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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September is Self-Care Awareness Month and the American Heart Association in Missouri is urging caregivers to take some much-needed time for themselves.

Missouri has around 600,000 family caregivers, many of whom provide unpaid care to loved ones with heart disease, cardiac events and other debilitating illnesses. The emotional and physical toll can be severe, with 21% of caregivers reporting their own health has declined.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare and a member of the American Heart Association of St. Louis, wants caregivers to understand proper self-care is not selfish.

"It's really important that after an acute event, whenever you've had a chance to kind of catch your breath, sit down and think about exactly what they need and exactly what you need and how much you can give," Johar recommended. "That's not being selfish. That's not, not taking care of them. That's doing the right thing for both of you."

According to the American Heart Association, it is important for caregivers to have someone they can confide in about their fears and doubts; a person who can offer reassurance and emotional support.

A 2023 AARP survey showed nearly 40% of family caregivers spend more than 20 hours a week assisting their loved ones from driving to appointments to providing direct care, many while also working and raising children. Johar stressed the importance of caregivers using time off from work wisely, which includes new mothers with babies in neonatal intensive care.

"The baby's getting the best care in the hospital and there's nothing you can do to help," Johar pointed out. "Go ahead and go back to work. Save that time, go in every evening. Spend all night or as much time as you want with the baby. But save your time off, because when this baby comes home, then you're really going to need to be there."

Doctors also emphasized the critical role of regular exercise, like brisk walks and the need for caregivers of all ages to maintain a heart-healthy diet. The habits help manage stress and boost energy levels.

Self-measuring blood pressure sites are coming to the Northwest, starting with a community organization in Portland.

The American Heart Association and Providence Health Plan have launched a program to bring self-monitoring blood pressure equipment to 20 clinics and community organizations in Oregon and Washington. The first was introduced at the Portland Opportunities and Industrialization Center, a training center serving more than 3,000 students age 17-65.

Michael Hale, a health navigator at the center, said some people get "white coat syndrome" when they visit the doctor, causing inaccurate blood pressure numbers.

"The beauty of this program is to be able to have our staff use the blood pressure monitors at home or in their office when they're regulated, before they drink their coffee," Hale explained. "Then they'll be able to log it throughout the week and then use that information, take it to the doctor."

Hale pointed out people can then discuss with their doctors whether it's time for blood pressure medication or lifestyle changes, depending on the readings. The program will loan out blood pressure monitoring equipment to students, families and staff at the center.

Blood pressure is an important indicator of health. Left untreated, high blood pressure can lead to heart attack, stroke and other health issues.

Meredith Collett, executive director of the American Heart Association of Oregon and southwest Washington, said the program is designed to bring monitoring to people who may not have access.

"Our hope with our collaboration with Providence Health Plan is to remove those barriers to health care access by setting up these self-measured blood pressure cuffs with POIC for at-risk communities," Collett noted. "They can really track and understand their numbers."

The initiative to bring self-measuring blood pressure equipment to clinics and organizations in the Northwest is expected to expand to 20 over the next three years.

Nonprofits across Texas are coming together to address disparities in health care for the Latinx community. A report by the Commonwealth Fund shows some factors that lead to the differences in health care include high poverty rates, elevated levels of pollution and crime and a lack of green spaces.

Paulina Sosa, Latinx Voces founder, said many in the Latinx community lack access to vital resources that could improve their overall health.

"Lack of physical access to a clinic or a doctor, the lack of information on how to go about accessing those health care services, and of course, it could be related to the lack of linguistics, otherwise known as information in Spanish," she said.

She added health disparities that had been in existence for years were brought to light during the COVID-19 pandemic when Hispanics experienced some of the highest death rates.

Edgar Carmona, president of the nonprofit Alliance for Progress in Dallas, which works to reduce health-care disparities among vulnerable populations, said some in the Latinx community don't seek medical care because they don't trust caregivers from other races.

"We just don't see the medical community being able to represent the community that it serves. We, as a society, are perhaps not creating the opportunities needed, or the encouragement for our youth to go into this field," he continued.

Both Sosa and Carmona said collaborations can help improve health outcomes for the Latinx community. Sosa added that during and after the pandemic, community partners, small businesses and faith-based organizations worked together to improve the lives of those most vulnerable.

"How do we ensure that the momentum, around addressing these disparities - particularly for Latino and Spanish-speaking communities - how do we ensure that the momentum continues? That is one of the biggest questions we're trying to tackle. We really believe that partnership is at the center of that solution," Sosa said.


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