The past year has been a significant one for health in the Shenandoah Valley.

Opioid overdoses have decreased from more recent years, as have injuries from overdoses, suggesting that the intensity of the opioid epidemic might be slightly waning. Throughout the year, 21 people have died of an overdose, according to the Northern Shenandoah Valley Substance Abuse Coalition. Last year, 40 people died of an overdose.

But fentanyl remains a powerful killer while methamphetamine and cocaine seizures have surged.

Perhaps the biggest health news in Virginia this year, though, was the expansion of Medicaid. After years of legislative battles, Virginia expanded Medicaid for the first time.

The expansion means that people whose incomes are under 138 percent of the federal poverty guidelines will be eligible for Medicaid in 2019.

Pam Murphy, the executive director of the Shenandoah Community Health Clinic, praised the decision.

“Hearing about Medicaid expansion was good news,” Murphy told the Northern Virginia Daily in May. “I’m very happy for Virginia that it’s happening.”

Local lawmakers, on the other hand, opposed expansion, citing concerns about the costs of expanding Medicaid.

Medicaid expansion is set to take effect in the state on Tuesday.

But its future is also at risk after a federal judge in Texas, Reed O’Connor, ruled that the entire Affordable Care Act was unconstitutional. Under the Affordable Care Act, the federal government is paying for 90 percent of the cost of Medicaid expansion, and Virginia is unlikely to fund Medicaid expansion if the Affordable Care Act is overturned.

Still, while O’Connor’s decision has placed the Affordable Care Act in a degree of peril, legal experts on the left and right have questioned whether the decision will be upheld on appeal.

Meanwhile, the Valley Health System has moved toward replacing Warren Memorial Hospital with a newer facility.

Valley Health received a certificate of need from the Virginia Department of Health. And the Front Royal Planning Commission approved the site plan for the hospital, while the Warren County Economic Development Authority issued a bond to Valley Health for the construction.

Valley Health came under some criticism by community members over its decision to cut obstetric services from the new facility.

Critics argued that the closure would harm infant and maternal health in the region, pointing to research in the Journal of the American Medical Association showing that when hospitals elsewhere in the country have closed their obstetric units, the number of preterm births increased.

Valley Health officials cited a low number of births at Warren Memorial Hospital as the primary reason for closing obstetric services at the hospital. Obstetric units at hospitals are more profitable and can be better prepared to respond to pregnancy complications when they have larger numbers of births.

Valley Health officials have added that women can travel to Winchester Medical Center, which has a higher number of deliveries each year, to deliver.

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Year in Review: Top health news in 2018: Overdoses, Medicaid expansion, new hospital planned – Northern Virginia Daily