Virginia Health Insurance Marketplace

Republicans Are Hurting the ACA, and All of Us

October 16, 2017 by David Toscano

Republicans’ Insidious Undermining of the Affordable Care Act

Newly-elected Donald Trump asserted that the Affordable Care Act (ACA) would be repealed on day one of his administration. Ten months and numerous close votes later, the ACA remains the law of the land. Nonetheless, the Trump administration and its Republican allies in Congress have been relentless in their efforts to destroy the Act from within, and all of us who support health insurance access at reasonable cost cannot let them go unchallenged. Their strategy is sophisticated and multifaceted. And Republicans in Washington and in Virginia have been complicit with this strategy by their deafening silence.

If You Can’t Win The Votes, Sabotage the Market

Trump’s consistent threat to withhold the subsidies (CSRs) which allow insurance companies to keep premium increases to a minimum became reality last week with his Executive Order. The result should surprise no one; faced with unpredictable markets and increasing costs, health insurance companies will either abandon offering coverage or increase premiums to cover their risk. The no-subsidy threat alone has had serious effects. In Virginia, for example, Anthem pulled out of the marketplace in August, leaving more than 60 jurisdictions with no insurer offering coverage. It was only after intense political pressure from Gov. McAuliffe and others that Anthem jumped back in, but premiums are expected to rise. Now that the administration is definitely reneging on federal payments, the reality will be devastating. Some 240,000 Virginians bought health insurance supported by ACA-mandated subsidies; their costs will rise and some will simply not re-enroll, thereby creating a so-called “death spiral” in the markets. [Read more…]

Medicaid – A Full and Fair Debate?

September 26, 2014 by David Toscano

As early as January 2014, House Republicans promised a plan to address the 400,000 Virginians who fall into the health insurance coverage gap because they make too little money to qualify for subsidies under the Affordable Care Act, but make too much money to qualify for Medicaid. The Governor and Democrats have offered, over the last eight months, three separate proposals by which we could access several billion dollars in federal monies to provide coverage. As you may recall, present Medicaid spending is matched, dollar-for-dollar, with federal monies. With the proposed Medicaid expansion, however, the federal government would pay 100 percent of the cost for the first several years, eventually dropping to 90 percent. I believe that this is a good deal for the Commonwealth. We could take monies that we save in the first years and apply it to the later years in the event that the federal government does not live up to its responsibility, a fear cited by House Republicans as a reason not to expand Medicaid, but an unlikely event.

Democratic proposals since January 2014 have included a two-year pilot plan advanced by Gov. McAuliffe; straight Medicaid expansion; and “Marketplace Virginia,” a proposal offered by Senate Democrats and Republicans to use federal monies to buy private health insurance through private companies. All of these plans have been summarily rejected by the House Republicans.

During the budget dispute in the spring, the Republicans promised a “full and fair debate” over Medicaid so long as it was separated from the budget. That occurred, and the Republicans scheduled this so-called full and fair debate for last Thursday, September 18, 2014. The “full and fair debate” consisted of a 15-minute discussion in the Rules Committee about another compromise proposal on Medicaid expansion, and a short debate on the House floor with the result predetermined. The Republican answer was another “No.” If you want to see some of the debate on this issue, click here; for my floor speech on the issue, click here.

Our meeting last Thursday also brought a compromise on addressing our budget shortfall. If you want to see my comments on how we should try to close some tax preferences to make up our budget shortfall, you can click here.

Finally, three new judges were appointed for our district, and they will take their seats on December 1, 2014. Although I continue to believe that the selection of judges is overly-partisan, I offer my congratulations to the three that were appointed, Judge Richard Moore, Deborah Tinsley, and David Barredo. I am confident that they will be very effective judges and will serve this community admirably.

Please feel free to contact me with your concerns. It is an honor to represent you in the General Assembly.

