All Virginians deserve access to quality, affordable health care. While we spend more on health care than any other nation (16.2% of GNP in 2008), we rate lower than many countries in life expectancy, chronic disease and even infant mortality. Consequently, we should not only focus on reducing costs but on improving performance. To do so, we need to improve access to health services, explore innovative ways to control costs, and maintain a strong network of healthcare professionals to provide care by addressing our nursing shortage. We also need to ensure that the Commonwealth is meeting its obligation to its mentally and physically disabled citizens by strengthening our community-based services network.
As of 2009, more that 1 million Virginians—14.4% of the population—lack health insurance, an increase from 13.3% in 2006. While 65.2% of Virginians receive health insurance through their employer, 81% of uninsured families have members who work either full or part time. This lack of insurance has a great impact on the Commonwealth’s business productivity, the economic viability of Virginia’s families, and the health care costs for all of us, even if we have insurance.
The Federal Affordable Care Act of 2010 is projected to bring greater access to health care and help Virginians in the following ways:
- 25,800 Virginia children are now eligible to stay on their parents’ insurance plans until age 26, ensuring that this under-insured population will have access to care
- 1.2 million Medicare enrollees in Virginia will get preventative services and an annual doctor’s visit without co-pays and 91,500 Medicare beneficiaries will benefit financially from closing a portion of the Medicare Part D “donut hole”
- 109,000 small businesses in Virginia will be assisted through federal tax credits that can reduce the cost of providing insurance to employees
- 123,000 Virginia children can no longer be denied insurance coverage because of their pre-existing conditions and, on January 1, 2014, insurers will be prohibited from denying coverage to anyone with a pre-existing condition
Virginia will continue to have challenges as it addresses the implementation of the Affordable Care Act, which requires that more Virginians qualify for Medicaid eligibility (which could mean greater budget demands) and that the Commonwealth determine how best to create a state health insurance exchange. It is important to continue to find ways to lower health care costs and increase access to care for our citizens. To do this, I support the following:
- Expanded use of electronic health records;
- Extending Medicaid eligibility for another 400.000 Virginians, using federal dollars;
- Expanding the number of children insured through the State Children’s Health Insurance Program; and
- Common-sense medical malpractice reform. In 2011, I voted for HB 1459, a compromise bill that allows for small, predictable increases in the medical malpractice cap that protects both doctors and patients.
Medicaid is the largest public health program (60 million enrollees) in the U.S., and it is administered by the states. With a difficult economy and the ever-increasing cost of health care, Medicaid is the fastest growing item in the state budget. Over the past ten years, the number of enrollees in the Virginia Medicaid program has increased by 49% and General Fund spending on Medicaid has increased on average 9.5% a year, from $1.3 billion in FY2000 to $2.6 billion in FY2010.
Medicaid serves those Virginians most in need. It is essential that we devote the necessary dollars to fund this important program while finding ways to increase its efficiency. Virginia’s Medicaid spending per capita ranks 48th in the nation (as of 2007) and our eligibility standards are among the most stringent in the country. We also have very low reimbursement rates for hospitals, doctors and other providers who treat Medicaid patients, and, by doing so, run the risk that these providers may leave the system. Without enough providers, Medicaid patients will fall back on Emergency Rooms for their medical care, thereby further increasing the cost of health care.
We need to both expand Medicaid eligibility and maintain our provider rates to ensure access to care. We must encourage other ways to save money in the Medicaid system, such as:
- Greater state involvement in regional purchasing pools for Medicaid purchases of prescription drugs and allowing Virginians to purchase reasonably priced, safe prescription drugs from Canada;
- Greater support for community-based solutions such as free clinics, which can leverage more private and institutional monies to assist the poor and uninsured; and
- Establishment of an All-Payer Claims Database (APCD) to access the actual cost of health care in the state.
It is projected that by 2020, Virginia’s nursing shortage will result in approximately 32% fewer nurses than necessary to meet demand. While we add approximately 2,000 new RNs each year, by 2015 the number of RNs leaving the workforce will exceed the number of new graduates. This is not due to a lack of interest in the field. Nationally, nursing schools report that they turn away three qualified applicants for every applicant they accept because of inadequate capacity. Our pressing need is to increase faculty: currently, nursing faculty salaries are not competitive with other nursing positions. I support investing in faculty and buildings at nursing schools to ensure the long-term supply of nurses is sufficient to meet future demands.
Maintaining a robust safety net of services to address mental health is also important. In February 2011, the Federal Department of Justice (DOJ) released a report that the Commonwealth’s system of “training centers” (mental institutions) violates the rights of hundreds of mentally- and physically-challenged Virginians. The report also determined that the Commonwealth’s community-based mental health care resources are inadequate to meet demand. In response, the General Assembly appropriated an additional $30 million to create 275 community slots to serve individuals currently in institutions. While this is a good first step, the DOJ report indicated that Virginia will need 400-1000 more slots a year to keep up with demand for services. I support creating more slots and strengthening our Community Services Boards to provide top-level care at the community level. I realize, however, that many individuals in Virginia’s training centers have been there for many years and may not be able to get the type of care they need in the community. It is important to ensure that these individuals will be able to obtain proper care before moving them from our institutions. When individuals can be served outside of an institutional setting, however, that is often better for the individual and less expensive for the Commonwealth: we spend approximately $120,000 more a year to serve an individual in a training center than it would cost in the community.