Delegate David Toscano and I will be hosting a Town Hall meeting on Wednesday, March, 19, from 6:30 p.m. to 8:30 p.m. at Monticello High School in the Forum (1400 Independence Way, Charlottesville VA, 22902). We will be providing an update from the 2014 General Assembly and discuss the upcoming Special Session on the budget. The Honorable Bill Hazel, Secretary of Health and Human Resources, will join us to discuss Medicaid expansion in Virginia.
Final Update from 2014 Session
The 2014 Session of the General Assembly is over; we adjourned on Saturday. However, the main work, the budget, remains to be accomplished. The General Assembly will go back into session on the 24th of March to try to finalize a spending plan for the next biennium.
Impasse over Medicaid Expansion
The big hang up, as I suggested from the beginning of the session, is the expansion of Medicaid. Opponents of expansion seem to be swayed by the argument that by refusing the federal dollars attached to Medicaid expansion Virginia will send a message to the President and in some way rebuke the Affordable Care Act. The predominant concern is over whether the federal government can sustain Medicaid payments, despite the requirement that the feds fund no less than 90 percent of the cost of expansion. The argument ignores the fact that the feds have never failed to make their payments to Virginia under the original Medicaid plan, started in 1965.
There are at least three reasons why Virginia needs to move forward with the Senate’s approach, Marketplace Virginia, to this issue.
First, ignoring the fact that a healthier population will result in a healthier community and a more robust economy, hospitals and insurance companies are already subsidizing the cost of providing healthcare to the uninsured. And thus, the people who pay the bills at the hospitals and the premiums to insurance companies are already picking up the tab. The people who will be covered by Marketplace Virginia are primarily the working poor, people who are already working but are not making enough money to afford insurance premiums and do not receive insurance through their work. For many, primary care is received through the emergency room, which cannot refuse care for a sick person. Those costs are subsidized by the hospital or other providers through increased costs for those who can pay and for insurance companies. We are already picking up the tab, and it just makes sense to provide coverage to the uninsured.
Second, the flow of federal money to Virginia, up to $1.8 billion a year, or about $5 million a day, is bound to have a positive effect on Virginia’s economy. Because the plan will provide healthcare coverage to over 200,000 Virginians, expanding coverage is expected to create as many as 30,000 jobs in the next six years. In an area where we need job growth, especially with a stagnant economy, this aspect cannot be ignored.
Third, we are paying for Medicaid expansion anyway. There is no doubt that fees and taxes went up at the federal level to pay for Medicaid expansion. In fact, Virginians are paying as much as $2.9 billion a year under the Affordable Care Act. Why should those dollars be spent anywhere but Virginia? It is true that we may not recoup all of the money Virginians pay the federal government under the Affordable Care Act, but why should we not receive as much as we can back from the federal government? Under the law, the feds have to pay 100 percent of the costs for three years and no less than 90 percent after that. What part of that deal is bad for Virginia?
Obviously there are people who disagree with my point of view. We will strive in earnest, I hope, to resolve the budget impasse as soon as practical. Millions of Virginians and hundreds of localities depend on Virginia getting its budgetary house in order.
Despite the budget impasse, the General Assembly did achieve some things this session:
A package of ethics reform bills passed, and, without question, raises the standard. For example, the new limit on tangible gifts to legislators is $250. However, for those looking for real reform, the legislation will not satisfy your hunger. One obvious flaw is that there is no limit on “intangible” gifts such as trips, or sporting events.
Increasing the Number of Judges
Every year there seems to be an argument about the appointment of judges, where the judgeships belong, and who gets appointed. To satisfy many questions, in 2012 the legislature directed the Supreme Court of Virginia to develop a system to evaluate caseloads and determine the appropriate use of resources in our judicial system. The National Center for State Courts completed the study on behalf of the Court in November. The results show that we need about twenty-eight judges more than we currently provide in the Code. Because legislators from different parts of the state can pick apart just about every section of the report, particularly those that dealt with their region, the report was somewhat controversial. Nevertheless, the report provided us with a metric to use, and we finally agreed to increase the number of judges provided in the Code to 429. That does not mean all of the judgeships will be funded, but at least it gives us a point from which to work.
Mental Health Policy Reform
My personal goals with respect to mental health reform were met. I needed the strongest bill possible to leave the Senate to increase my negotiating power with members of the House of Delegates. The Senate supported legislation to establish a 24-hour ECO period, a registry of psychiatric beds, and the establishment of state facilities as providers of last resort for any individual deemed to require hospitalization. While we did not achieve the 24-hour wait, the House agreed to the proposal to ensure that the state provide a bed of last resort. This is significant. It changes the paradigm. Under existing law, the issuance of a temporary detention order is triggered not by the need or behavior of the individual, but by whether a bed exists in which to place said individual. That makes no sense. The new process will effectively end what is known as “streeting”, where one in need of a bed is released at the end of the ECO period because a bed is not identified. We also lengthened the period of the TDO from 48 hours to 72 hours. These changes in the law will give the state enormous tools in mental health crisis situations.
