Environment of Care
Environment of Care153 As of today, the health care environment in Virginia remains in flux. On one hand, the Commonwealth continues to benefit from federal funding coming into the state for health reform. On the other hand, the Commonwealth continues to actively contest federal health reform. In June 2012, the Supreme Court upheld the Patient Protection and Affordable Care Act (ACA) as constitutional including the individual mandate and Medicaid expansion. Medicaid expansion is optional for states, and those wishing to implement expansion will receive 100% ACA funding to support this, to be phased to 90% over time. States not implementing the expansion must still comply with provisions of the Medicaid Act or risk losing funding. In addition, the new ACA Medicaid provisions must be adhered to by all States, including increased payments to Medicaid-participating primary care providers, mandatory coverage of freestanding birthing centers, options for expanding coverage for community-based services and support for people with disabilities and the elderly, and gradual reductions in disproportionate-share hospital funding beginning in 2014.154 In Virginia, Republican Governor Bob McDonnell stated he is waiting until after the 2012 presidential elections before proceeding with the health benefits exchange hoping that Republican presidential candidate Mitt Romney will be elected and repeal the ACA, including Medicaid expansion. In addition, current Republican Lt. Governor Bill Bolling and Attorney General Ken Cuccinelli are calling for state legislatures to opt out of Medicaid expansion prior to the elections.155 Recognizing that the Commonwealth may still have to act further on health reform, the Governor continues to have the Virginia Health Reform Initiative move forward to discuss and create recommendations on ways to improve health care access and delivery, lower costs and address the growing costs of Medicaid. The focus of this group's efforts will be on designing a health benefits exchange that the Commonwealth will implement.
153
Unless otherwise indicated, information provided was received from the Virginia Community Healthcare Association, 2012 Virginia State Health Care Environment Update, as of April 23, 2012 154 NHelp National Health Law Program, Summary of the Supreme Court Decision on the ACS: Court removes the “gun from the States’ heads” but leaves open the possibility of States shooting themselves in the foot, prepared by Jane Perkins, Sarah Somers, and Byron Gross, June 29, 2012 155 The Roanoke Times, Editorial: Uninsured shouldn’t be political pawns, Lt. Gov. Bolling and Attorney General Cuccinelli are pushing the state to make a bad decision. July 18, 2012.
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