Virginia: "This is a blue state": Gov. Northam pushing forward with state-based ACA exchange & much more

A few weeks ago I noted the following press release from Democratic Virginia Governor Ralph Northam, just ahead of the critical state legislative elections:

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

“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.”

More specifically, via his op-ed in a local newspaper:

...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.

Well, earlier this week Virginia Democrats did indeed flip both the state House and Senate...and Gov. Northam intends on moving quickly on his (and their) agenda:

In declaring Virginia a “blue state,” Gov. Ralph Northam vowed Wednesday to move ahead on liberal issues he said have long been stalled by Republican control of the statehouse.

Inside a room on the upper floors of the Capitol, Northam held an open Cabinet meeting that featured talk of “a new landscape” full of “great opportunity” for the administration’s ideals.

The full list includes a long list of issues, but obviously the ones most important to this site have to do with healthcare policy:

Secretary of Health and Human Resources Daniel Carey said his office was working on a proposal that would bring a state-based health insurance marketplace to Virginia. The marketplace would allow Virginians to compare and enroll in a health care plan through a state-run website that pools in available plans. Right now, Virginians not covered by their workplace can enroll through the federal government’s marketplace.

Some states that rolled out their own marketplaces, many of which were controlled by Democrats, ran into technological roadblocks that forced them to return to the federal marketplace. But an April report by the National Academy for State Health Policy showed that state-based exchanges enrolled more people and offered lower health care costs than the federal marketplace.

Northam said the model would give the state “a lot more control and would save the commonwealth a lot of money.”

Carey also talked about maternal health and said that in the coming weeks, his office would release a five-year plan aimed at improving maternal mortality. Northam directed state officials earlier this year to study racial disparities in maternal mortality in Virginia that result in more black and Hispanic women dying during or after childbirth, compared with white women.

There's no mention of the reinsurance program in the new article, but moving to a state-based ACA exchange is given a lot of space.

Between this and Andy Beshear's win for Kentucky Governor, there's a strong possibility that as many as seven additional states could move off of the federal exchange (either halfway or fully) next year, and a year after that up to 20 states could be operating their own full tech platform.

UPDATE: Thanks to Blue Virginia and Esther F. for providing this link and transcript of Gov. Northam's cabinet meeting in which they discuss the state-based exchange proposal, among other things...including the previously-mentioned reinsurance waiver:


Gov. Northam: I'm going to turn for the next two hours to health care [LAUGHTER AROUND TABLE], something that is near and dear to my heart.

Secretary Carey, I know that we have had a lot of discussions. We talk about quality of health care in Virginia and I think we are second to none. We talk about access. We want all Virginians to have access to affordable and quality care. We took a large step forward with the expansion of Medicaid. We now have over 330,000 Virginians enrolled, that didn't have coverage prior to that. The last part of that quality access is the cost. We've had discussions; we really need to wrap our arms around that. And I was pleased to see that the Medicaid forecasts for this year were much lower, so we're on a good trajectory in that regard.

Can you talk to us a little bit about maybe reinsurance and our marketplace and how we can look at ways of reducing costs for Virginians?

HHR Sec. Carey: Sure, I'd be delighted, Governor. There are options that we are preparing for you, for your consideration. One of the things that is high on our list for your consideration is creating a state-based marketplace here in Virginia. That would have a number of benefits. First, it would allow us to market directly to individuals in the community that may have had difficulty entering the insurance market. It will also allow us to manage low-income Virginians as they come on and off of Medicaid, as they get a better job that may have insurance coverage, or if they may lose a job but get another job that doesn't have benefits, but they have access to coverage through the marketplace. We can follow those people much more closely in making sure no-one falls through the gaps, with a state-based marketplace.

And also for your consideration, Governor, is the option of using some of the waivers that the federal government has to reinsure the marketplace for individuals above a certain amount. That would be doing a partnership with the federal government with funds coming from the commonwealth to reduce the costs of premiums for all Virginians that get their insurance through the individual marketplace. So I think that would be a great option for you to consider as we go into this legislative session and your budget consideration. That would be one way that we could lower the cost of coverage for many Virginians, for the hundreds of thousands that get their insurance in the individual marketplace.

And we also continue to work with stakeholder groups around the commonwealth about how to lower the actual price, the actual cost of care, whether it's reducing the amount of low-value care in the commonwealth, that really is reducing waste, to make sure that every dollar that we spend, the individual dollar, the government dollar, or an employer's dollar, has maximum impact here in the commonwealth.

Gov. Northam: I appreciate that. I know you've been going on listening tours, and something that's near and dear to my heart is our infant and maternal mortality rate in Virginia. If you could kind of fill us in on how that's going?

HHR Sec. Carey: I'd be delighted, Governor. Our first round of maternal health listening sessions ended this past week with a listening session here in Richmond, as well as one in Winchester, and we've had 10 across the commonwealth, and that's important to make sure that as we develop a plan, our five-year strategic plan, to meet your goal, Governor, of eliminating the inequity, racial and ethnic inequities in maternal outcomes by 2025. That's a bold goal, and it will take a lot of hard work, Governor, to succeed, and we're committed to putting forth a five-year strategic plan.

And to make sure that plan is rooted in the communities we want to serve, we need to listen. That was the goal of our listening sessions. And the plan that we develop over the next several weeks will be rooted in those sessions, to make sure that women are heard, especially women of color are heard, to improve their experience, not just the access, but their experience of care. And how do we make sure that every health professional has the knowledge, and the skill set, to make sure that they understand racial bias, they understand how to make the health care system in Virginia as welcoming, as trust-building, as it possibly can be.

Gov. Northam:: I appreciate that, Dr. Carey. And you know one last thing I would say, when people have asked me, what is our largest challenge in Virginia, especially regarding health care, my response has always been the opioid and addiction challenge. And I know our numbers flattened out this last year, but we still lost over 1200 Virginians, so I appreciate your continued work in that area as well.

HHR Sec. Carey:: Thank you, Governor. It's going to take coalitions across the commonwealth. Each community is different and each community has its own set of problems, whether it's stimulants like methamphetamine or cocaine versus opioids, so it will take all of us in a continued effort with your leadership.