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.

Medicaid Expansion

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,, or (804) 698-7525.