Note: This interview was originally published in the Fall 2016 edition of Williams Mullen On Call.

Williams Mullen recently interviewed Virginia Secretary of Health and Human Resources Dr. Bill Hazel to discuss the current health care system and health care forum. Secretary Hazel’s thoughts are set out below: 

This interview has been edited and condensed.

1. What do you see as the two primary challenges in health care in Virginia during the next two years?

"The biggest issue we face is getting the mental health system better organized, better funded, more responsive and more available to the community. The opioid epidemic signifies the surge in addiction issues we are addressing.

One of three things happens to individuals with addiction – they die; they live in addiction with harm to themselves, their family and their community with increased crime, incarceration, emergency room usage, etc.; or they recover. Those are the three choices. We need to get the recovery piece done. The parallels with mental health are very similar.

Another big issue is the access to health care problem has not been solved completely. It becomes an issue of how do we make health care affordable for people and for the country.

We have to address the market breakdowns, or acknowledge that we do not have a market, one or the other. When you compare U.S. health care spending to European health care spending, it is clear the Europeans do not have the high prices that we have in the U.S. We are running 50 to 60 percent higher. It is not easy to talk about, but that is where the conversation is going to have to go."

2. What is the most important state-based initiative coming in the near future?

"If we are going to make a significant dent in mental health or opioid use, we have to figure out a way to bring in the federal money. How we do that is going to be a big state issue, because federal coverage through Medicaid expansion would bring a couple hundred million dollars per year for mental health and a hundred million dollars for substance abuse treatment. You have to fund it in order to build it, and the money comes through CMS.

Also, there has been so much said about Medicaid. We need to stop and ask if the understanding that everyone has of Medicaid is accurate or not."

3. What can be most easily accomplished to help the uninsured and small businesses?

"The best thing you can do for small businesses is to allow them to buy into the marketplaces. Perhaps expand the eligibility up to groups of 100. There are a series of things that have to be done around the marketplaces and in the Affordable Care Act. Some of it has to do with the risk rebalancing that was envisioned in the Affordable Care Act. Increasing the populations in the marketplaces will also help. Around the country, there is some evidence that where there has been a Medicaid expansion, marketplace premiums are about seven percent lower."

4. What trends do you see in health insurance premiums? 

"The key will be whether we are able to get to value-based purchasing quickly enough. The issue is that it is hard to identify what your markets are in health care. We know even high deductible plans do not work for everybody. Some people forgo the necessary preventive care and end up with higher costs when they do enter the system. We know high deductibles stress the providers because you have to collect the individual specific plans, and one of the biggest places of bad debt apparently is uncollected copayments and deductibles."

5. Overall, what are you most optimistic and pessimistic about in health care in the coming two years?

"As much as I have talked about addiction and mental health, the good news is that people are now more aware than they ever have been that these problems exist and that it is going to take some sort of collective action to address them.

With respect to pessimism, we have not managed the cost of health care completely yet, but the cost and coverage go hand-in-hand. We have to spend a lot of time in that area."