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HARRISONBURG — Costs associated with health care continue to rise across the country, and to find out the local impact, the Daily News-Record spoke with area experts Summer Sage and Timothy Jost.

Sage is the executive director of the Harrisonburg-Rockingham Free Clinic and board member of the Rural Health Association, and Jost is a nationally recognized health care policy and law expert and professor emeritus at Washington and Lee University.

The United States has the most expensive health care system in the world “by far,” said Jost, during an interview for an episode of the DN-R podcast The Bottom Line.

“Growth in the cost has evened out in the last decade or so, but it’s still generally growing faster than wages,” he said.

Costs for uninsured patients and those with high deductibles and high premiums can be steep, Jost said.

“That’s a huge problem for our community,” he said.

Deductibles are the costs that a person must pay before the insurance policy kicks in for coverage, while premiums are the costs that a person must pay to keep their insurance active.

Generally, health care costs have been leveling out, except in the deductible and premium parts of the sector, Jost said.

Some of the reasons for cost increases have to do with increased complications in the health care system, according to both Sage and Jost.

“We to look at the way that we’re asking our hospitals to process their paperwork and information, which has gotten more convoluted,” Sage said.

Each insurance company has its own requirements, and this complication comes at a cost, Jost said.

“We have the most administratively expensive health care system in the world,” he said.

Measures have been taken to try and address this issue, Jost said.

“The Trump administration has been talking about trying to standardize quality measures, which I think is a good idea,” he said.

Though affordability is important, “it’s one piece of a very big pie,” Sage said.

Accessibility of care is also important, she said.

“When we think about Virginia as a whole — and how about 64% or 63% is rural — how do we have coverage in those areas,” Sage said.

Approximately 38% of households in Harrisonburg and 29% of households in Rockingham County fall into the ALICE population, which stands for Asset-Limited, Income Constrained, Employed, according to a 2017 report by the local United Way.

“In light of those numbers, the Free Clinic expanded its eligibility guidelines to 300% of the federal poverty level — which is $23,000 for a single adult and $68,000 for a family of four,” Sage said.

And the 2019 Medicaid expansion in Virginia made more than 500 patients eligible for care at the free clinic, she said.

“This meant they were going to get whole, inclusive, wrap-around care, and we’re very excited for them,” Sage said.

Since the process for enrolling these new patients was complicated, the Free Clinic often had to educate the patients, she said.

“Although they had access to affordable care, they didn’t know how to necessarily implement or use it,” Sage said.

Many of these new enrollees may also fall back out of support, as the General Assembly eyes work requirements for Medicaid, Jost said.

“That has just proved to be a disaster,” he said. “In states that have implemented it, you have thousands of people who have dropped off of Medicaid because it just becomes so complicated.”

Part-time jobs often don’t qualify and other standards often unnecessarily complicate the process, Jost said.

“I think it’s pretty clear at this point work requirement are not getting people back to work — it’s just getting people off of Medicaid,” he said.

The Medicaid expansion also did not include those in the community on work visas or temporary residents, Sage said, adding that those demographics make up a large part of the local population.

Jost added that it also does not apply to non-citizens, who cannot even pay for access to care through the Affordable Care Act — the comprehensive health care act passed in 2010 that expanded health coverage.

This population segment “was the driving force behind looking at what was the Free Clinic’s role moving forward now that Medicaid was expanded,” Sage said.

In January, the board of the Free Clinic unanimously voted to support people regardless of their citizenship status, Sage said.

“We have definitely seen that that was a need,” she said.

When the General Assembly reconvenes on Nov. 18, the Free Clinic will be watching how lawmakers move forward on the work requirements for Medicaid, Sage said.

And Jost said he would continue to look at how the courts proceed in dealing with some aspects of the Affordable Care Act.

Contact Ian Munro at 574-6278 or Follow Ian on Twitter @IanMunroDNR

(3) comments


I believe that the estimate of 63% or 64% of Virginia's population being rural is much too high. The Economic Research Service of the US Department of Agriculture gives a thorough explanation of the different ways in which organizations classify areas as urban or rural. All of these measures put Virginia between 15% and 41% rural.

citizen t

I am still trying to figure out what part of the affordable care act is affordable!! Is it my premium that went up 400% or my deductible that went up 1200% my total out of pocket limit went up 500%, yes very affordable.


The Democratic party owns the healthcare woes in this country. And now they have a "new" plan that I'm sure will cost trillions and reduce quality.

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