RICHMOND, Va. - Although the Republican leadership in the General Assembly is frowning on it, Democrats and the governor are reopening Virginia's debate on expanding Medicaid. One reason it won't go away is because federal money available to close a big gap in Virginia's healthcare coverage would also close a big gap in the state budget.

As Michael Cassidy, president with The Commonwealth Institute puts it, the state is leaving federal money on the table. Funds he says Congress or the other states will gladly spend.

"Virginians are paying all of those taxes in the other parts of the Affordable Care Act," says Cassidy. "Our state lawmakers are just opting not to bring some of that back, drawing down the federal money that's available to cover more Virginians."

Governor Terry McAuliffe's budget plan counts on the more than $200 million in new federal Medicaid funding to close a budget gap of more than $300 million. But expanding Medicaid under Obamacare is very unpopular with much of the Republican majority in the Legislature.

Critics of expansion say they don't want to commit to enlarging a state program and risk having federal funding cut in the future. But supporters point out the state could pass a so-called circuit breaker, withdrawing expansion if the federal money goes away.

Cassidy says even though Congress has been fighting fierce battles over the budget, it's never shown any appetite for cutting Medicaid funds.

"In all of these rounds of federal deficit-reduction talks and agreements we've had," he says. "None of them have monkeyed with the federal match rate for Medicaid expansion."

According to Cassidy, Medicaid has always been better at controlling expenses than private insurance, with much lower overhead and administrative costs. He adds one irony is that expanding Medicaid would save Virginia a lot of money in other parts of the state budget. He points out the uninsured end up using other types of expensive, state-supported care at such places as clinics, hospitals and jails.

"There's a wide array of services that the state currently pays," he says. "If we went ahead and closed the coverage gap, then the state would get very significant state budget savings."


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Most people probably never give a second thought to their visits to the dentist, but not everyone can navigate this process with ease. People with intellectual or developmental disabilities may face challenges in finding quality dental care.

Dr. Bill Milner founded Access Dental Care with those patients in mind. It's a mobile dental service that makes care more accessible by visiting places such as nursing homes, group-home day centers, PACE programs and retirement communities.

Milner said the goal is to provide a dental home for a population that is too often overlooked.

"We've had to develop our own delivery system," he explained. "It has to be rolled in, five days a week, into different facilities. We treat 15 to 18 patients a day, and then we gather everything up at the end of the day, roll it back out, put it in the truck and go home."

Sponsored by the North Carolina Dental Society, Access Dental Care serves 60 counties in the state, and visits about 160 facilities. Milner has also won this year's American Dental Association Humanitarian Award.

Milner acknowledged that efforts are being made to improve access, but said barriers still exist -- from navigating behaviors to having few providers trained to give specialized care. He said even small changes within the profession can lead to improvements.

"We're having folks roll in, in wheelchairs, into offices -- and they don't know how to transfer folks into dental chairs," he said, "and it's as simple as getting a physical therapist in to train their staff."

Another significant challenge is Medicaid funding for providers, which Milner said typically only reimburses 38 cents for every dollar of the dental bill. Nonetheless, he said, his team will continue to advocate for special-care services, with plans to open more clinics.

Milner sees it as a priority to raise awareness and encourage more dentists to work with these patients.

"We need them to speak up and continue to be advocates for oral health," he noted, "and for them to understand that infection in the mouth is infection in the body."

There is movement on this issue at the state level. In the North Carolina Legislature, Senate Bill 382 would give students the chance to work in the community at nursing homes and group homes. The bill is now in a conference committee and has bipartisan support.

The holiday season is filled with recipes passed down from years before, and feasting with family and friends. But think again before you have seconds.

The top three days for heart-related deaths are Dec. 25-26 and Jan. 1, according to a study in Circulation, a publication of the American Heart Association. Missouri dietitians and the Heart Association are reminding people to mind their heart health and overcome excuses.

Registered dietitian Ariel Johnston at The Tasty Balance in St. Louis said it's fine to enjoy favorite holiday foods - but add something, to help keep it balanced.

"Maybe you have your favorite recipes that was handed down from Grandma, and maybe it's not the most 'heart healthy.' You can still have that, but let's add some greens or salad, or your appetizers that include some fruits and veggies," she said. "You don't want to deprive yourself of those favorite things."

Winter weather can be another trigger for increased heart-attack risk, with cold temperatures restricting blood flow through already constricted blood vessels. But the research says even in a mild climate, about one-third more heart attack deaths occur in December and January than in June through September.

If it's willpower you need to keep from overindulging, the Heart Association offers tips online at heart.org.

Johnston added that so-called "yo-yo" dieting or crash diets, which are often popular following the holiday season, can be detrimental to heart health.

"A lot of the rhetoric that we hear at this time of year, as far as, like, 'This is how many pounds people gain during the holidays,' and then, you're going to start seeing all the advertising for the new diets coming up," she said. "Yes, people might lose weight and maybe improve lipid profiles a little bit. But really, they aren't sustainable."

The Heart Association also has recipes online that can help with healthier substitutions or additions to holiday meals.

Research in Georgia is getting a boost to help enhance the lives of people living with Alzheimer's disease and provide better support.

In Georgia, more than 150,000 people age 65 and older are living with Alzheimer's, and the number is only expected to rise.

Leslie Tripp Holland, senior director of marketing and communications for the Alzheimer's Association, said the state has received an additional $600,000 to advance research efforts.

"For instance, we have one researcher at Emory University," Holland explained. "Her research brings dementia awareness into the Black American churches and she is creating dementia-friendly congregations."

Right now, 19 projects are active in such areas as Atlanta, Athens and Kennesaw. Holland noted in addition to the search for a cure, many of the projects are assisting in risk mitigation, creating opportunities to spread awareness and allowing people to participate in clinical trials, ultimately helping provide increased representation in research.

Breaking down the stigmas surrounding brain health, dementia, and Alzheimer's is another significant aspect of the research being conducted in Georgia. Holland emphasized by investing in research, the state is advancing its understanding of the diseases while working toward developing effective treatments.

"We now have two FDA-approved treatments that are also approved by Medicare that clinically changed the course of the disease," Holland stressed. "We have never had that in the past."

The funding was part of a $100 million investment into research around the country by the Alzheimer's Association, the largest investment since 1980. Data show more than 6 million people in the U.S. are living with Alzheimer's, and by 2050, this number is projected to rise to nearly 13 million.


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