A Healthy Virginia

Thank you all for being here today.

A little over two months ago, I stood in this very room and vowed I would never stop fighting to get hard-working Virginians and their families the health care they need and deserve.

During the legislative session, I traveled to more than 20 hospitals, health centers, and free clinics and met with countless Virginians who were generous enough to share their stories with me.

I met Lori Piper, a former business executive who lost her job, her health insurance, and even her home for a time, not because she didn’t want to work, but because she was diagnosed with a serious auto-immune disease and was forced into bankruptcy. 

In July, I went down to Wise County in southwest Virginia for the Remote Area Medical free clinic.

There, I met many proud, hardworking Virginians who camped in tents, slept in cars or waited all night in the rain for their once-a-year chance to see a doctor in a barn stall --or a dentist outside in a tent in the mud and rain.

More than 2,000 people lined up to get care they could not otherwise receive, and many more were turned away.

These hardworking Virginians deserve so much better.

Fighting for them is why I ran for governor. And meeting them has made me even more committed to tackling one of the great moral challenges of our time: access to health care.

I tried to do this by expanding Medicaid services in a bipartisan way. Doing so could have helped 400,000 of the poorest Virginians quickly get access to lifesaving care.

Closing the coverage gap is the most cost effective way to get people care.

In the long run, it would save Virginia money. And we could keep people healthier and out of the emergency room. Vital resources now spent on indigent care could have been redirected to the creation of jobs, education, and other priorities for Virginia’s future.

And we could take advantage of services that we have already paid for and that 27 other states are already using.

Our neighbors certainly see the benefits.

Governor Steve Beshear of Kentucky and Governor Earl Ray Tomblin of West Virginia are both closing the coverage gap, which puts Virginia at a competitive disadvantage.

If a company is deciding where to move, doesn’t it only make sense that they will choose the state with lower health care costs and healthier workers? The Republican governors of both Tennessee and Wyoming certainly think so, since they both recently announced they are looking to expand Medicaid. 

I have also talked to some of our nation’s most conservative governors including Mike Pence of Indiana.

They too are making the smart business decision to close the coverage gap. 

Many of these states are seeing a dramatic increase in jobs and economic growth, their safety net hospitals stabilized, and thousands of formerly uninsured workers and their family members getting healthier because they now have access to affordable quality care.

This is what I want for Virginia.

But the House of Delegates blocked any and all bipartisan efforts to expand coverage through Medicaid and refused to consider or offer any compromise.

They rejected a straight expansion of Medicaid. Then they rejected Marketplace Virginia. Then they rejected a Pilot program that we could terminate at any time. 

And just last week a McClatchy analysis showed that over the next eight years, states that have refused to close the coverage gap will pay $152 billion in taxes.

This money will be used to provide healthcare to people living in states that have expanded Medicaid.

Eighty-eight billion dollars of that money will be paid for by Virginia and just four other states.

And while we are paying that money in—we won’t reap any of the benefits—benefits like job creation, a healthier workforce, and saving hospitals’ bottom lines.

This lack of action is part of why when it comes to health, we have a divided Virginia.

A male in Fairfax County is likely to live 14 more years than a male in Petersburg and 9 more years than a male in Wise County.

Those disparities are driven by a variety of factors including poverty and education, but ultimately by the availability or lack of access to health care.

But it doesn’t have to be that way. And that is why I’m not giving up.

I’m not giving up because I know how important quality affordable health insurance is to people like James Martin, who is here today with his grandmother, Virginia.

James had health insurance through FAMIS and it saved his life earlier this year, allowing him to have open-heart surgery shortly before his 19th birthday in May.

James just started classes at Patrick Henry Community College and has a promising future ahead. But, he also faces serious health care challenges.

He lost his insurance when he turned 19, but because of his heart surgery, he must take medication for the rest of his life.

James would benefit from Medicaid expansion, and he would like to have the security of health insurance once again.

