Five ways health care is (and isn’t) shaping debate in this year’s General Assembly election

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This year’s General Assembly elections have led to sharp exchanges between Democrats and Republicans on health care, which poll after poll has shown voters view as a top issue.

But with candidates on both sides of the aisle campaigning on promises to ensure access to affordable care, it’s not always easy to discern exactly what’s at stake when voters head to the polls on Nov. 5.

Most of the debate has focused on what’s already happened: Medicaid expansion

The General Assembly passed a bipartisan compromise last year which, at last report, enrolled more than 330,000 people. In some localities, especially in southern Virginia, that’s led to almost 10 percent of the population gaining coverage. Democrats, who unanimously supported the move, are stressing expansion as a major victory, noting that it only followed massive gains in the 2017 election that put them two seats shy of a majority in the House of Delegates.

The party argues that while the subject may seem settled to voters, the General Assembly will have to continue to support the program in forthcoming budget votes. “Expansion’s not just done-and-over-with accomplished,” said Kathryn Gilley, a spokeswoman for the House Democrats.

Republicans, who blocked expansion for five years, remain bitterly divided on the subject, but House Speaker Kirk Cox’s office dismissed the notion that if the party holds its majority a repeal would follow.

“As far as the speaker is concerned, and the speaker is head of the caucus, he would not support undoing what we did in 2018,” his spokesman, Parker Slaybaugh, said. “Nor would he support anything that would roll back coverage of pre-existing conditions.”

Likewise, Del. Chris Jones, R-Suffolk, who chairs the House money committee and initially played a key role in blocking the measure before voting in favor last year on the condition that the state pursue a work requirement, has wholeheartedly embraced it, telling voters in ads that he “led the fight to expand Medicaid,” prompting a “Half True” rating from PolitiFact.

Republican lawmakers who opposed expansion have taken varied stances on what they’ll do going forward. Sen. Glen Sturtevant, R-Chesterfield, said in a recent debate that he would not vote to undo the law, saying it’s “now the law of the land.” Meanwhile, a handful of Republicans campaigned explicitly on a promise to repeal the measure. Among them: Paul Milde, who made the issue central to his successful primary challenge against Del. Bob Thomas, R-Stafford.

Debate remains on short-term insurance plans and drug prices

Outside of Medicaid, candidates have occasionally sparred over support for short-term insurance plans, which some Democrats deride as junk plans and some Republicans back as an affordable option that should be expanded.

The debate was particularly contentious in the suburban Richmond Senate race between incumbent Republican Siobhan Dunnavant, a doctor, and Democratic Del. Debra Rodman.

Rodman called Dunnavant a “quack” for her support of the plans, which don’t cover preexisting conditions and aren’t required to comply with the Affordable Care Act. Dunnavant argues the policies provide important gap coverage for people with no other options.

Gov. Ralph Northam later weighed in, writing in an opinion piece that short-term and catastrophic plans backed by Republicans “deliberately undermine ACA protections and incentivize health insurance companies to provide less meaningful coverage, which will lead to more struggling families and wider insurance coverage gaps.”

A few candidates have also focused on prescription drug prices. During a recent debate, Dunnavant touted a bill she authored aimed to make it easier to use coupons at pharmacies. Rodman called for stronger protections against what she described as price-gouging. And Del. Lee Carter, D-Manassas, is proposing legislation to cap the costs patients pay for insulin at $30 a month.

A fight over health industry campaign contributions

One element of the health care debate that’s played an outsized role in campaign literature: campaign contributions from the health care industry.

Democratic candidates around the state have fired off a steady stream of campaign mailers attacking their Republican opponents for accepting donations from companies and executives in the healthcare field, tying the contributions to votes candidates made against expanding Medicaid and short-term health plans.

Republicans note that Democrats around the state, and the party’s caucuses as a whole, have taken substantial contributions from the exact same sources.

“The Democrats have railed against big insurance and these health-related special interests, but are still taking their money,” said Slaybaugh. “You can’t have your cake and eat it too.”

A spokeswoman for House Democrats argued that “even in cases where it’s donors giving to Republican and Democrats … Republicans are the ones taking money and doing exactly what special interests want.”

The claims in the ads, however, have not always stood up to scrutiny. An ad targeting Roxann Robinson, for instance, reads: “Health care interests gave Roxann Robinson’s Committee $200,000. Roxann Robinson voted to allow insurance companies to deny coverage for pre-existing conditions.”

As evidence, the ad cites a vote in favor of a bill expanding access to short-term health plans. PolitiFact rated a similar line of attack false, reasoning that under federal law, short-term health plans could already deny coverage for pre-existing conditions — with or without the vote.

Many of the big health care debates aren’t partisan

There’s disagreement within both the Republican and Democratic caucuses about the best approach to addressing surprise medical bills, which has pitted health insurance interests against hospitals and doctors.

There’s also lingering bi-partisan disagreement about how hospitals are licensed – the long-debated Certificate of Public Need, which determines what kinds of health care facilities can open where.

Northam hints at future action

In an executive order earlier this month, Northam issued a broad — but not particularly detailed — directive to his staff to come up with ways to address health care access and affordability in the budget proposal he will introduce next year.

Northam’s office said the work would be guided in part by recommendations made earlier this year by a work group on health care. Among the suggestions explored in their final report: providing state funding to health insurance providers to offset the costs of covering people with expensive medical needs; opening a state based Affordable Care Act exchange, which would give the state more authority over the plans offered and how they are marketed; and implementing stronger oversight of short-term plans – for instance, a ban on advertising them through telemarketing.

“While specifics of legislative and budgetary proposals are still in development, this directive will result in concrete policy initiatives aimed at increasing affordable coverage and access to care,” said Northam’s spokeswoman, Alena Yarmosky.