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State of confusion

SoVaNow.com / January 30, 2014
The Virginia legislature is in session, which means confusion is in the air, sorta like the five-day weather forecast. Case in point: Sunday hunting. It appears that the prohibition is headed on the way out, although anything is possible, I suppose, after the House of Delegates voted overwhelmingly this week to ditch Virginia’s one-day hunting ban, shared by only six other states.

The legislation in question, House Bill 1237 sponsored by Shenandoah Republican Todd Gilbert, will soon cross over to the Senate. Barring a complete collapse of support in the upper chamber, approval there is expected. (The vote in the House this week wasn’t even close: 71-27). As a last ditch tactic, opponents sought to cede control of the issue to localities, which would be given the authority to decide whether Sunday hunting should be allowed within their borders. One imagines that more than a few county supervisors, none too eager to have this controversy fall in their laps, were relieved to see the gambit fail.

As someone who doesn’t hunt and doesn’t have a rooting interest in the matter one way or another, the Sunday hunting debate nevertheless fascinates insofar as it pits two flavors of conservatism against each other: church-going conservatives who believe the Sabbath should be a day of rest, worship and positively no BLAMMO, versus freedom-loving conservatives who assert the right to pull the trigger on Bambi whenever they want to. (There aren’t a lot of issues where you’ll find the Virginia Farm Bureau and the National Rifle Association on opposite sides, but this is one.) Occupying the mushy middle, folks like me had to be at least somewhat mollified by the restrictions attached to Gilbert’s bill — no running of dogs on Sundays, hunting only on private lands — which just goes to show that even hard-core libertarianism has its limits.

Southside’s delegation led the charge against the bill, with a degree of success generally associated with General Pickett. It’s hard to avoid the conclusion that their inconsistent ideological worldview proved fatal to their cause. Lawmakers such as James Edmunds, Frank Ruff, Tommy Wright and Charles Poindexter may be adamant in their belief that hunters shouldn’t be allowed to venture out on the Sabbath, but they’re fine with bills that let people bring guns into libraries and bars. What’s up with that? Personally, I’ll take my chances out in the field.

At least confusion is a trait that one comes by honestly. It’s positively endearing compared to the dissembling and distortion that dog other issues. Case in point No. 2: expanding Virginia’s Medicaid program under the Affordable Care Act. Tommy Wright, a Republican delegate who represents neighboring Mecklenburg County, offered the going GOP line on Medicaid expansion in his weekly constituent column published this Wednesday in our sister newspaper, The Mecklenburg Sun. If you’re looking for the cookie-cutter version of the Republican position, look no further. Take it away, Delegate Wright:



I believe it would be premature to expand Medicaid right now. Medicaid is a costly program that needs reform. It has grown by 1600 percent over the last 30 years and now consumes 22 percent of the state budget. According to the Secretary for Health and Human Resources, 30 percent of all healthcare spending in Virginia is waste, fraud and abuse.

It does not make sense to expand a poorly-run program. Instead, I would like to see the work of the Medicaid Innovation and Reform Commission continue. I believe we should reform Medicaid first, before we consider expansion.



Personally, I happen to like Tommy Wright, the same way I do our local delegate, James Edmunds. Decent men, both. As politicians go, neither is particularly slick (a good thing). I especially appreciate their leadership in fighting uranium mining in Southside Virginia. But Del. Wright, and presumably Del. Edmunds, will sully their reputations if they continue to spout this nonsense about Medicaid. More than that, they will do tremendous harm to their low-income constituents — and there are a lot of them — for whom the provision of health coverage under Medicaid would come as a blessing. It would be one thing if Wright et al were correct in asserting that the cost of Medicaid expansion outweighs the benefits. But this is not true. Not even close. Are our area lawmakers really prepared to shame their reputations by peddling such falsehoods?

