Crossover for the 2016 Session of the Virginia General Assembly is at hand. On Wednesday, February 17, all bills that remain under consideration will have crossed over to the other body for action. We will begin the process of serious negotiation on the budget and will have a better idea of which bills stand the best chance of becoming law.
This is crunch time in the legislative session, and like human nature dictates, the tough decisions are often delayed until the last minute. We’ve seen some of the more controversial issues of the day arise in the last few days just before crossover.
The notion of proffers is not one that many rural areas must deal with, but it is important in growing communities. The only localities in the area that I serve that routinely consider proffers are the City of Charlottesville and Albemarle County. Proffers essentially are concessions that a developer or builder makes when that developer wants to have property rezoned. A proffer typically is intended to pay for the infrastructure that the locality will be required to build to support the new development that will come about with the rezoning. Proffers are an essential tool to ensure schools, transportation and public safety infrastructure, and other community services such as libraries are there to support the new development. However, the issue of proffers has not been without controversy.
Any number of times over the course of my years of service, this issue has come before the General Assembly. In general, I have sided with localities, preferring to let local governments make decisions about local growth. This year, I voted in favor of a proffer reform bill that dealt only with residential development. It says that a cash proffer can only be accepted or requested if it is for infrastructure built to serve the new development. In my view, the measure basically meets my notion of the intent of proffers. Moreover, any time an issue was raised objecting to any portion to the bill, amendments were offered. I realize the process moves fast and that the bill is not perfect, but I have confidence in the direction it is headed. The bill passed the Senate by a vote of 29-8.
Another significant issue that will be decided in the next few days involves the Certificate of Public Need (COPN) process by which hospital beds and a number of medical services are added to a particular facility or in a region. The applicant must show a demonstrated need in the region. Critics decry the process because it reduces competition and ensures a monopoly, to a certain extent, for certain services in different regions of the Commonwealth. Proponents of the system argue that because hospitals are required to provide a certain amount of charity care, particularly in the emergency room, they should have the protection afforded by the COPN process. The argument is that without this process, someone else could open an ambulatory center that provides highly profitable service, such as joint replacement, and avoid the less profitable services the hospital provides, such as obstetrics and emergency care. This would potentially close hospitals, as they would lose profitable business.
The issue has been highly contentious for a number of years. This year has seen a flurry of bills and at least three general approaches. While I would need to develop a complex spreadsheet to fully illustrate all of the bills, I wanted to provide a brief overview.
One approach follows more than a year of study dictated by legislation adopted by the General Assembly last year. This moderate approach (see Senate Bill 641 and components of House Bill 350), which is supported by the Administration and by the state hospital association, removes certain services from requiring approval such as new obstetrical or nuclear imaging services, but maintains the overall protection of the COPN process for hospitals. A second approach promoted by the HCA hospital network would allow deregulation of the NICU and other services. The hospital in Low Moor is an HCA facility. Lewis-Gale in Salem for years has attempted to establish a NICU through the COPN process, an application I have supported. A number of other bills have been introduced with such targeted changes. The physicians are supporting a third approach (see SB 561 and HB 193) that begins phasing out the COPN process.
The bills present very different ideas. I prefer to take a moderate approach to this to protect the hospitals as much as possible. Health care is a huge part of the economy, and I cannot imagine anyone would argue that hospitals are not vital to that system. But our hospitals are getting hammered from both sides of the debate surrounding the Affordable Care Act. The Act was funded in part by a reduction in Medicare reimbursement rates, which some argue overpaid for services, but nonetheless were built into the bottom line of many hospitals. In addition, federal payments to hospitals who serve the indigent were reduced given the intent of the Act for everyone to be insured. On the other side of the argument, since Virginia has failed to expand Medicaid, our hospitals are not seeing the benefit of providing care for an estimated 400,000 people who are currently uninsured. Expanding Medicaid would have brought about $1.1 billion of federal funding into Virginia, which would have helped the bottom line of hospitals. Given these economic pressures on our hospitals, I am concerned that the cherry picking that would result from the loss of the COPN process would result in significant financial difficulties for our hospitals and perhaps result in a reduction in services or closure.
The western part of the area I represent is served by hospitals in Lexington, Low Moor and Hot Springs. None of those hospitals offer obstetrics. And, each of the hospitals faces a certain amount of economic uncertainty given the current challenging health care economy. The two hospitals in Charlottesville are a huge part of the economy in the eastern part of the district I serve. Health care centers in Albemarle, Highland and Nelson Counties also play an important role. I am afraid that radical change to the COPN process would increase the challenges faced by each of those facilities.
The Senate rolled all of the bills into Senate Bill 561, which was subsequently continued to the 2017 Session. The House, however, has reported several of the bills out of committee but has postponed taking a final vote on the floor.
I heard from a number of constituents regarding Senate Bill 671. If you or a loved one does not suffer from Lyme disease, you may not be aware of this piece of legislation. The bill as it came to the Senate floor would prevent the Board of Medicine from disciplining a physician for following a protocol maintained on the National Guideline Clearinghouse for the treatment of Lyme disease. In my view, the bill sets a very dangerous precedent. If we provide this exemption for Lyme, why would we not provide it for other treatment protocols and diseases? I just don’t think that the legislature needs to be in the business of practicing medicine or micromanaging the Board of Medicine.
The reality is that there is no effective treatment for Lyme disease that has been medically proven. I understand people’s frustration as I have a family member who suffers from symptoms related to a tick bite. While I appreciate the intent and feel for people looking for physicians to try alternative treatment methods, I just do not see this bill as accomplishing that goal. I voted against the bill, which now heads to the House of Delegates for consideration.
Of course, there are many other issues before the General Assembly. Committee work has slowed down as we near Crossover. Serious debates lengthen our floor sessions now due to the number of controversial bills on which we have delayed action.
Please do not to hesitate to contact me if I can be of service or if you have views on any issues before the General Assembly. The phone number in Richmond is (804) 698-7525 and the email is firstname.lastname@example.org. It continues to be my pleasure and honor to serve in the Senate of Virginia.