Sen. William M. Stanley Jr. (R-Glade Hill) this week announced the second release of a series of legislative initiatives for the 2015 General Assembly session that will benefit citizens of the 20th District and the commonwealth.

The series of legislative proposals include creation of a patient-centered medical home advisory council, private health insurance exchanges, regional care organizations for existing Medicaid patients, medical scholarships for doctors who practice in rural areas, and a rural healthcare telemedicine pilot program.

The legislation focuses on the efficient delivery of quality healthcare for all Virginians as a more thorough alternative to Gov. McAuliffe’s unaffordable Medicaid expansion under President Obama’s unpopular Affordable Care Act.

Establishment of a patient-centered medical home advisory council to advise the Department of Medical Assistance Services on the commonwealth’s medical assistance program.

This should increase the quality of care for the needy while managing costs through a patient-centered medical home system.

A patient-centered medical home system is a team approach that: originates in a primary care setting; fosters a partnership among the patient, the doctor, other health care professionals, and as appropriate, the patient’s family; uses the partnership to access all medical and non-medical health-related services needed to achieve maximum health potential; and maintains a centralized, comprehensive record of all health-related services to promote efficiency and continuity of quality care, which will benefit the patient and reduce costs.

Private health insurance exchanges. A private health insurance exchange is a marketplace for employers and employees that pay to participate in the process in order to reduce the cost of the employees’ monthly health insurance premiums that have been skyrocketing under Obamacare.

For example, several small businesses join together to allow their employees’ the ability to enter into a private exchange (marketplace) for their insurance benefits, thereby reducing the overall cost of the premium for the employee.

This legislation provides that one or more private entities may establish private health insurance exchanges within the commonwealth.

The measure requires exchanges to be registered with the State Corporation Commission to protect the consumers.

Participating employers may elect to purchase health benefit plans for their eligible employees and their dependents from a participating health carrier.

Alternatively, a participating employer may authorize its eligible employees to purchase a health benefit plan directly from a participating health carrier using funds provided by the employer, and the employee may use their own funds to supplement the level of coverage that the employer’s contribution would cover.

This is not a public health insurance exchange under the Affordable Care Act.

Creation of Medicaid regional care organizations (RCOs). An RCO is an organization of health care providers that would contract with Virginia’s Department of Medical Assistance Services (subject to approval of the federal Centers for Medicare and Medicaid Services) to provide a comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of Virginia.

The Department would then pay the RCO capitated payments, which are set fees for enrolled persons (whether they seek treatment or not).

The Department would be required to enroll a majority of the commonwealth’s Medicaid beneficiaries into RCOs.

An RCO may contract with any willing health care provider to provide services in a Medicaid region if the provider is willing to accept the payments and terms offered to comparable providers.

In order to attain RCO status, an organization would satisfy eligibility requirements (i.e., financial standards and service delivery network requirements) and acquire department certification.

Board of Health medical school scholarships. Expands the eligibility for the medical school scholarship program administered by the Board of Health for medical students who agree to practice in underserved and/or rural areas of the commonwealth to include students of any accredited medical school.

Under the current program only students who attend medical schools in Virginia are eligible. Amends § 32.1-122.6, of the Code of Virginia.

Telemedicine; pilot program. Directs the Department of Health in partnership with a hospital licensed in the commonwealth, to establish a three-year telemedicine pilot program for the provision of healthcare in underserved and/or rural areas in Virginia.

It is designed to reduce patient use of emergency department facilities for the treatment of low-acuity and the management of chronic medical conditions.

All Virginians, no matter their zip code, should have access to quality healthcare. We have now seen that with Obamacare, the middle class and small businesses are losing their health coverage and are being forced to pay much higher premiums for their insurance, the cost of health care continues to skyrocket, and our hospitals are seeing drastic reductions in payments for the federal government for the care of our senior citizens.

And, part-time workers are having their hours drastically reduced by those small businesses and employers who can’t afford the high cost of insurance.

We must reform our healthcare system and provide quality healthcare for those who need it. But Medicaid expansion is not the answer, and it is no guarantee of quality healthcare for those who have it.

While our system is not perfect, we must seek other options for real solutions for this issue, and not an oppressive blanket policy like Medicaid expansion, which costs more money without offering better results.

Continuing the fight for these legislative initiatives are significant steps toward accomplishing that goal.

I am very pleased that these legislative proposals have gained some bi-partisan support since they were introduced at the Special Session a couple of months ago.

Consideration of these bills again indicates that there is a need to seek reforms in the healthcare industry that will increase the efficiency in its delivery and lower the cost to patients.

The fiscal unsustainability of Medicaid expansion is alarming: Virginia’s existing Medicaid costs are in excess of 21 percent of the state budget (or over $18 billion every two years), and Medicaid grows at 8 percent per year (more than $1 billion every three years) before any Medicaid expansion under Obamacare.

In order to meet the current budget and pay for Medicaid expansion, Virginia would have to either take the money from our children’s education and our public safety, and/or increase taxes by up to an additional $1 billion each year after the first three years of the expansion program.

That is both unreasonable and unrealistic. We need other options for the citizenry to consider.

(1) comment


A plan to enrich private insurance companies. And impoverish consumers.
Adequate health, like Medicare, should be made available to all citizens. Not legislation that benefits private interests, which is what Stanley is proposing here.

And in case you forgot: Stanley is the same guy who filed a notice of appeal to the U. S. 4th Circuit Court of Appeals 135 days late!

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