May 2, 2018
Thank you for consistently opposing Obamacare’s Medicaid Expansion in Virginia. The target expansion popu-
lation deserves better choices than Medicaid. In fact, all Virginians deserve better. Please continue to oppose
Medicaid Expansion, and instead promote Medicaid reform and alternatives to Obamacare.
Able-bodied, childless adults with incomes below 138% of the Federal Poverty Level don’t want government
handouts. They want to be able to choose an affordable health plan that meet their needs, not the one-size-ﬁts-all
government plan that delivers an exceptionally low value of care. In fact, most Americans want choice and afford-
First, to offer choice and affordability, the health insurance market must be unleashed. We are very pleased with
the General Assembly’s passage of SB 844, SB 934, SB 935, and SB 964 that track changes introduced by
President Trump through Executive Order. These initiatives begin to loosen the stiﬂing regulations of Obamacare
and have already spurred health plans to offer choices in the individual and small group markets. More can be
done, but these are encouraging initial steps.
Secondly, alternatives to Medicaid already exist for these able-bodied adults: health sharing arrangements, direct
pay practices, direct primary care, and innovative healthcare models such as JoinTheWedge.com . Unlike the low-
value of Medicaid dollars (only 20-40% of reimbursement is for actual care), these third-party free options deliver
high-value care in a market-efﬁcient system. Government’s role should be to promote alternatives such as these.
Virginians enrolled in traditional Medicaid — and the taxpayers who fund Medicaid — deserve better than a
bloated, inefﬁcient, wasteful, unsustainable program. Reform is urgently needed; expansion is not.
We strongly encourage you to hold the line against Medicaid Expansion in budget deliberations. Show compas-
sion to constituents by not raising taxes, by lowering government spending, by returning to taxpayers any budget
“savings” and by restoring health freedom to Virginians through free enterprise solutions and regulatory reforms.
Nancy J. Piotter
Virginians for Quality Healthcare
P.O. Box 223472
Chantilly VA 20153