But we cannot lose our urgency about the need for changes in our mental health system. We are still severely lacking, not just in Virginia but around the country, in our system of delivery of mental healthcare services. Importantly, my legislation creating a legislative study committee passed, and we will spend the next four years working to develop in Virginia a mental health delivery system that, I hope, can be a model for the rest of the country. In fact, I will not settle for less. I hope to examine and weigh the costs and benefits of every aspect of our system. Many argue that funding is the problem. I know that our system of community services boards has been underfunded and that the ones that work best are those that receive a significant amount of funding from local government. However, funding is not the entire issue. For example, a recent Inspector General’s report showed that one of the reasons we have a shortage of psychiatric beds is that the state hospitals are inefficient in the discharge of patients. I believe that we can squeeze inefficiencies out of the system and ensure that money is spent on effective, patient-focused care.
It continues to be my high honor to serve you in the Senate of Virginia. Should you have concerns, questions or views you wish to share, please contact me at (434) 296-5491 or [email protected].
Last Week of the Virginia General Assembly Session
Every year as the General Assembly session winds down, it’s important to take some time to reflect on the things that have been accomplished, the things yet to accomplish, and perhaps the missed opportunities. With less than a week left before the scheduled adjournment of the 2014 session, a couple of things are clear.
The biggest opportunity this session has been to try to find a way to provide health insurance to perhaps as many as 400,000 additional Virginians and also recapture some of the federal taxes we are paying to fund the Affordable Care Act. Some people deem this the expansion of Medicaid. We in Virginia have come up with a different response, Marketplace Virginia, that basically turns this over to the private insurance market. Perhaps the next week, and more likely the next few months, will determine whether we are able to take advantage of this opportunity.
I have been on a journey to bring reform to the area of delivery of mental health services. The road to reform has been somewhat bumpy. My proposals, many of which were roughed out in my mind as I tried to process what happened in November, are moving forward. The details will be finalized in conference this week. These proposals are just the first steps of a concerted effort to improve our mental health system.
A number of other issues, some a regurgitation of past efforts and others brought on by the exigency of circumstances, have been considered this session. A few of those are as follows:
- Legislative ethics reform has been put forward in bills sponsored by Delegate Todd Gilbert of Shenandoah County and Senator Tommy Norment of James City County. Both of these bills represent a very modest step forward, and many who call for reform in the area of ethics, including me, are going to be left unsatisfied with the results. Those bills will be in conference this last week.
- Sunday hunting has been championed through bills from Senator Phillip Puckett of Russell County and Delegate Todd Gilbert. Those bills limit Sunday hunting to private property with written permission from the landowner and are headed to the Governor’s desk. He has indicated he will sign them.
- Delegate Tim Hugo and Senator Dave Marsden, both of Fairfax County, sponsored legislation to require social studies textbooks used in Virginia to identify the body of water between the Korean Peninsula and Japan as both “Sea of Japan” and the “East Sea.” This legislation appears to be enjoying the majority of support in both bodies but is tied up procedurally right now. The Governor has indicated he will sign this legislation if it reaches his desk. The legislation has many proponents in the Korean American population.
- My effort to increase the court fee paid by those convicted of crime to fund the Internet Crimes Against Children units in Bedford and Fairfax, grants to localities throughout the Commonwealth, and maintenance of the Child Pornography Images Registry appears to be stalled in the House of Delegates. The bill enjoyed unanimous support in the Senate. The legislation would raise the fee $5 and generate an additional $900,000 a year for this important work.
- The legislature has tackled SOL reform through bills championed by Senators John Miller of Newport News, George Barker of Fairfax, and Delegate Tag Greason of Loudoun County. I also sponsored two bills on the matter. The number of tests, especially for elementary age students, will be reduced as a result of this effort. High standards are the right thing for our schools and students, but the emphasis on testing has diminished the role of teaching the basics of reading, writing and arithmetic. Many of the concerns some of us had about the SOLs when they were adopted back in 1994 are being heeded 20 years later.
- The additional hybrid fee added last year as part of the comprehensive transportation package was repealed. As many recall, Governor McDonnell included the fee in his transportation proposal in 2013. Both the Senate and the House removed the provisions from their versions of the legislation. When the bills went into conference, the conferees reinserted the language into the bill. At that point in the process, the bill could not be amended. While many opposed this particular provision, a majority of legislators voted for the proposal in its entirety. Governor McAuliffe has signed the legislation, which will become law July 1.
- For the second consecutive year, the General Assembly has passed a resolution to place on the ballot this fall a proposed constitutional amendment to allow localities to grant real estate tax relief to the surviving spouses of service members who were killed in action. The companion bill that stipulates the details of how this exemption would work is still moving through the process. Voters should expect to vote on this measure in November.
