Doctor’s Note: Dunnavant Introduces Health Care Reforms to Increase Coverage and Reduce Costs

 

 

RICHMOND – Senator Siobhan Dunnavant (R-12) today announced initiatives to increase health care coverage and address the rising costs of insurance and treatment in Virginia. The reforms she has introduced will provide Medicaid coverage to Virginians who need it the most, incentivize private market savings, and create accountability.
Speaking about her proposals, Dunnavant said, “Health care in Virginia does not have to be ‘either or’ – we can help those that most need care and save Virginians money without turning to a massive federal mandate like Medicaid expansion. The new Priority Needs Access Program I am proposing will provide Medicaid coverage to our sickest and neediest. And, we will implement it through a managed care system and cover in-patient services for those on Medicaid”
“The number one concern I hear about from constituents is the cost of their health insurance, and rightly so. We must get the cost of insurance in check. The bills I have proposed to address this will increase the number of plans competing in the market, help create new coverage options for small businesses, and promote cost savings that will result in patient rebates through shared savings.
“The Governor and his predecessor propose ‘Medicaid expansion,’ but spend 60% of the ‘savings’ on something other than healthcare – instead the money went to spending that would continue to balloon our budget. All the while we have a waiting list of over 3,000 for Priority 1 waivers. You can’t partially fund mental health treatment and substance use disorder or waivers and fix our healthcare problems.
“Health care absolutely needs to be reformed in Virginia and too many people are without care or paying rising amounts for private insurance. But simple ‘Medicaid expansion’ does not solve these problems. What I am proposing is an authentic solution that will provide much needed care that is fiscally and morally responsible.”

Private Market
It is essential that the rising cost of individual health insurance is addressed. Dunnavant has introduced legislation that would create a shared savings program in Virginia. Through this program, individuals will be able to find the lowest cost alternative for procedures through a portal operated by their health insurance. In return, the individual will receive a portion of the savings the health plan realizes. She would mandate that health plans that have lucrative contracts with the state government offer plans in the private sector too, more plans increase competition and lower costs. She has also introduced legislation that would direct the governor to request a waiver to modify the expensive individual marketplace that the federal government already mandates. Innovation can reduce cost in that market as well.

SB 639: Requires health plans to establish an incentive program under which savings are shared when the patient receives a covered health care service from a lower-cost provider.

Budget Amendment Item 81 #3s: Directs DHRM to report to the money committee chairmen no later than Nov 1 on the progress of implementation.

SB934 and SB935: Allows for group health benefit plans and authorizes small business associations to offer benefit plans to its members.

SB844: Requires health insurance plans to actively participate in the individual marketplace if they are offering Medicaid managed care programs.

SB845: Creates a state based reinsurance plan to stabilize premiums for those participating on the individual marketplace.

Medicaid
Dunnavant has filed legislation to redefine the existing GAP program to Priority Needs Assessment Program (PNAP) providing a safety net for our neighbors most in need as Medicaid was always intended to do. PNAP would cover:
–  All priority one waiver slots
–  Mental health illness
–  Addiction treatment
–  Life threatening and complex illnesses
– Early diagnosis and intervention for childhood trauma
– Alternative transportation for children and adults under temporary detention orders
– Higher reimbursement for hospitals, especially smaller rural hospitals

Budget Amendment Item 303 #40s: Creates the funding stream to cover the issues listed above.

SB915: Redesigns and redefines the existing GAP Program to PNAP.

Accountability
Dunnavant has filed budget amendments to transform spending. Long term cost control will depend on both improving access to care AND improving the systems that provide it. We must hold programs accountable for success. Restructuring will also work to align duplicated services in agencies and initiate evidence based innovation and programs.

Budget Amendment Item 1 #5s: Directs the Joint Subcommittee for Health and Human Resources Oversight to contract for a vendor to develop a Pay for Success program within the secretariat that will outline performance targets.

Budget Amendment Item 307 #3s: Funds an actuary to conduct a review of health plan capitation rates for the CCC+ and Medallion 4.0 programs which would verify the funding they receive is justified and appropriately serves enrolled individuals.