James, I want you and every uninsured Virginian to know that I am still committed to closing the coverage gap.

But I know it will take time.

And that is why I instructed my secretary of Health and Human Resources, Dr. Bill Hazel, to come up with executive actions in the interim that will both increase coverage and strengthen care for our neediest Virginians.

I told Dr. Hazel to be aggressive – and to go after what others may not be willing to do.

Because every increase in coverage has the potential to significantly improve or save someone’s life.

I will continue to push the envelope to ensure that I am doing EVERYTHING within my legal authority to expand access to those who need it most.  That really is the true goal. 

This isn’t about politics; it’s about people and trying to improve their lives.  Medicaid expansion is just one tool to do this, but I have other tools at my disposal. 

And today, we should recognize the real and significant changes we are about to achieve.

Through my plan, A Healthy Virginia, I am taking action by authorizing 4 emergency regulations and issuing 1 executive order that will help improve the lives of over 200,000 of our residents. These health needs are urgent and we must do whatever we can to address them now.

Our program – divided into ten steps - will not only expand access to care, but will also improve care for veterans and for those with severe mental illness, and will enhance value and innovation across our health system.

Step 1:  We will cover people with serious mental illness.  

I will launch the Governor’s Access Plan, or GAP, to make sure real health care reforms reach our neediest citizens.

This new and innovative plan will provide medical and behavioral health care to approximately 20,000 uninsured Virginians with severe mental illnesses.

These are Virginians who need care, and have no access to help at this moment. It’s an unprecedented step towards providing care to some of our most vulnerable citizens.

As we know, mental illness does not discriminate. It affects many of our families and ALL of our communities. And without treatment or support, tragedy strikes far too often.

However, with effective treatment, people can recover.

And I am confident that my new program will make a significant difference in the lives of thousands of men and women across the Commonwealth.

In order to achieve this coverage, today, within my power under Virginia Code Section 2.2-4011, I am authorizing my staff to start the emergency regulation process and work with CMS on the needed waiver to ensure that these folks get coverage. 

Under existing law, I have the authority to seek this waiver without the General Assembly.

DMAS will post an overview of this program on their website starting the thirty day public comment period required for this 1115 waiver. 

In addition, DMAS will be hosting public hearings on September 16 and 17 to get stakeholder input to move forward on this much needed access. 

Step 2: We will improve the coordination of care for adults and children who are already covered by Medicaid and have a serious mental illness.

Today I am authorizing the Department of Medical Assistance Services to issue regulations to establish health homes for individuals with severe mental illness. These health homes are not physical spaces, but instead, are a model of care in which all of an individual’s primary, acute, behavioral, and long-term care services are coordinated and integrated.

We can use health homes to enhance the treatment of both mental and physical health conditions and significantly decrease the suffering experienced by those with mental illness. I believe the key is to connect people with the care they need rather than waiting for them to stumble upon those services on their own.

I am convinced that if we take an active role in the delivery of their care, we can empower more Virginians with severe mental illnesses to live healthy and productive lives.

By implementing this program with minimal investment, we can get a 90 percent match rate of federal money. This is a fiscally responsible step that will provide 13,000 of our neediest Virginians the quality care they need.  

Steps 3 & 4: We will sign up more Virginians for the Federal Marketplace, Medicaid, and FAMIS.  

As a country and a Commonwealth we decided years ago that children ought to have access to health care.

When children’s health issues are not addressed promptly, they fall behind in school and experience delays in all aspects of their lives as adults. 

My predecessors, Governor Kaine and Governor Warner worked hard to get thousands of low-income people enrolled in Medicaid and FAMIS so they could have access to basic care.

Unfortunately, in recent years those enrollment numbers have declined and Virginia is below the national average in enrollment. I am determined to reverse that trend.

Despite the new health care options available to Virginians on the federal marketplace, we have yet to take an active role in marketing that care to the people who qualify.

