- - Friday, August 3, 2012

Virginia has been a laboratory of democracy since the beginnings of our country, and as we debate the future of health care in our great nation, the Old Dominion should again step forward to lead in the discussion. To do this, Virginia must continue to work toward meaningful health care reform but stand up and object to the significantly flawed national health care mandates that threaten the economic stability of our country.

Three years ago, President Obama told Senate Democrats, “As we move forward on health reform, it is not sufficient for us to simply add more people to Medicare or Medicaid to increase the rolls, to increase coverage in the absence of cost controls and reform. Another way of putting it is we can’t simply put more people into a broken system that doesn’t work.” Mr. Obama has ignored his own advice, and if implemented as intended, the Patient Protection and Affordable Care Act (PPACA) will put 16 million to 20 million people into a broken Medicaid system. In Virginia, our Medicaid program already is nearly 20 percent of the commonwealth’s budget, and this number continues to grow. This is without the proposed Medicaid expansion under PPACA. I was elected to be a careful and responsible steward of our limited tax dollars, and it would be irresponsible to infuse billions of tax dollars into a program that we all agree is broken.

The Medicaid expansion, though optional now, is only one of many flawed pieces of PPACA. I strongly support, as do all governors, increasing coverage and access to care. But PPACA aims to achieve that laudable goal in the wrong way: by favoring dependency over personal responsibility. In its current form, the law will destroy the private insurance market while increasing health care costs. America’s economy continues to recover slowly, but it is greatly restricted by skyrocketing deficits and a record national debt. Our national spending is both immoral and unsustainable. PPACA only makes that spending worse. Neither states nor the federal government can afford the Medicaid expansion or the promised federal subsidies needed to make any health benefits exchange functional.

Reform does not happen when it fails to be sustainable or affordable, and PPACA is neither. The United States spends nearly 18 percent of its gross domestic product on a broken health system, while it’s projected that 42.7 million Americans will not have access to health care in 2013. We should not be pushing these uninsured Americans into a crippled paradigm that does nothing to reform the health delivery and payment systems that are the root of the health crisis today. For all these reasons, I continue to call on Congress to repeal PPACA and replace it with meaningful health reforms. We don’t need excessive federal mandates, the creation of bureaucrat-influenced marketplaces, and ill-conceived ideas that are expected to be implemented in unreasonable time frames. We need real market-based health care reforms that will actually make this system work both now and in the years ahead.


Notwithstanding the failed policies within PPACA, an area of significant concern that the spotlight often misses is that our existing health system is currently incapable of handling an increased demand for health care. Why? Because we simply do not have a health workforce large enough to appropriately care for the surge of patients that will flood the system in 2014 if PPACA remains in place. In Virginia, we are taking steps to address this problem by allowing physicians and nurse practitioners to practice in a team-based model of care. Additionally, we are encouraging coordinated care to ensure that people are receiving the right care at the right time and in the right setting.

Bigger government is not the answer to our health care crisis. There has to be an impetus for change, and the change must be an economic driver. In Virginia, employers of all sizes purchase private health coverage for more than 4.3 million employees. Recognizing that an opportunity exists to align economic incentives while promoting quality and value, the newly created Virginia Center for Health Innovation (VCHI) is the central hub for employer engagement in health reforms and innovation. VCHI is a nonprofit, nonpartisan partnership sponsored by the Virginia Chamber of Commerce and designed to fast-track the adoption of value-driven models of wellness and health care throughout the commonwealth. This privately led entity is a place where employers, providers and other stakeholders can come together to establish priorities for research, design demonstration projects, and engage employers to leverage their purchasing power to encourage the adoption of proven delivery-system practice and payment reforms. The results of this organization will enable businesses to optimize their health care investments and increase their global competitiveness. Essentially, the private sector is coming together to reform from within.

Reforming in this manner is the key difference between PPACA and our approach in Virginia. The PPACA was drafted without meaningful dialogue with governors and other vested stakeholders. Congress ultimately passed, on a party-line vote, a law that essentially has been impossible to support, much less implement. I continue to call on the president and his administration to provide meaningful guidance about health-benefits exchanges and the Medicaid expansion. I continue to believe in the ability of the private sector to create and impart positive change that will enable more Americans to receive the health insurance coverage they need in a fiscally responsible and affordable way.

Bob McDonnell is the Republican governor of Virginia.