Sincerely,

P.S.: I want to express my thanks and gratitude to the citizens of this community, the local and state police, City Police Chief Tim Longo, and Secretary of Public Safety Brian Moran for all the work being done to bring Hannah Graham home. I was at JPJ Command Central last Saturday and Sunday and watched the volunteers stream in from around the Commonwealth and nation. I saw the line up of City School buses, UVA buses, and Jaunt buses at 7:30am on Sundayready to take the teams of volunteers out into the field to search for Hannah. The generosity and caring of this community is remarkable.

Pollin’ and Explainin’

May 16, 2014 by David Toscano

Earlier this month a poll from Christopher Newport University’s Wason Center has the Commonwealth’s political class in a “twitter.” Republicans argue that the poll is conclusive proof that Virginians do not favor Medicaid expansion, and some Democrats are choosing to ignore the poll on the theory that “if you are explainin’, you are losin’.” My take is that all polls are “data points” that need to be assessed at face value, and we have an obligation, as elected officials, to explain what policy choices are before us and how citizen views should be taken into account in making them.

All polls are surveys based on samples from a larger population. Polling is not a perfect science, and is subject to considerable error. A good poll should be both scientifically valid and reliable. To be so, social scientists first need to be sure that the questions test what they are designed to test. Second, the results should be capable of being replicated through another sample. So does the recent CNU poll pass the test? In some ways, yes; and in others, no.

First, to ensure a scientifically valid poll, the questions must first be worded in a clear and neutral fashion. Without clarity or neutrality, the results will be slanted. This is clearly where the CNU poll has problems. As Republican Sen. Emmett Hanger of Augusta pointed out, the poll’s statement “Democrats propose to subsidize…” is factually incorrect; there are three Republican Senators who developed and support “Marketplace Virginia” and that approach is not “strict Medicaid expansion”. There are several other words that could influence the outcome of a poll such as “subsidize, fear, waste, and abuse.”[1]

Second, the subject in the sample must be randomly selected; in this poll, that appears to be the case.

Finally, the survey must be sufficiently large to reduce the “built-in sampling error.” That usually requires about 400 or more subjects for a population the size of Virginia, something that apparently the CNU poll has met.

But the biggest issue in the use of polling data, and thus the biggest problem with the CNU poll, is the extrapolation from one data point of the survey results into suggesting the results suggest a “trend.” When the CNU pollster concludes, as a result of the survey, that “Democrats are losing the debate on Medicaid expansion,” he is making a jump not justified by the poll.

Although this is not really a “push poll,” you cannot infer a trend simply on the basis of these results. The only way you can discuss a trend is if the exact same question was asked to a randomized sample from the same universe at two different periods of time.[2] The CNU poll did not do this and any conclusions about “trends” are meaningless as a result.

As always, it is a pleasure representing you in the General Assembly and I hope that you will contact me with your views and comments about issues affecting the region and the Commonwealth.

David Toscano
[1] The actual poll question reads, “In [the Medicaid] debate, the Democrats propose to subsidize private insurance for 400,000 uninsured and low income Virginians by using federal Medicaid money that would otherwise not come to Virginia. Republicans oppose this expansion because they fear the federal Medicaid money will not come as promised, and also say the current Medicaid program has too much waste and abuse and needs reformed [sic] before it is expanded. I’d like to know where you stand, would you say that you generally [RANDOMIZE: “support using federal Medicaid money to expand health coverage” or “oppose using federal Medicaid money to expand health coverage”]?

[2] The February 3, 2014 CNU poll asked the question: “Medicaid is a health care program for families and individuals with low income that is funded by both federal and start tax dollars. Currently, Virginia is faced with decision about whether to expand the Medicaid program to cover an additional 400,000 mostly working poor Virginia who are uninsured. In general, do you support Medicaid expansion or oppose it?” 56% of the respondents said they supported expansion.

