Weekly Report – January 21, 2011

Advocacy Report and Bill List – February 20, 2010

Advocacy Report February 7,  2010 and Virginia General Assembly Bill List February 7, 2010

Legislative Report 2009

Download This Report

Virginia Hemophilia Foundation
Legislative Summary, 2009 General Assembly Session
March, 2009 with update from the April “reconvened” session

On February 28, 2009, the General Assembly passed the conference version of the budget bill, along with other contested legislative matters, and went home. This report will summarize the work of the General Assembly as it affected VHF priorities. Following will be a summary of the disposition of the two bills that we followed limiting mandated benefits for certain insurance policies.

The Budget

Our interest in the budget are primarily focused on money for healthcare; however, K12 funding is also a concern for members whose children receive educational services in part at the HTCs, so this summary touches on both healthcare and K12 education. As a reminder, the extra funding for premium assistance to the bleeding disorders program, for which we were advocating, was not funded.

Health Care

Prior to the infusion of funds from the federal stimulus package, formally known as the American Recovery and Reinvestment Act (H.R. 1), the ARRA, the Virginia budget looked bleak with an almost $4 billion gap between projected revenues and expenses. In December 2008, Governor Kaine submitted his budget bill that called for huge cuts in Medicaid reimbursement to hospitals, long-term care settings, and providers and to K12 education. As part of the ARRA, the Federal Medical Assistance Percentage (FMAP) was increased to 56% (from its current 50% federal match of state funds committed to the Medicaid program). The FMAP increase will mean jobs retained in healthcare and increased access to care for current Medicaid recipients as well as those Virginians who will become eligible for Medicaid as a result of job losses.

K12 Education

We’ve also been watching closely funding to public education. For detailed information on the federal package, click on the Virginia Education Association website for details.

Here is the short version:

• Virginia will received $1.822 billion from the federal stimulus plan for K12 spending. That amount is almost half of the entire amount that Virginia will receive (the other half is primarily aimed at Medicaid and healthcare spending).
• The cash infusion also means targeted increased funding for Title I, special education, and Head Start.
• The total federal infusion of approximately $4 billion exceeds the current projected budget deficit of $3.7 billion.
• National estimates indicate that the federal package will provide an extra $870 per pupil spending over the next two years. That means retention of jobs and perhaps new positions.
• At this point, we do not know the impact that the federal stimulus will have on funding education specialists at the HTCs. The fine details about how funds will be spent in the localities are unknown. It appears that local school divisions will have discretion on how to allocate the funds, with the exception of Title I and Head Start funds.

Please note: The federal funds are due to expire in December 2011. We can all hope that the economic situation will be improving by then.

Bills We Have Been Watching

VHF worked with a coalition of other stakeholder groups to lead the “concerned opposition” to two bills that became known as “Protect the Uninsured” bills. These were HB 2024 and SB 1411, which are now identical. The bills grew out of work conducted by the Small Business Commission (http://dls.state.va.us/business.htm).

The new laws will authorize the Commonwealth to approve health insurance plans for small businesses (less than 50 employees) that may offer some or none of the mandated health insurance benefits. Coverage for hemophilia and congenital bleeding disorders is a mandated insurance benefit.

Currently, Virginia health insurance plans must include all 32 of the state-mandated health benefits. However, less than half of the plans in Virginia are susceptible to these provisions. The majority of health plans meet the statutory requirements of the Federal Employee Retirement Income Security Act (ERISA); these include larger employers and/or companies that self-insure.

HB 2024 and SB 1411 are both good and bad news. The good news is that more people may be covered, in fact, by these bills. The bad news is that hemophilia will not be covered.

The “concerned opposition” believed that these bare-boned policies will have some basic cost/benefit issues. No one can argue that too many people are uninsured. However, it was always our position that the mandated benefits were mandated for a reason, and that in order for the Commonwealth to mandate a benefit, it had to demonstrate a public health need and/or a cost benefit. The primary reason that was touted for removing the mandates was that it would lower the cost of healthcare insurance to some level that would be affordable by small business owners. Unfortunately representatives of the health plans were never able to state how much of the cost of health coverage was due to the mandated benefits.

And no one is saying for certain how the new “mandate-lite” plans will provide coverage for employees of small businesses. Will they be so bare-boned that employees will have large out-of-pocket expenses for such things as doctor visits, drugs, and hospitalizations? What good is health insurance coverage if it fails to cover basic health care? These are questions that the “concerned opposition” including VHF asked and for which no answers were forthcoming.

As a result, our coalition was successful in getting an “enactment clause” written into each bill such that the Bureau of Insurance will be required to report annually on the number of small employers and individuals using these plans. They will also have to provide information on the cost of premiums and out-of-pocket expenses. The first report to the Governor and General Assembly will be due August 1, 2010.

The Governor’s actions on HB 2024 and SB 1411 and the General Assembly’s reactions. On April 8, the General Assembly reconvened for a session to consider the Governor’s amendments and vetoes of certain legislation. Among them were HB 2024 and SB 1411.

The Governor amended HB 2024 in the nature of a substitute, meaning that he introduced amendments that were so substantial as to re-write the entire bill. The substantial amendment related to adding a provision to extend and modify COBRA coverage for employees laid off from small businesses of less than 20 employees. The Governor’s version of HB 2024 passed unanimously in both houses and will become law July 1st.

The COBRA provisions authorized by this bill are as follows. As part of the American Recovery and Reinvestment Act (AARA, the federal stimulus bill), the federal government will pay 65 percent of healthcare costs for laid-off employees who had employer-provided healthcare insurance. The individual will be responsible for 35 % of the cost of the coverage (as opposed to 100% of the cost as is currently the case). There is no cost to the employer, because the federal government will reimburse the insurance companies for the 65%. This coverage will be extended 9 months from the termination date.

In addition to the COBRA provisions, HB 2024 contains amended language that strengthens the notice that employees will receive when small businesses decide to purchase a mandate-lite policy for their employees. these policies are introduced by small businesses. Specifically the language of the bill states that “a small employer shall prominently disclose any and all state-mandated benefits that the policy or subscription contract does not provide.”

SB 1411 did not fare quite as well as HB 2024. The Governor amended this bill to require reinstitution of some of the mandated health benefits, including coverage for children’s health, childhood immunizations, mental health/substance abuse, mammograms, pap smears, PSA testing, colorectal cancer screening, and diabetes. Because of the presumed cost of some of these mandates, the General Assembly voted to exclude coverage for child health and immunizations, mental health/substance abuse, and diabetes. The “prevention” mandates will stand. With the changes made, both houses passed the bill unanimously.

Is there anything VHF can do to influence the outcome of these mandate-lite bills? Since we were part of the concerned opposition to the bills, we must remain vigilant about the implementation of the plans as they move forward. We will be watching for the first report to be issued in August 2010. We should help collect information about members who are denied coverage because they work for a small business that adopts one of these plans. We should look for evidence that people with hemophilia and congenital bleeding disorders are dropped from plans as employers move to purchase one of the mandate-lite plans. Finally we should keep track of the possible cost to the Commonwealth if people with hemophilia lose their coverage and become eligible for Medicaid as a result of job loss.

Questions? Don’t hesitate to contact Becky Bowers-Lanier at becky[at]macbur.com