To say the 2017 elections changed the dynamic of Virginia’s General Assembly would be an understatement. The Democratic party swept all three statewide elected offices and trimmed the Republican majority in the House of Delegates to a razor-thin 51-49 split. Republicans were able to maintain control of the House of Delegates after one race ended in a tie, resulting in Delegate David Yancey (R) having his name pulled out of a bowl to secure Republican control of the House mere days before the start of the 60-day 2018 legislative session.
This changed dynamic resulted in a significant shift in the years-long debate regarding Medicaid expansion. After thwarting former Governor McAuliffe’s efforts to expand Medicaid year after year, leading Republicans in the House of Delegates signaled a willingness to expand Medicaid if it included provisions such as a work requirement, hospital assessment to fund the state share of expansion and a “kill switch” if the federal government ever reduced its 90% match. While most Republicans in the House of Delegates still oppose expanding Medicaid, a coalition of Republicans and all the Democrats in the House provided enough support for Medicaid expansion to be included in its budget.
The Senate is controlled by a 21-19 Republican majority. While two Republican senators have expressed a willingness to consider expanding Medicaid, the Senate has refused to include Medicaid expansion in its budget.
Unable to reach a compromise on the state budget, the 2018 General Assembly session adjourned without enacting a budget. Governor Northam called a special session for the purpose of enacting a budget. At the time of publication, the House of Delegates passed a budget that includes Medicaid expansion and is nearly identical to the budget it voted for during the regular session. The Senate Finance Committee has not yet met to consider its budget. While all parties expect the General Assembly to enact a budget prior to July 1, it will not be a quick process this year.
While the topic of Medicaid expansion dominated the budget conversations, another controversial topic caused significant discussion during the session. Virginia’s Certificate of Public Need program was back in the spotlight with over 30 bills introduced seeking to provide exceptions to the COPN requirements for specific projects, with the clear majority being for imaging services or ambulatory surgery centers. None of the exception bills ultimately became law, but a few of the COPN bills passed one chamber before failing. This has led Delegate Bobby Orrock (R), chairman of the House Health, Welfare & Institutions Committee, to convene a special workgroup of delegates to explore COPN reform during the summer and fall.
Many other bills impacting health care providers were debated or enacted during the General Assembly session, including House Bill 793 authorizing independent practice for nurse practitioners after five years of full-time clinical experience in their practice category. In addition, the General Assembly considered a variety of bills to expand health insurance options, including Senator Siobhan Dunnavant’s (R) Senate Bill 934, which will permit a sponsoring association to create a benefits consortium to sell benefits plans to its members. The governor amended Senate Bill 934 to require it be re-enacted during the 2019 legislative session, but the General Assembly rejected his amendment.
While the regular General Assembly session has concluded, the special session to enact a budget continues. Every budget enacted by the General Assembly is consequential to Virginia’s health care industry, but this year has the potential to alter Virginia’s health care landscape for years to come.
