Virginia: Gov. Northam suggests reinsurance waiver & state-based exchange may be on the agenda next year

It took me a couple of days to post this, but it's an important development, especially on the cusp of the Virginia legislative election next month which could flip both the state House and Senate to the Democrats; thanks to Esther Ferington for the heads up:

Governor Northam Signs Executive Directive to Ensure Access to Affordable, Quality Health Care Coverage for All Virginians

RICHMOND—Governor Ralph Northam today issued Executive Directive Five, directing actions to increase the number of Virginians enrolled in quality, affordable health care coverage.

This year, Medicaid expansion is providing access to health coverage for more than 325,000 eligible Virginians who have enrolled, positively impacting their health. But meaningful health coverage remains unaffordable for too many Virginians, due in large part to federal policies that have increased cost and decreased the quality of available coverage.

Esther sent me a VA Medicaid expansion enrollment update a few weeks back which I never got around to posting, but here it is now...note that Virginia was originally estimated to have around 400,000 expansion-eligible residents last year, so they're up to around 80% of that so far. Not bad!

“Health coverage should be both meaningful and affordable, but unfortunately, policies from Washington threaten to increase the number of families who are uninsured or underinsured,” said Governor Northam. “It’s more important than ever that we identify and implement policies at the state level that control costs and ensure that Virginians can afford to buy health insurance that covers their health care needs.”

Executive Directive Five requires Virginia explore strategies to reduce health insurance premiums statewide, and protect Virginians from federal uncertainty. The Secretary of Health and Human Resources, in collaboration with the Secretaries of Finance and Public Safety and Homeland Security, will review policies and programs and take actions to promote greater access and enrollment in quality, affordable health insurance coverage. The Secretary of Health and Human Resources will work with state agencies, community partners, providers, health plans, and policy makers to implement policies and processes that will result in measurable and sustained improvement in access to affordable health care coverage.

“Health care is about wellness and well-being, but it is also an economic issue for many Virginians,” said Secretary of Health and Human Resources Daniel Carey, M.D. “We know that quality, affordable health care coverage allows families to maintain employment, pursue educational opportunities, and have more money for other important personal investments and we need to protect and build on the gains we have made.”

The Secretary of Health and Human Resources will develop data-driven strategies to create efficiencies in coverage and improve health outcomes, with a special focus on particularly vulnerable populations, including but not limited to: pregnant women, justice-involved populations, non-English speaking populations, individuals with disabilities, and youth in foster care. The Secretary will also look for solutions to improve affordability through state innovations.

OK, that all sounds good but that's pretty vague. What's he actually have in mind? Well, this follows up his Op-Ed in the Richmond-Times Dispatch a few days earlier where he went into more specifics:

But meaningful coverage is under threat. In Washington, President Donald Trump has continued his effort to demolish the health coverage protections established by the Affordable Care Act, and sadly, he has received help from legislators here in Richmond.

As costs continue to block so many Virginians who want access to affordable, meaningful health coverage, the president and several Richmond legislators have pushed health coverage plans that lack protection for Virginians with pre-existing conditions, or that would allow insurers to raise rates or drop coverage once a person actually gets sick. They’re low cost, but they’re also low care.

...Additionally, last fall, the Virginia Market Stability Work Group detailed a number of policy proposals to expand access to meaningful, affordable health coverage. The group’s ideas included the creation of a fiscally responsible, sustainable reinsurance program to lower premiums. They also suggested Virginia create a state-based health insurance marketplace, which would allow us to manage our own insurance market rather than letting Washington do it.

Other ideas include working with providers to implement more value-based care, which is less costly to patients but just as effective, and establishing consumer protections to safeguard against predatory practices that hurt Virginia families.

As we approach the 2020 General Assembly session, our administration will evaluate all of these proposals as we fight for affordable health insurance that includes meaningful coverage for all Virginians.

I could obviously be reading too much into this, but when the Governor of the state name-checks and highlights a specific policy proposal as part of an op-ed in a major newspaper, just ahead of a formal executive order, it seems pretty likely that they're planning on moving forward with that proposal. In this case, there's two of them...both of which are pretty much no-brainers given that numerous other states have either implemented or started work on them this year alone:


If Virginia were to do both of these, they'd join a dozen other states in implementing an ACA reinsurance waiver, and anywhere from four to seven other states in establishing their own full state-based ACA exchange (beyond the twelve which were already operational before this year).

Nevada just launched their state exchange. New Mexico, New Jersey and Pennsylvania are on track to launch theirs next year. Oregon has sent out a RFQ (a couple of times, actually) to vendors, and the governor of Maine just announced her intention to move on at least a partial state exchange.

There's also Kentucky, which hasn't announced anything yet, but if Andy Beshear wins the governor's race and retakes his father's old office, there's a very strong chance that he'll take the state's beloved "kynect" ACA exchange out of mothballs and fire it back up again (ok, to be honest I don't know if it'd be that easy...I have no idea whether the techology platform has actually been scrapped or simply had the plug pulled).

Assuming all of these state, including Virginia, were to move ahead with their plans, it's possible that by November 1, 2022, you could see up to 20 states operating their own full ACA exchange platforms.

Of course, all of this assumes the ACA itself is still the law of the land after the final Texas Fold'Em lawsuit ruling is issued...