Virginia Site Visit Report

A report funded by the Robert Wood Johnson Foundation, as part of its Affordable Care Act (ACA) Implementation-Monitoring and Tracking Series, examines Virginia’s progress toward implementing health care reform—both the ACA and the state’s own health reforms.

Virginia has made significant progress in health reform implementation, despite significant political opposition in and out of the state government. Governor Robert McDonnell, despite his strong opposition to the Affordable Care Act (ACA), appointed the Health and Human Resources secretary Dr. William Hazel to lead an effort to consider federal health reform implementation and health reform initiatives for Virginia that go beyond the federal reform. Secretary Hazel developed the Virginia Health Reform Initiative (VHRI) at the request of the governor, which included an Advisory Council of key legislators and stakeholders. In December 2010, the council affirmed that Virginia should establish its own exchange. The recommendations of the council led to legislation which passed in the general assembly in April 2011 and was signed into law by the governor.

The VHRI Advisory Council continued the discussions on issues surrounding the health benefit exchange and the questions posed by the 2011 legislation. A series of public meetings (with public comments) were held, a survey of small businesses was conducted, and a report was filed in November of 2011 that contains the VHRI Advisory Council’s recommendations. An exchange does not yet exist, only recommendations for one, including the recommendation to create a state-based exchange in accordance with federal law.

There is significant political opposition to the implementation of health reform in Virginia. The state has not indicated at this date how it will respond to the now optional expansion of Medicaid coverage or whether it will establish an exchange. But at the same time, the state has created a highly regarded process for debate on the exchange, and also benefits from the extraordinary leadership of Dr. Hazel. The state experiences ongoing budget pressure because of the recession which is affecting state decision-making. When the health reform law is implemented, the state could benefit from strong competition within its insurance and provider markets.

This report is one of 10 state case study analyses that will be completed in 2012.