Local Commentary

From the Front Row: Kaye Kory’s Richmond Report

This week I have been pleased to accept an appointment to the Virginia General Assembly’s Joint Commission on Health Care (JCHC). The commission was established in 1992 with this mission: “to ensure that the Commonwealth as provider, financier and regulator adopts the most cost effective and efficacious means of delivery of health care services so that the greatest number of Virginians receive quality health care.” The commission has 18 members, all legislators, and a staff of four. Delegate John O’Bannon (R-73rd) serves as commission chair. Dr. O’Bannon is a neurologist and was formerly chief of staff of Henrico Doctors’ Hospital. He is eminently qualified for this role and has demonstrated a willingness to work across the aisle.

The commission agenda for 2014 contains a number of items that I am currently working on, including improved access to both inpatient and outpatient mental health services and access to brain injury services (which includes concussions). The agenda also includes review of viral hepatitis treatment in Virginia, mental health care services in local and regional jails, and new quality and safety measures to improve hospital related care.

I know that many of my readers, having come to this point in the column, are frowning as the overwhelming thought rises: “What about the elephant in the room (pun deeply intended) … Medicaid Expansion?”

Yes, referring to the stated JCHC mission above, it is difficult to understand how the ability to provide 400,000 uninsured Virginians with medical insurance coverage under Medicaid could be missing from the JCHC agenda. In fact, the Affordable Care Act (ACA) is on the agenda. The commission will be looking at “the likely impact of ACA provisions on health care costs.” Frankly, I find it a challenging concept that the JCHC will be investing Virginia taxpayer dollars in assessing the impact of legislation that it has determined Virginia will not participate in! Perhaps the idea is we need a better fix on the lost revenue to the Commonwealth, given that the estimates range from $700 million to $1 billion per year! Perhaps the thinking is that we need to estimate the lost revenue to Virginia health care providers – hospitals, physicians, orthodontists, etc. – who before the ACA would have been charging higher prices to the thousands of uninsured Virginians who became sick or injured. Instead, if these Virginians purchased insurance on the Obamacare website then providers must accept lower fees. Likewise for uninsured children up to age 26 now on their parents’ policies, and Virginians with pre-existing conditions who purchased this insurance as well. Of course, there’s also the question of how to treat the tax revenues that would be generated by the 20,000 to 30,000 jobs created in Virginia’s health care sector to deliver the additional care that would be provided. Should these revenues be deducted from the costs?

If you are confused by my slightly tongue-in-cheek musings regarding the impact of the ACA on health care costs, it is because the question has such broad, complex ramifications and complications that one could frame the question and develop the response in support of whichever political agenda one might choose. And although the JCHC is “bipartisan” to a large extent, it is not “nonpartisan.”

I believe the true reason the JCHC is not directly engaged in the debate in Richmond is that it is “above our pay grade.” Governor McAuliffe and Speaker Howell are running the show at this point. Oddly, they seem almost to be acting as surrogates for President Obama and Speaker Boehner. I am not sure that they would be pleased by this observation. Be that as it may on the national level, Republicans at the state levels could be grudgingly recognizing that the ACA is a reality and states that refuse to accept these federal funds are taking money out of the pockets of citizens, as well as directly undermining the health and well-being of many. Editorial opinion from media throughout Virginia and across the political spectrum supports finding a way to accept federal dollars to expand health care coverage. Speaker Howell has scheduled a special session of the legislature in September, exclusively to debate this issue. We will all be losers if we are unable to compromise.


Delegate Kory represents the 38th District in the Virginia House of Delegates. She may be emailed at DelKKory@house.virginia.gov.