Budget Dispute Continues

April 11, 2014 by David Toscano

We returned to the General Assembly on Tuesday, April 8, 2014, to continue our debate over the budget. It was a very short session because House Republicans refused to consider a budget passed by the Senate which included provisions for closing the coverage gap for up to 400,000 Virginians. In early March, Governor McAuliffe proposed a new budget that added $225 million for education and public safety because of the expansion of Medicaid. These savings were generated by taking monies that our taxpayers have sent to Washington and bringing them back to Virginia, where they can work for us. With Medicaid expansion, the Commonwealth would receive federal monies to provide 100 percent of the reimbursement of costs of new enrollees. The expansion would create 30,000 new jobs while bolstering our hospitals which are facing large financial losses. We have lost almost $500 million since January 1 by refusing Medicaid expansion.

The McAuliffe budget proposed additional spending in critical areas such as jobs and economic development, public safety, and public education. Charlottesville and Albemarle school divisions would likely receive additional monies if the McAuliffe budget was passed.

There is substantial support from around the Commonwealth to close the coverage gap, not only because it helps real people address their insurance needs, but it makes business sense. Here is just a partial list of the editorials from newspapers across the Commonwealth on this issue:

Danville Register and Bee: Patient care, not politics, for Virginia
Richmond Times Dispatch: “Marketplace Virginia is the way to go. It is the type of alternative conservatives interested in governing and in serving the entire citizenry should embrace.”
The Roanoke Times: “In January, Speaker Bill Howell penned a commentary calling for an “alternative approach” to expanding Medicaid. Nearly three months later, he has yet to offer any alternative of his own. Meanwhile, the Marketplace Virginia plan sits untouched, waiting for someone to show up at the negotiating table. Like a misplaced pair of glasses, it’s in plain sight.”
Loudoun Times-Mirror: Virginia should support Medicaid expansion
The Washington Post: “Using allocated federal money to expand the availability of health-care coverage for some of the most vulnerable is a cause worth fighting for — in Virginia and every other holdout state.”
The Virginian-Pilot: Good Sense and Medicaid
Fredericksburg Free Lance Star: Expand Medicaid
The Daily Press: “The best way forward is by using federal money to purchase coverage for the uninsured through a market-based private opinion. It is a plan similar to one in Arkansas, and which already passed the Senate. It is supported by the state Chamber of Commerce and many medical groups as a practical way to break the impasse in Richmond.”
Staunton News Leader: “Rather than accept a Republican-written compromise — one of our best of that rare breed, crafted in part by Sen. Emmett Hanger, R-Mount Solon — to accept federal money without expanding Medicaid, the House said no. This means Virginia continues to lose $5 million in federal dollars everyday, money that is supposed to go toward helping our poor get access to health insurance, money that Virginians are already sending to Washington in federal taxes, money that can keep our hospitals fully staffed.”
Culpeper Star Exponent: “Virginia should expand Medicaid, even if legislators don’t agree with the ACA.”

The Town Hall meeting held March 19, which Senator Deeds and I organized, was extremely successful. Many people came to support Medicaid expansion and even “Tea Party” opponents who were there raised good questions and debated the issue in a civil and respectful manner. I greatly enjoy having both the proponents and opponents of policy ideas in the same room at the same time because it gives both sides the option to hear the arguments of the other.

Right now, the House Republicans’ refusal to act has put us at a standstill. The Governor’s budget has made it plain; the Commonwealth will gain financially from Medicaid expansion and our localities, educators, and law enforcement personnel would benefit by the passage of a budget that includes it. With the exception of the “veto” session scheduled for April 23, no other meetings have been scheduled – which means another day leaving Virginia taxpayer dollars in Washington and another day without a budget for the Commonwealth.

As always, it is a pleasure representing you in the General Assembly and I hope that you will contact me with your views and comments issues before the Commonwealth.

David Toscano

Winding Down or Gearing Up?