- A number of bills were introduced to delay the July 1, 2014 start date for local governments to have in place new stormwater management programs that reduce runoff. Many localities were concerned about the implementation costs and whether they had sufficient time to put in place the necessary regulations and staff by the deadline. During the deliberations, a compromise measure came forward that makes the adoption of this program optional for localities that do not operate a municipal separate storm sewer system. The Department of Environmental Quality will manage a stormwater management program in those localities that opt out.
Over 2,700 bills and resolutions were introduced this year, ranging from resolutions recognizing great Virginians we lost this year to legislation effecting major policy changes. Today is the final day for committees to meet. In this final week, we will finish up work on bills in conference and take action on the bills coming out of committees today. I look forward to your continued input during this last week.
It continues to be my honor to serve you in the Senate of Virginia. This session is rapidly winding down and while it is true that some issues may not be resolved by the scheduled adjournment period, I expect to be able to be back home practicing law soon. If you have concerns or questions please contact us at [email protected]. We can be reached by phone in Richmond at (804) 698-7525. Beginning March 10, please contact the district office at (434) 296-5491 or P.O. Box 5462, Charlottesville, VA 22905.
Nearing Sine Die
The 2014 session of the General Assembly is rapidly moving toward the scheduled adjournment on March 8. Both houses passed competing budgets this past week and bills are headed to conference.
On Thursday the House and the Senate passed out their respective versions of the biennial budget. As with all legislation, the budget bills must be approved by the other chamber. Every year, the House and Senate insist on their amendments and send the budget to a committee of conference. The General Assembly is expected to finalize the budget for fiscal years 2014-2016 before the scheduled adjournment, but the deliberations may stall this year over Medicaid.
At least twice this session I have used this space to talk about Medicaid expansion and about the Senate’s approach, Marketplace Virginia. A couple of things need to be clear whether or not we expand Medicaid in Virginia. First, individuals and Virginia businesses will pay additional taxes to the federal government. Second, Virginia hospitals will experience reduced Medicare payments from the federal government and must continue to provide treatment to the uninsured. The gap between the cost of providing care to these patients and the reimbursement will grow into the hundreds of millions of dollars.
The primary hang-up between the budget advanced by the House of Delegates and the Senate of Virginia involves these issues. Marketplace Virginia is an attempt not only to provide insurance coverage to about 285,000 Virginians but also to recapture almost $2 billion in federal taxes Virginians are paying. The Senate proposal recognizes the reality of the federal actions and tries to take advantage of it. The House budget rejects that reality and instead uses millions of state tax dollars to reimburse hospitals for the Medicare cuts imposed at the federal level. Under the House plan, Virginia taxpayers will pay for Medicaid expansion while nobody in Virginia will receive any benefit under that program. Virginia taxpayers will also be asked to pay a second time for the cost of Medicaid expansion through the reimbursement program to the hospitals.
Some of my colleagues in the Senate who have been philosophically opposed to the Affordable Care Act recognize that it is the law and believe we should put the law to work in order to benefit as many Virginians as possible. Enacting a market-based insurance plan to expand coverage to the uninsured is more fiscally prudent than doing nothing. A rejection of Marketplace Virginia is not a vote against the Affordable Care Act. At best it is a symbolic gesture, but the action will cost Virginians real tax dollars. The ongoing discussion about health care is at the heart of why a budget will likely not be agreed to on time.
Mental Health Policy Reform
There was some progress on my efforts to make changes in the mental health laws of Virginia. Mental health has always been an important issue to me throughout my legislative career. The community services boards, particularly Region Ten and Alleghany Highlands Community Services, have made great strides over the years in improving services, and the staff has kept me abreast of the needs in our communities. Family members of institutionalized loved ones have been vocal advocates about Virginia’s abysmal ranking for spending in these vital areas. Particularly after the tragedy at Virginia Tech in 2007, I have been involved in efforts to ensure that the laws will be responsive to the needs of all Virginians.
I did not ask to be more involved than that, but my circumstances have made it necessary for me to be more directly involved in reforming our mental health laws. To that end, I introduced a number of bills this year. I can report that my bills relating to crisis intervention are moving along. The legislation requiring the Department of Behavioral Health and Developmental Services to reexamine qualifications for intake agents and establish a data base for psychiatric beds is still under consideration in the House. Disagreement remains about how long we should extend the emergency custody order period. I am confident that we will have a satisfactory bill emerge from conference. Importantly, the study resolution that asks for a two- year comprehensive examination of the mental health system appears headed for passage. It has been amended to specifically include the effective re-institutionalization of those with mental illness in our jails and prisons. Needless to say, this study is the vehicle by which we hope to make significant long-term changes in the mental health system. I am convinced that through this work we can improve the quality of people’s lives for years to come.
It continues to be my pleasure and distinct honor to represent you in the Senate of Virginia. If I can be of service, do not hesitate to contact me at PO Box 396, Richmond, VA 23218, [email protected], or (804) 698-7525.