president of The Commonwealth Institute for Fiscal Analysis, said figures from the Congressional Budget Office and from states that have expanded Medicaid programs indicate that's not the case.

Cassidy said Virginia would save $225 million in the next two-year budget cycle.

"A more financially responsible path is for Virginia to go ahead and close the coverage gap," he said, "because there's a lot of stuff we currently pay for through general-fund dollars that would no longer be needed when folks have coverage."

Critics charge that the states that are expanding Medicaid are benefiting from unsustainable federal spending. According to the CBO, however, health-care reform will cut the deficit by $10 billion a year over the next decade.

Dr. Christopher Lillis, a primary-care provider in Fredericksburg and Virginia director of Doctors for America, said he thinks expansion will make a chaotic and inefficient system smarter and more focused on prevention.

"We are already paying for the uninsured through our tax dollars, through higher insurance premiums and higher health-care prices," he said, "but we're doing it in the most inefficient manner."

Lillis gave the example of a woman with breast cancer who ends up with a huge emergency-room bill she can't pay, for lack of an inexpensive screening.

One hospital system in West Virginia reported it is seeing 85 percent fewer uninsured patients this year, largely thanks to Medicaid. Cassidy said Virginia's hospitals would be hurt without expansion.

"Hospitals are really left holding a bag, because they know they have cuts coming down the pike," he said, "and yet Virginia lawmakers refuse to close the coverage gap, leaving 400,000 folks without health care."

Expanding states say they're gaining as much as $10 to $15 in federal funding for every dollar they invest. Cassidy said Virginia could expect a similar return.


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Summer is usually a fun time to enjoy the outdoors with family and friends, but experts said Missourians should be taking precautions to keep a day of fun in the sun from causing serious health concerns.

With climate change, summers have been measurably hotter in the Midwest than in previous years.

Dr. Peter Panagos, professor of emergency medicine and neurology at Washington University-Saint Louis, said if you are going to be outside, choose the right time of day.

"Typically in the Midwest this time of year, it's quite hot with ambient temperatures above 90," Panagos pointed out. "If you can avoid the hottest part of the day, with often can be around noon, between, like, 10 and 2 p.m. or 3 p.m., where the sun is at its highest and its hottest."

Panagos noted it is best to plan activities for early morning or early evening. If you are exercising or hiking, he suggested you go around 7 or 8 in the morning. He advised hikers and runners to take plenty of water and a wide-brimmed hat or baseball cap to help keep your face shaded and your head cool.

Even if you take precautions, being outdoors in the summer can lead to dehydration and sometimes, heat-related illnesses. Panagos emphasized knowing the signs of heat stress can help you deal with it before it becomes a serious matter.

"You may notice things such as dry mouth, kind of all of a sudden shutting down or lack of sweating, dizziness, confusion, headaches, muscle ache," Panagos outlined. "That is your body's way of telling you that it's advancing from just heat exposure to potential heat exhaustion."

Kids love the outdoors, and favorite summer activities include playing their favorite sports, bike riding or going to the pool to cool off. But children are often more susceptible to injuries than adults.

Dr. Donna O'Shea, chief medical Officer of population health for UnitedHealthcare, said a video chat with your doctor can help you decide whether to treat a problem at home or seek medical help.

"Virtual care can help you determine how much, how long to wait, before you go to the emergency room," O'Shea recommended. "Same thing even for sunburns, or for bike safety: 'Do I need to go in?' 'Do you think I need stitches?' And we don't think about that."

Until the pandemic, telehealth and telemedicine were still outliers in health care but they have gone mainstream, especially benefiting underserved and rural New Mexico communities.

Heather Dimeris, director of the Office for the Advancement of Telehealth at the Health Resources and Services Administration, the primary federal agency tasked with improving access to health care services for people who are uninsured, isolated or medically vulnerable, said a national conference being held today will bring public- and private-sector leaders together to discuss topics related to best practices.

"Telehealth licensure, agreements between states to help practitioners practice across state lines, as well as access to broadband," Dimeris outlined. "This is free and virtual and it's open for the public."

Dimeris explained government data show patients who get telehealth services have the same, and in some cases better, outcomes as in-person visits.

Dimeris noted underserved communities often see benefits and improvements in their quality of life through behavioral-health services via telehealth. And those who qualify can leverage the federal Lifeline program, a free government phone service through the Federal Communications Commission.

"Internet is really a foundation of good telehealth services and we can do audio-only appointments, or appointments over the phone, but it's always nice to at least have the video chat," Dimeris pointed out. "That connectivity can be really hard in remote areas of New Mexico."

She added expanding virtual visits could cut down lengthy waitlists for urgent appointments. And she acknowledged many people seeking mental health services prefer to talk with a doctor in order to bypass stigma sometimes experienced with office visits in small communities.

A new analysis from Washington state shows passing an initiative making a long-term care benefit program optional could cost taxpayers millions.

Initiative 2124 would make optional the WA Cares program, in which workers contribute a little more than 0.5% of their paychecks for access to long-term care benefits. The Office of Financial Management estimates passage of the initiative would cost the state between $12 million and $31 million within three years.

Kristin Hyde, press secretary for the group No on 2124, said other analyses have found even greater consequences.

"This initiative would effectively actually end the program, it would shutter it, it would bankrupt the program," Hyde contended. "By 2027, in effect benefits would not be able to be paid out for the nearly 4 million workers who have been vesting in the program."

Supporters of the initiative, including Rep. Jim Walsh, R-Aberdeen, said the program provides little practical effect and people should have choice on whether to contribute to the program. Under the program, Washingtonians will have access to up to $36,500 in benefits from the WA Cares Fund starting in 2026.

Hyde noted the program can be used to pay home aides, for instance, which could help more than 800,000 family caregivers in the state. She added many caregivers are women who sometimes have to choose between work and taking care of family members.

"Long-term care is not covered by regular health insurance and it's also not covered by Medicare," Hyde pointed out. "It's this gap and so we're really in a rock and a hard place here. We don't have anywhere to turn."

Hyde explained it is why state lawmakers approved the WA Cares Fund. She stressed the benefits are flexible and available for use on expenses like home modifications as well.


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