March 6, 2014 by David Toscano

The General Assembly session is scheduled to adjourn on Saturday, March 8, 2014, and it is not clear that we will have a budget by that date. The stumbling block continues to be Medicaid expansion. Many of us have advocated for a budget that includes closing the coverage gap for over 275,000 Virginians. We support bringing some $1.7 billion of Virginian’s taxpayer dollars back to create 30,000 jobs and bolster hospitals that are experiencing severe financial losses at this time. The Senate’s budget includes a compromise approach to Medicaid expansion called “Market Place Virginia,” a proposal which turns over the coverage of these vulnerable Virginians to the private insurance market. Many thought this compromise might win enough support in the House among Republicans, given that it is based on private sector principles, to obtain passage but that does not appear likely at present. For a recent press conference on this issue, click here. You can also watch several speeches on the House Floor on this topic by clicking here.

While much of the focus this session has been on Medicaid expansion, there are other significant initiatives that will likely pass in the next few days. We are making changes in the mental health system to provide better assistance and infuse monies to serve those most in need. The details of these will be finalized in the next several days, but reforms will likely include implementing an internet bed registry so that finding a bed will be easier and provisions that will allow authorities to detain citizens in crisis for a longer period so that assistance can be provided.

Second, we will pass a legislative ethics reform bill that, while not perfect, represents a modest step forward toward restoring some faith that citizens have lost as the result of the McDonnell scandal. We have reduced the number of high-stakes testing associated with the Standards of Learning (SOL), and have set in place a study group to further analyze what needs to happen in the coming years. Finally, the fee on hybrid vehicles that was imposed as part of last year’s transportation package was repealed. Many of us thought that this was not a good idea last year and we are happy to see it overturned.

I was able to pass a number of bills which you can find summarized here:

HB121 – Requires the Department of Taxation to provide to the General Assembly the total amount of credit given for a tax credit regardless of the number of taxpayers who take the credit. Presently, if four or fewer taxpayers take the credit, the Department of Taxation does not release these figures. We allocate approximately $4 billion in tax credits each year. In order to make sound decisions on whether a tax credit is effective, it is necessary to know the total amount of the credit being taken to compare against the economic benefit to Virginia, if any.
HB312 – Allows courts to award attorney fees in civil cases of financial exploitation based on fraud or undue influence. This will assist our senior citizens and their families in the recovery of assets that have been fraudulently taken from them.
HB890 – Co-patroned with Delegate Chris Peace (Hanover), this legislation corrected oversights in the Code created when some Department of Social Services offices changed the title of their ‘social workers’ to ‘family services specialists’. There were many duties that were specified in the Code to be accomplished by ‘social workers’ by definition that are essential to the delivery of services.
HB407 – This measure provides adult adoptees an alternative to the expensive cost of petitioning the Court for identifying information on their birth parents when the parents are deceased by allowing the Commissioner of Social Services to grant their request after the Commissioner has done a full investigation to determine whether or not good cause is shown to release the information
HB1110 – This measure allows a locality to recoup the additional cost of educating a non-resident student enrolled in a special education program from the student’s originating locality. This measure is particularly helpful to Charlottesville City Schools who host a number of non-resident students who attend specialized public education programs available in Charlottesville. The additional cost to the local taxpayers is approximately $36,000 per student. This bill allows Charlottesville to be reimbursed for this additional cost by the locality where the student resided with their parents before being sent to Charlottesville.
HB1233 – Brought to me by the Attorney General, this measure allows individuals who are the target of stalkers to be included in the Address Confidentiality Program. This program allows individuals to hide their physical address from public records if they have been the victim of domestic violence. This bill would provide protection to those who fall victim to stalkers.

In the next few days, we are likely to determine whether to adjourn and go into a special session for purposes of discussing Medicaid reform or remain in session and continue to debate this issue in the coming weeks.

Finally, Nancy and I want to thank you so much for the outpouring of support that we have received in the last couple of weeks. It has made a huge difference to our family and we are humbled by it.

As always, I enjoy hearing from you during the assembly session with your concerns and views about specific bills. This year, Session is scheduled to adjourn March 8, 2014. Please do not hesitate to contact my office. It is a pleasure serving you in the General Assembly.
David Toscano