Listening to the two of the experts on the Affordable Care Act’s impact on Virginia, it’s clear that state Democrats and Republicans agree on very little. Is it a “complicated” scheme with “highly uncertain” outcomes or a “no-brainer” that will work like “rocket fuel” for health care reform in the state.
Attorney General Ken Cuccinelli (R) and Del. Patrick Hope (D-Arlington) took turns giving their views and taking questions on the topic during the Loudoun County Chamber of Commerce’s Policy Maker Breakfast at Wednesday.
As Cuccinelli—a longtime and vocal opponent of the law commonly referred to as "Obamacare"—put it, the act involves “a complicated set of variables … that is highly uncertain in terms of what exactly you’re getting into.”
Cuccinelli urges state legislators to move forward cautiously before agreeing to participate in the act, most of which was upheld earlier this year by the U.S. Supreme Court.
“I don’t think we should proceed until we know what we’re getting into,” the attorney general said, adding that it’s possible the entire law will be overturned after the fall election. “Repeal is going to be decided on Nov. 6.”
Hope, on the other hand, said the law includes many proposals originating in the Republican Party over the decades that have become “suddenly controversial.”
The delegate said the law would mean health insurance coverage for an additional 1.1 million currently uninsured Virginians.
“They’ve really taken a lot of the best approaches and put it into the affordable care act,” he said. “It’s a no-brainer. This is the easiest decision. We’ll be ahead. The Affordable Care Act is like rocket fuel for us in some of these areas.”
Cuccinelli expressed concern about an insurance “exchange” that either the state must create or the federal government will impose. A state exchange means complying with government mandates and the potential for small businesses to face “very, very substantial” penalties for not participating, he said. On the other hand, the state would have little control over the federal exchange and may not be able to withdraw.
“Do we want to the federal government to bypass us to set up this exchange?” he asked.
However, the rules for setting up a state exchange do not provide enough leeway for the state.
“There doesn’t appear to be any discretion for these health care exchanges, at least not now,” Cuccinelli said.
Hope said the exchange would give small businesses more leverage to compete for lower insurance prices because they would form one large pool, rather than thousands of individual businesses. Small businesses now “have no market power” to push for lower premium costs, he said.
“You should demand that we set up an exchange,” he said
He also said those who cannot afford coverage would receive assistance in the form of tax credits. And the state can apply for establishment grants.
“You’ll be able to do a side-by-side comparison of the company’s competing for your business,” he said, adding that time is running out to begin work on a state exchange. “If we don’t do it, the federal government will do it for us.”
And, he said, if the federal government runs the exchange, decisions about how to fund it and the benefits provided will not be in the hands of the state.
Hope estimated the exchange would charge participants a $3-$5 surtax per month on premiums, but could also fund it some other way.
The two also disagreed on the impact to the state with respect to Medicaid.
Cuccinelli said that while the law directly impacts only businesses with 50 people or more, rising insurance costs would be passed along to everyone from the “transformation of the insurance market.”
Jared Melvin of the Loudoun Insurance Group called the law "pretty scary stuff."
“The business community is concerned about all aspects of this law,” he said.
NOVA Medical Group’s Grace Keenan asked how the law helps physicians who are struggling to keep up with overheads costs and reduced payments for Medicaid.
“Unfortunately for physicians, there’s nothing in this law that impacts you,” Hope said, to which Keenan made an important point regarding the medical community.
“Without us, it doesn’t happen,” she said.
Cuccinelli said the uncertainty about elements of the law that have not been implemented—which he estimated to be about 150 provisions that will take as long as five years—are the primary concerns for businesses.
“What does it cost you to hire another person? That’s hard to say right now,” he said.
But Hope said part of that uncertainty is a result of the state’s lack of work on creating it’s own exchange.
Cuccinelli offered his own ideas for lowering health care costs if the federal law is repealed, including the creation of a national market to lower medical costs, limits to malpractice lawsuits and the optimization of medical care.
He also said that health insurance was never intended to handle routine doctor visit, but rather catastrophic illness. As an example, he said car insurance does not pay for oil changes.
Hope pointed to other benefits he believes the law will provide, such as growth of jobs in the medical industry, which in turns creates new revenue for the state.
When someone expressed concerns that her insurance premiums were rising 20 percent, Hope said the law is intended to limit those fluctuations, but also pointed out that insurance premiums would rise with or without the law.
The debate is certain to continue through the election season. Cuccinelli said that if George Allen is elected to the U.S. Senate and Mitt Romney wins the presidency, then Republicans will have the votes needed to repeal the law. Cuccinelli said the law could not be fillibustered by Democrats because it involves a tax, meaning only 50 senators would need to vote for repeal, with the Romney's vice president breaking the tie. The House has previously voted to repeal the bill and the GOP appears to likely to retain that chamber.