Checkup on Health Care

[Ed Note: This article originally appeared in print in Bearing Drift’s January 2011 issue. To subscribe, join our mailing list and get a first peek in print every month.]

By Eve Marie Barner Gleason

When you are sick, you want a doctor. You want quality care: good value for the money you spend. You also don’t want to bankrupt yourself or your loved ones paying for the care you need.

With health costs growing 35% faster than income over the last ten years, one million uninsured Virginians, and current government health subsidy programs facing bankruptcy, there is little doubt that the entire health care system is sick.

However, when many Virginia leaders look at the Patient Protection and Affordable Care Act (aka “ObamaCare”), they don’t see a solution, they see more problems.

Dr. Chris Stolle, a member of the House of Delegates from Virginia Beach puts it simply: “The biggest threat to our health care system today is too much government intervention.”

Stolle, a physician and medical administrator, has reason to know. He suggests that “states are far better at understanding the needs of their citizens and responding to those needs than is the Federal government.”

Congress didn’t consult Stolle and other Virginia lawmakers before passing its health care reform law, but top officials say the new law could have devastating effects on the Commonwealth.

In a statement released immediately after the law passed, Governor Bob McDonnell said,

“The proposed expansion of Medicaid is an historic unfunded federal mandate on the states. This expansion will put at least 400,000 more individuals on Virginia’s Medicaid rolls. The Virginia Department of Medical Assistance Services has estimated that it will cost the Commonwealth an additional $1.1 billion by 2022. … We simply cannot afford this expansion.”

With implementation deadlines looming for the new federal health care law, Virginia Republicans have developed a two-pronged strategy for responding to its mandates: the Attorney General is trying to overturn them and the Governor is preparing to implement them with the least disruption possible to Virginia’s economy.

Citing Virginia’s Health Care Freedom Act, which states that no individual shall be compelled to purchase health insurance, Attorney General Ken Cuccinelli is suing the federal government over the “individual mandate” portion of the health care law. On December 13th, U.S. District Judge Henry Hudson ruled that the federal law exceeds Congress’s constitutional authority by compelling private citizens to purchase an insurance product. Hudson declined to stop the implementation of the law while the appeals process continues. Although Cuccinelli and McDonnell have requested expedited review of the law by the U.S. Supreme Court, they are not expected to decide the case before 2012. By that time, the law requires states to have taken several steps to implement its provisions.

For Cuccinelli, the Federal health care law represents an unprecedented violation of individual liberties. When discussing his decision to sue the federal government over the law, he cites his oath to uphold the Constitution:

“If we cross this constitutional line with health care – where the government can force us to buy a private product and say it is for our own good – then we will have given the government the power to force us to buy other private products, such as cars, gym memberships, or even asparagus. The government’s power to intrude on our lives for our own good will be virtually unlimited.”

Even as he has become a nationwide hero to conservatives and libertarians who oppose the health care law, Cuccinelli says he is sympathetic to the concerns of those who cannot get health insurance:

“Regardless of whether this current health care act stands or falls, I would urge the next Congress to look into solutions that make the insurance market a freer market, not a government-controlled market. That is what will increase competition and make a dramatic difference in the affordability of health insurance.”

While Cuccinelli’s lawsuit against the federal measure proceeds, the McDonnell administration is preparing to work with the General Assembly to implement its mandates on the state. Dr. Bill Hazel, Virginia’s Secretary of Health and Human Resources, said their goal is to create a Health Benefits Exchange (HBE) that reflects “Virginia values.” Hazel, who chairs the Virginia Health Reform Initiative (VHRI), explained,

“We see it as our job to prepare Virginia for implementation of the federal law so that we don’t end up in a federal exchange. The model we are looking at is more Utah than Massachusetts…. A basic structure with a market oriented approach.”

Hazel’s Initiative is seeking to re-imagine the future of health care policy in Virginia. Right now, “absent significant reform in delivery, costs are simply unsustainable.” Hazel said the VHRI “has outlined a road forward to improve the value of healthcare in Virginia. This should in turn improve quality, enable access, and provide a competitive advantage for our employers.”

Hazel wants his initiative to succeed where he believes the health care reform efforts of the last Congress failed:

“Issues related to value and cost were not an urgent priority at the national level, so the health bill is basically unaffordable.”

Beyond implementing the requirements of the federal health care law and setting up reforms to payment and delivery systems in Virginia, Hazel stressed the need to control the cost of Medicaid. He expressed support for Medicaid reforms, such as those outlined in a recent report released by Congressman Paul Ryan and former White House Office of Management and Budget (OMB) Director Alice Rivlin. Hazel noted:

“Block grants would help break the stranglehold that the funding formula has on the Virginia budget. It would allow for better value, flexibility and creativity with use of Medicaid dollars.”

The McDonnell administration, Hazel said, is also “advocating changes federally to allow cost sharing with recipients. Research shows that cost sharing helps patients make cost conscious decisions.”

The Initiative’s recommendations, he noted, are about “making health care more affordable, independent of the federal law.”

While Republican leaders strategize over the implementation of the federal health care law and examine possible state level health care policy changes, Virginia’s top Democrats are touting popular aspects of the law.

In a statement late last year, Sen. Jim Webb focused on new mandates on insurers, rather than premium increases and the individual purchase mandate. Webb reminded consumers that children with pre-existing conditions must be covered and insurers can no longer drop coverage arbitrarily, young adults can stay on their parents plans until they are 26 years old and individuals can appeal unfavorable insurance company decisions to an independent third party.

Senator Mark Warner’s public statements have been even more cautious than those of his senior colleague. His statement about the bill focuses on his efforts to bring down its costs and incorporate “private sector solutions.”

As big picture health care policy has garnered policy makers’ attention inside and outside the beltway, private and market oriented solutions are likely to take center stage. Uninsured and underinsured patients in Virginia continue to struggle to get needed care. Even if it is upheld in subsequent court decisions, the individual mandate does not go into effect until 2014. In the meantime, premiums continue to rise, the jobless often lack insurance and many people ineligible for Medicaid are still unable to afford top tier policies.

For these individuals, Virginia’s non-profit community health centers serve a vital role. Funded by a combination of federal, state, and local taxes and private donations, they serve 220,000 people a year. Republican and Democrat legislators have a history of bi-partisan support for community health centers that may point the way forward for future health care solutions.

Eve Marie Barner Gleason is a Northern Virginia activist and political observer. As a former aide to then Senator Cuccinelli, she appreciates the often-overlooked role of state and local government in the American political landscape. Gleason loves chocolate mint brownies and ice cream and camping in Virginia’s state parks.

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