Let’s take this line from Wright’s column: “According to the Secretary for Health and Human Resources, 30 percent of all healthcare spending in Virginia is waste, fraud and abuse.” You have to parse that statement carefully to see what the Republicans are trying to do with the Medicaid issue. In testimony last month before legislators, Virginia Secretary of Health and Human Resources Bill Hazel (a Bob McDonnell appointee who was reappointed by Gov. Terry McAuliffe) indeed mused that 30 percent of health care dollars are wasted, although he attributed a relatively small share of that to fraud and abuse. But Hazel wasn’t talking about Medicaid in particular — he was talking about all medical spending. (The biggest culprit, by the way, is unnecessary procedures.) By twisting his words into an indictment of Medicaid alone, the Republican leadership “does fundamentally misrepresent what I presented” to lawmakers, Hazel told reporters this week.

What does it say for the GOP’s position that it would be called out as a lie by a Republican-appointed cabinet secretary? Contrary to the implication of Wright and others, Medicaid is actually more efficient than the private-pay insurance system, at least according to the New England Journal of Medicine, whose authority on the subject far exceeds anything you should expect from the Virginia General Assembly. (From the Journal, August 2, 2012: “With the per-enrollee spending growth in Medicare and Medicaid less than that in private insurance and close to the growth in GDP per capita, it’s hard to argue that spending on either program, on a per-enrollee basis, is ‘out of control.’”) As far as Virginia is concerned, to the extent that the program has grown, it’s largely because the General Assembly — Republicans and Democrats alike — opted to expand Medicaid to cover more elderly and disabled individuals. This is a good thing, of course. But it’s a very bad thing that Republicans would use the expansion of the program for one group as grounds for opposing its expansion for another.

Under the Affordable Care Act, 100 percent of the cost of newcomers to Medicaid would be borne by the federal government for the first three years, falling to 90 percent after that. Persons making under 133 percent of the federal poverty level would become eligible for coverage, which means that potentially 400,000 Virginians could gain health insurance, many for the first time. (Going into 2013, the state had roughly 1 million uninsured persons). Credible estimates suggest 1,859 Halifax County residents would become eligible for coverage with the expansion. In Mecklenburg the number is 2,081. Many of these people have low-paying jobs that don’t provide insurance, and they aren’t eligible for tax credits to purchase policies on the new healthcare marketplace. (This is a quirk in the Affordable Care Act for which you can blame the U.S. Supreme Court.) Hence the stakes for Southside Virginia in the Medicaid debate are enormous: the General Assembly can take a huge step to improve the health and well-being of local communities, especially poor ones such as our own, or members can sit back, do nothing and hide behind falsehoods. It would be embarrassing if Delegate Wright knew all this and yet failed to show the independence of mind and action that his constituents presumably expect from their elected representatives.

You know what else is embarrassing? In a presentation this week to legislators, Hazel estimated that Virginia actually would save $1 billion through 2022 by accepting the federal Medicaid expansion. There are various reasons for this, but an obvious one is that fewer uninsured patients would be showing up at the local hospital emergency room, unable to pay their bills. The position that Republicans have staked out for themselves is truly absurd: In their hatred of Obamacare, they would deny health care for their neediest constituents and force everyone else to pay the tab for this show of intransigence. Given such information, one does hope that Republicans will drop the pretense that they’re looking out for the taxpayers’ interest in Richmond.

As the events of the past week demonstrate, legislators are as prone as anyone to taking confused positions — in the case of Sunday hunting, the argument of the Southside delegation seems to have as much to with gut feelings and ingrained practices as anything else. (In all likelihood, lawmakers also are sincere in the belief that a majority of their constituents are as opposed to the change as they are). Yet if Sunday hunting does become a reality, life will pretty much go on as before, with some persons gladdened by the General Assembly’s actions, others inconvenienced. But the Medicaid debate isn’t the same thing. It’s about poor people being able to pay for, and thus obtain, medical treatment for diseases that don’t discriminate according to income. It’s also about doing right by the Virginia taxpayer. If the interests of both groups were in collision, a certain amount of confusion on the issue might be understandable. Here, no such conflict exists. So what, pray tell, are Medicaid’s opponents so confused about?













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