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Virginia and Health Reform

While much of the federal health reform law affects every single state, two options were given to each state in order to implement the law as they saw fit in their community. Although Virginia did not have a choice in establishing an exchange, the state was able to decide how they wanted to do so. All states were able to determine if they wanted to create their own and run it on the state level, have the feds operate the entire project, or enter a partnership and balance responsibilities. Additionally, the state had the option of adding a new group to their Medicaid program and offering coverage to several hundred thousand low-income adults throughout Virginia.

Other parts of the law have already changed some aspects of health insurance in Virginia, making it easier for children and young adults to stay insured, and preventing other policyholders from losing their benefits. In the coming months, even more changes will be made to insurance, providing greater freedoms for people with health problems, women, and those who work in risky jobs. The market will be very different, and it will surely change how the people of Virginia regard insurance.


Current Insurance Reforms in Virginia

Since the law’s inception, several changes have occurred in Virginia individual health insurance. One of the first insurer liberties to go was the ability to rescind a health plan for any reason other than fraud, misrepresentation, or nonpayment of premiums. This is part of guaranteed renewability, which ensures you keep your benefits as long as you are honest and pay for your plan, and requires insurers to offer to renew your plan each year. It may seem logical, but before this law, Virginia insurers could cancel your coverage for getting sick.

Individual insurance companies can also not refuse to insure a sick child under age 18, according to the law. While adults with conditions could still be declined for coverage prior to 2014, it is illegal for any health plan to turn down a child applicant. Adults with health problems were able to get coverage through the PCIP, a temporary risk pool for sick people which lasted from 2011-2014.

One of the most significant parts of the law kept young adults in Virginia insured for several years longer than previously, extending the age limit for dependents to 26. This provision has allowed millions more people to stay insured from this group across the country, as it was previously 19-23 depending on the state.

If you’re insured through any private plan, whether group or individual, you have noticed your preventive care services such as annual exams and check-ups for children have been free for the past few years. Additional services have also been approved by the federal government as preventive care, allowing insured Virginians to avoid paying a copay or out-of-pocket fee for a variety of screenings, medications, and other services.


Virginia Health Reform in 2014

Virginia’s Republican Governor Bob McDonnell has been back and forth over whether the state would establish its own health insurance exchange, rather than give control over to the federal government. The most recent and final verdict, however, is shared responsibility without officially entering a state-federal partnership. In this agreement, Virginia’s State Corporation Commission (SCC) and Department of Health will perform plan management operations and additional functions such as technical assistance, managing consumer complaints, and decertifying issuers. Therefore, the state will determine premium rates, benefits, and cost sharing amounts for plans on the Virginia Health Insurance Exchange.

The exchanges will offer health plans to any Virginian, with tax credits for those who earn between 138 and 400 percent of the federal poverty level to make premiums more affordable. Plans will include every type of essential benefit, which means formerly difficult services to cover, such as maternity and mental health, will be covered. To reinforce the necessity of utilizing these newly available options, the individual mandate requires people to enroll in a health plan or pay a penalty. Some are exempt from the penalty, however, based on income and other conflicts.

As for Medicaid expansion, the Virginia State Senate recently approved an amendment to the 2013 budget which included exploring this option. Under health reform, the program would grow to include adults without children who earn up to 138 percent of the poverty guideline. The Senate decided conditionally expanding Medicaid would be a great improvement for the state and help many residents, though the state budget must still be reviewed by the conference committee, then sent to the Governor.

As with every other state, the decision is divided between parties, mostly supported by Democrats. “This is going to give healthcare to almost 400,000 people without it,” Senate Democratic Caucus Spokesperson Joshua Karp said. “For every cent that we put into that program, the federal government will give us $1.70” throughout the next 10 years. Though there is support in the Senate, it is unsure whether Medicaid expansion will be finalized.

In individual insurance, new laws will establish a nondiscrimination policy in underwriting, which allows anyone with a pre-existing condition to obtain coverage and not be declined. Insurers are also unable to increase premiums based on gender or occupation, and can only rate according to age and tobacco use. This is the guaranteed issue provision that already exists in states like Massachusetts. Virginia will also choose a set of essential health benefits for each private plan to include in certain policies. The state will choose ten categories of benefits to provide, which may include maternity and newborn care, prescriptions, emergency care, and many other services already provided by individual plans – but not mandatory.




1. Kaiser Health Reform. State Exchange Profiles: Virginia.

2. Cavalier Daily. Virginia Senate expands Medicaid.