In commemoration of World Asthma Day, we’re taking a look at the state of asthma care in Virginia.

One out of every ten adults in Virginia suffers from asthma in their lifetime, according to the Virginia 2018 Asthma Burden Report from the Virginia Department of Health.

Using data from 2016, the report estimated that there are 874,713 Virginians who are diagnosed with asthma at some point in their lifetime, while 560,419 adult Virginians suffered from asthma that year. The report found that 130,000 children in Virginia also live with asthma.

Asthma is not only a public health issue, but also an economic one. From 2008 to 2013, the annual economic cost of asthma for the United States was $81.9 billion, which included medical costs and loss of work and school days.

What does that look like on the state level?

According to a study published in the Journal of Asthma, in 2012, asthma generated an estimated $2,208 in medical costs per patient in Virginia and a total cost of $76.7 million in lost work and school days.

From 2014 to 2016, the number of asthma inpatient hospitalizations in Virginia declined from 7,582 to 4,120, a 54% decrease. But at the same time, the number of individuals with asthma in Virginia is increasing and 2016 saw nearly $87 million charged for hospitalizations due to asthma in Virginia, with the average charge for inpatient hospitalizations being $21,359.

On the plus side, the average total annual cost per individual for asthma treatment in 2016 was $974.05, a steep decrease from 2012.

What changed in that time?

The Affordable Care Act

The Affordable Care Act went into effect on January 1, 2014 and among the regulatory rules included in the ACA (also known as Obamacare), is a list of ten “essential benefits” that insurers must cover.

One of these “essential benefits” is chronic disease management, meaning insurers must offer plans that cover care for chronic diseases such as asthma.

The ACA also changed the law so that health insurance companies could no longer refuse to cover patients with pre-existing conditions, such as asthma. It also prohibits health plans from placing annual or lifetime dollar limits on benefits you receive and instituted a cap on yearly out-of-pocket costs.

The goal of the ACA was to provide affordable insurance to the tens of millions of Americans who were uninsured, and by 2016, more than 421,000 Virginians signed up for health care through the ACA marketplace, according to the Kaiser Family Foundation.

For asthmatics, the law was intended to help them obtain cost-effective and needed care. Among the specific protections for asthmatics was a mandate that doctor-recommended asthma screenings and tests be covered under all plans at no extra cost to patients.

Has the ACA worked as intended?

It appears so.

A 2016 study from Health Affairs found that people who got insurance through the ACA, including asthmatics, were significantly more likely to get prescription medications than they were before, and when they did, they spent less of their own money on those drugs.

While the ACA helped many asthmatics in Virginia, it’s likely that the state’s Medicaid expansion will help tens of thousands more.

Medicaid expansion

One of the main obstacles to treatment and care for asthma is the cost of medication, especially for disadvantaged populations. Indeed, asthma does not affect populations equally; it disproportionately affects adult women, female children, African-Americans, Hispanics and those living in poverty.

In 2018, the Virginia General Assembly expanded Medicaid coverage to 400,000 low-income residents. All Virginia residents earning up to 138% of the poverty level ($16,754 for a single person and $22,715 for a family of two) are eligible for the expanded program.

These same populations are the most likely to currently suffer from asthma: 14.4% of adults in households with an income less than $15,000 have asthma and 11.9% of adults in a household earning between $15,000 and $25,000 are asthmatics.

In comparison, only 6.9% of adults in a household with an income between $25,000 and $50,000 suffer from asthma.

Since people in poverty experience consistently higher rates of asthma compared with the general population, Medicaid expansion is likely to have a significant impact on their lives.

A 2018 report from the CDC backs this up and indicates that Medicaid is a substantial source of coverage for people living with asthma. According to the report, adults between the ages of 18 and 64 on Medicaid suffer from asthma almost twice as much as those with private insurance (13.1% vs 7.1%).

The state is also expected to benefit since more asthma patients are now more likely to seek treatment early on, which will prevent costly ER bills that the system then absorbs.

Future risks

While recent years have seen a drop in asthma hospitalizations and an increase in health insurance coverage for asthmatics in Virginia, the future remains uncertain.

Republicans repealed the individual mandate portion of the ACA in 2017 and President Trump continues to sabotage the healthcare law. In late April, Trump appeared before the NRA’s Annual Convention and boasted about eliminating the individual mandate and indicated he’d continue his attempts to repeal the ACA.

This was the latest in a long string of statements highlighting his stance on the ACA. In late March, Trump’s Department of Justice asked a federal judge to strike down the entire law.

Should the ACA be struck down, 21 million Americans could lose their health insurance, including the 272,000 Virginians who’ve already signed up for Medicaid this year.

The most widespread impact would be felt by Americans with pre-existing medical conditions.

According to a 2017 government analysis, 133 million Americans have pre-existing conditions that could disqualify them from buying a health insurance policy or cause their premiums to surge if the ACA were overturned.

The loss of protections for pre-existing conditions would impact the more than 500,000 Virginians who currently suffer from asthma, including those who don’t get their insurance through the marketplace or through Medicaid.

While most Virginians would still get their coverage through an employer-sponsored plan or a federal program, protections for pre-existing conditions are critical to them as well.

Prior to the ACA being passed, employers often refused to cover certain conditions, and should the ACA be invalidated, these companies would once again have the right to refuse to cover people with chronic conditions such as asthma.

How bad could things get for asthma patients?

According to a 2018 study from The Commonwealth Fund, the average out-of-pocket costs for those with asthma would rise by a whopping 27%. For many Virginians with asthma, this could be the difference between seeking treatment and not, which could have devastating consequences for the state’s public health.

The fate of the ACA remains unclear, but for asthma patients in Virginia and all Americans with pre-existing conditions, the stakes couldn’t be higher.