"Health in general is a problem"—Kaine talks patient care in Culpeper

"Health issues will be the driver this year in Congress," U.S. Sen. Tim Kaine, D-Virginia, stated during a roundtable meeting Thursday in Culpeper.

And it was a topic for serious discussion among leaders from the PATH and Culpeper Wellness Foundation, Encompass Community Supports, Rappahannock Goodwill, Culpeper Human Services and the Free Clinic, all concerned about more loss of coverage for the un and under-insured.

They gathered with hospital officials in the boardroom at UVA Health Culpeper Medical Center Jan. 22 for a more than hour-long discussion with Kaine on the topic of healthcare and people's ability to access it, especially in rural America.

It was Kaine's third stop around Virginia last week during a congressional recess to hear from constituents about issues impacting them most.

"I want to hear the ones you're grappling with, back in D.C.," he said, referencing stops in Hampton Roads and the Shenandoah Valley.

The extension of enhanced premium tax credits under the Affordable Care Act, health savings account expansions and Medicaid are top of the list, Kaine said.

Base tax credits in place when the ACA was first adopted, the senator said, were enhanced during COVID, "becoming enormously helpful to families," though originally meant as temporary. Some Republicans want to end the enhanced credits in favor of funding health savings accounts that individuals could use to cover medical expenses like copays.

HSAs could be an area of agreement, Kaine said. The future of Medicaid funding and new work requirements for recipients is also on the table.

"The effects are starting to become very apparent," the senator said of last year's massive budget reconciliation bill. "Three clinics closed in Virginia because of it; the Farmville hospital is closing its OB practicethey have to go to Lynchburg to have a baby."

Kids, disabled adults and seniors all relay on Medicaid, Kaine said, adding its future will be a very dominant discussion when Congress convenes. That will include a look at the longstanding 340B Drug Pricing Program that allows low-income citizens and their providers to access pharmaceuticals at a lower cost. The program has seen growth and abuse, Kaine said.

UVA Community Health CEO Erik Shannon sat at the head of the roundtable near Kaine.

"One thing we all know, healthcare options takes the entire community to provide," he said, referencing partners at the table, like the free clinic.

At UVA Community Health, including the Culpeper hospital and three others in NOVA, ACA annual payments amount to around $100 million, Shannon said, noting an anticipated impact in the 20% range with cuts in the program. Another 25% of patients receive Medicaid, he said. Cuts to ACA tax credits will mean higher costs for patients and ultimately, delayed care, Shannon said.

"We're all watching the enrollment numbers," he said, noting many ACA enrollees are switching to the cheapest option, the bronze plan, about half of all enrolled locally. "How are we making sure we are able to do preventative in a timely way before we see them in the ER?"

UVA Health plays an important role in the commonwealth, Shannon added, in that anyone can come there for treatment.

UVA Health Culpeper Medical Center CEO Donna Staton said access to the drug discount program can be the difference between profitability and unprofitability at the local hospital. She added they are seeing an increase in demand for financial assistance. Money saved through the drug discount program allows them to provide that assistance, Staton said.

The local hospital CEO highlighted a striking statistic300% of local women are underserved for pregnancy care.

"People will go to the ER for that," Staton said. "We're back to some of the crisis in healthcare we saw during COVID over demand for hospital services."

Around 25% of patients do not have access to prenatal care, as many private providers do not accept Medicaid, Staton said. That's compared to around 5% statewide, Shannon said.

"There's more complications nowhypertension," he added.

Kaine commented it's impacting the immigration population, and local officials agreed.

"The transient nature of these populations," Staton said, adding a large part of Medicaid enrollees are children.

The region's top three health issues for the past several years have remained staticaccess to care, behavioral health/substance use and chronic disease management, health leaders said.

Culpeper Wellness Foundation Director Shari Landry spoke of services provided through their Piedmont Regional Dental Clinic in Orange, where up to 80% of patients receive Medicaid. The rest, with no insurance, receive free or reduced cost services, Landry said. Access to dental care prevents so many other health issues, she said.

"If the Medicaid dental benefit changes, they won't get dental care," Landry said. "They will be sicker and, in the ERit's such a snowball effect."

There's also a lack of primary care physicians in the area, said Sheryl Reinstrom, executive director of Encompass Community Supports. It took her over a year to get an appointment when she moved from Philadelphia.

Cuts to Medicaid "is going to absolutely flood the ER," she said. "They will be boarding centers."

For people in recovery, having to wait for services, means the chance for relapse goes through the roof, Reinstrom said. Medicaid is a safety net, she added: "How big are the holes in that net? If they can't pay, we have to take them. How many businesses do you know that can survive without revenue?"

The increase in need is greater than the clinicians who provide medication assisted treatment for substance use disorder, she said.

"Their recovery will be threatened," Reinstrom said.

And speaking of prevention, there is the issue of safe and affordable housing, she added. Appointments and medications become unstable when the housing is unstable, Reinstrom said.

Other feedback Kaine received from local providers is that a six-month reenrollment requirement for Medicaid is not manageable for patients or medical staff. Patient literacy of the intricacies of modern healthcare is so low, said Becca Buncie, RN, patient care coordinator at the free clinic.

"They are at a loss for the next stepshow do I follow up? Patients are not knowledgeable enough to navigate the system on their own," she said, adding the advent of community health workers, grantfunded positions, has helped with patient literacy.

The fact that healthcare in America is complicated came up at all of the roundtable session, Kaine commented.

Christy Connolly with the PATH Foundation said her organization loves community health workers, referencing their PATH Community Link free, confidential call center to connect people with resources, at 855-495-LINK (5465) from 9-5 Monday through Friday or communitylink@pathforyou.org

"It's like 211 on steroids," Connolly said.

While there have been no easy answers on stable housing, the call line will be inundated with questions on medical access, she said.

Staton commented many go to social media for guidance and direction on healthcare, which she advised not doing and seeking out a verified source.

Katie Lindsay, Encompass behavioral health director, spoke up for the effectiveness of peer recovery services in treating substance use disorder. The program only exists with Medicaid funding, she said. Peer recovery is used in the hospital and jails and Encompass has a whole site dedicated to it at the SEE Recovery Center, Lindsay said.

"Encompass is a pioneer in peer so that's a huge concern," she said.

Kaine asked if there were any innovative workforce strategies as a solution to healthcare. Marty BaldwinBywaters with Rappahannock Goodwill said $24/hour is the living wage in Culpeper.

"There's not a lot of jobs willing to pay $50K a year," he said. "On the solution side, the healthcare is there, when they're willing to pay that living wage and we're letting young people see what these jobs are."

Culpeper Technical Education Center works with Germanna Community College, Career Partners and others to link high school students with real world career paths with employers who provide healthcare coverage.

There's a need for healthcare employees too, said Kaine.

"How do we make healthcare sexy?" he said. "AI will not take away these positions."

Jason Ford with Rappahannock Goodwill noted "the intersectionality of all the organizations" at the Jan. 22 roundtable in aiding healthcare access for local citizens. In his work helping the local workforce, he said he's seen a lot of older people coming back needing employment, including one man living in his truck.

Alvin Petit, a local health insurance agent, said ACA deductibles have skyrocketed from $10K to $20K.

"It's hurting a lot of peopleforcing them to go to catastrophic coverage because they don't have any other options."

"Health in general is a problem," said Ben Thompson, a licensed professional counselor with Encompass Community Supports.

He said his son couldn't get a primary care appointment for two years when he turned 18 and that's with insurance.

"We can't serve everybody who needs it," Thompson said. "We don't have the staff. If we lose Medicaid, we lose even more ability to pay."