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Joint panel in Virginia to monitor health care policy changes under Trump administration

This article originally appeared in the Richmond Times-Dispatch.

A new legislative subcommittee will monitor health care policy changes that President-Elect Donald Trump proposes in order to help Virginia lawmakers prepare for either the repeal or repair of the Affordable Care Act, as well as other potential shifts in federal health care laws under the new administration.

House Appropriations Chairman S. Chris Jones, R-Suffolk, and Senate Finance Co-Chairman Emmett W. Hanger Jr., R-Augusta, said Wednesday that a small working panel would allow the legislature’s budget committees to respond more quickly to policies that emerge from the Trump administration after the General Assembly adjourns in late February.

“I’m all for that,” Hanger said in an interview from Blacksburg, where the Finance Committee began its two-day budget retreat.

“I don’t expect them to move quickly,” he said of the incoming president and his administration. “But they may do some things we have to react to.”

Jones made the same point to the Appropriations Committee as it wrapped up its budget retreat in Richmond with an overview of the state Medicaid program and the ongoing debate of its expansion under a law that Republicans in Washington have vowed to “repeal and replace.”

“We need some oversight so we’ll be able to react to what might be coming from Washington,” he said.

The creation of a joint committee also reflects the uncertainty in Richmond over what will happen to the health care law that outgoing President Barack Obama championed and how those changes could affect hundreds of thousands of Virginians who have bought insurance from the federal marketplace and rely on an estimated $1 billion in subsidies to pay for it.

Nationwide, an estimated 1 million people have enrolled for insurance next year through federal and state exchanges between the opening of enrollment on Nov. 1 and the end of last week. Federal health officials don’t have a breakout for consumers in Virginia, but nearly 380,000 Virginians are receiving health coverage through the exchange this year.

Of the Virginians insured through the marketplace, 319,000, or 84 percent, are receiving federal tax credits to offset the cost of premiums and about 220,000 receive additional subsidies for cost-sharing required under their plans.

“We’re super busy,” said Jill A. Hanken, senior attorney at the Virginia Poverty Law Center, which operates a system of navigators to help consumers find the coverage they need and can afford on the marketplace. “A lot of consumers have questions about whether their insurance is still available.

“There’s a lot of concern about the future for their families and themselves around the availability and affordability of health insurance,” Hanken said.

Virginia’s health insurance plans are carrying out signed contracts to enroll people through Dec. 15 for coverage in 2017, said Doug Gray, executive director of the Virginia Association of Health Plans. “I find it very unlikely that a move to undermine the federal exchange will be made for 2017.”

What’s more, insurance companies will have to submit rates to the State Corporation Commission in April for plans that it intends to offer in the marketplace in 2018, Gray said. “If there’s not a plan about what to do in the next four to five months, it will be difficult to be prepared for 2018.”

Trump’s election has short-circuited the intense debate in the General Assembly over the potential expansion of Virginia’s Medicaid program with billions of dollars in federal money raised by taxes under the Affordable Care Act. As a result, the Republican-controlled Appropriations Committee skipped over much of a planned staff presentation on Wednesday about the potential costs and savings to the state from expanding coverage.

“The issue of Medicaid expansion might be in flux because of recent events,” Jones quipped. “Duh.”

Other House Republicans were blunter in their assessment.

“Expanding Medicaid absolutely makes no sense at this point,” Appropriations Vice Chairman R. Steven Landes, R-Augusta, said after the retreat.

But the debate isn’t over. Expansion already has occurred under the law in 31 states and the District of Columbia, including Indiana, where it was put into place by then-Gov. Mike Pence, who will become vice president under Trump. Reversing course will have economic consequences for those states, which have received billions in federal money to pay the full cost of expanding coverage, as well as the millions of people who have become eligible under the law.

In Virginia, Gov. Terry McAuliffe has said he intends to include Medicaid expansion in the budget he submits to the assembly money committees on Dec. 16, despite being rebuffed for three consecutive years in his attempt to expand health coverage for hundreds of thousands of uninsured Virginians.

McAuliffe has not said whether Trump’s defeat of Hillary Clinton, a longtime friend of the governor’s and supporter of health care reform, will change his plans.

“It’s something we’ll talk about,” Secretary of Health and Human Resources Bill Hazel said Wednesday.

Hazel said one of the big policy questions for Virginia that Trump’s election raises is: “What does it mean in terms of economics for the state?”

Currently, the Affordable Care Act covers the full cost of expanding coverage through the end of this year and then gradually reduces the federal government’s share to 90 percent by 2022.

McAuliffe’s administration estimates that Virginia would save more than $211 million in state general funds in this biennium if it expands the program on July 1, although the net savings would be $73.1 million after paying the state’s share of the cost.

The governor also has appeared to be counting on Virginia hospitals, which want the federal money to reduce their cost of uncompensated care, to pay a possible provider tax to cover the state’s share of the expansion costs. However, the industry now is bracing for the likelihood of repeal or replacement of the law.

“Whether full or partial repeal occurs, we can anticipate dramatic impacts on the hospital and health care networks in Virginia,” said Julian Walker, spokesman for the Virginia Hospital and Healthcare Association. “We strongly encourage Virginia’s state leaders to refrain from any significant health care-related legislation until Washington has acted.”

The chairmen of the Appropriations and Finance committees would appoint the new legislative subcommittee to monitor those changes, with a likely membership of four members from each chamber, said Jones, who compared the panel to joint subcommittees that work together on K-12 and higher education.

“It’s going to look different,” he said of the health care law. “It’s going to require a discerning eye and very close attention.”

Hanken said she was heartened that legislators “seem prepared to take a wait-and-see position.”

As for advocates, she said they will continue to work for expanded health coverage of the uninsured.

“We’ll deal with things as they come,” Hanken said, “but for now, the law is still in place.”

This article originally appeared in the Richmond Times-Dispatch.