I am preparing an aggressive campaign to get the word out to people are eligible and help those adults and children actually get enrolled so they can get the care they need.

Just last Friday, my team and I learned that CMS has approved the use of $4.3 million in federal health care funds to communicate with Virginians about the opportunities they have to access coverage.

On August 15th we also applied for an additional $10 million that will further amplify our outreach efforts.

This outreach campaign will inform Virginians about coverage options that are already available through the federal marketplace, Medicaid and FAMIS.

I am optimistic that we can leverage these resources to help enroll an additional 35,000 children in FAMIS and 160,000 people in the marketplace.

Virginia has sat on the sidelines for too long when it comes to marketing the health care options that are available to our friends and neighbors. Now we are going to get in the game.

Step 5: We will open up FAMIS for eligible state workers to insure their children.

I am especially proud that as part of this larger effort I am also reaching out to the state employees, with whom I have the honor of working every day.

While there is a lot of debate on how to move forward with expansion, I think we can all agree that expanding access to Virginia’s children is the right thing to do. 

And that is why I am directing DMAS to issue an emergency regulation making FAMIS available to the children of lower-income state workers.

By opening up FAMIS, we can provide 5,000 children access to affordable, high-quality, and comprehensive health care. This is also a smart business practice as well since it will shift some of the costs of care from our state budget to the federal government.

Step 6: We will provide dental benefits to pregnant women in Medicaid and FAMIS

During my visit to the RAM clinic in Wise County this summer, I saw for myself the importance of oral health. More than 70 percent of the people there that weekend needed dental care.

This issue is far too serious to ignore. And that is why I am directing DMAS to issue emergency regulations to provide comprehensive dental coverage to 45,000 pregnant women in Medicaid and FAMIS.

When a woman becomes pregnant, having access to good dental services is imperative for a healthy delivery and baby. Adding dental coverage for pregnant women enrolled in Medicaid or FAMIS MOMS will reduce the prevalence of preterm birth, cut-down on emergency dental expenditures, and decrease the state’s cost of dental care for children. 

Step 7: We will launch an innovative new website to inform Virginians of their coverage options and help them enroll.

To make it easier to apply for coverage, you will see a new and improved Cover Virginia website by this November. We will ensure that the Cover Virginia website is more user-friendly, has all the information our citizens need, and makes it as easy as humanly possible to apply for coverage through our existing programs.

Step 8: We commit to accelerating access to quality health care for our veterans.

A recent report showed Virginia ranked LAST in the nation in the number of VA hospitals and clinics available, per capita, to meet the needs of our rapidly growing veteran population.

This means many of Virginia's veterans have to drive too far and wait too long to get access to the health care our nation owes them.

We have to change this situation in Virginia and we will.

That's why I've directed my team to conduct a full court press to change the dynamic of veteran access to health care in the Commonwealth.

Working with their counterparts in the Veterans Health Administration, Secretaries Hazel and Harvey will lead Virginia's efforts to take full advantage of the recent legislation signed by President Obama that made $10 billion in federal money available to veterans to seek health care outside the VA system if they have barriers to access. And I do not need anyone’s approval to bring this federal money to Virginia.

Too many of those barriers currently exist in Virginia and we're going to knock them down.

And let me be clear, I will NEVER leave federal money on the table when it can be used to help Virginians – especially Virginia’s veterans. 

We will do everything within OUR power to make sure our veterans are getting the care they need, including aggressively pursuing EVERY federal dollar available.

Step 9: We must act to reduce deaths from prescription drug and heroin abuse.

In order to ensure that Virginia continues to thrive, we must act quickly to address a growing health threat in the Commonwealth--prescription drug and heroin abuse.

Last year, more Virginians died of overdose than were killed in car accidents. The prescription drug problem has reached a crisis in Virginia, where some county death rates are the highest in the entire nation.

Under my plan, I will act to significantly reduce the number of drug-related deaths in Virginia.

In order to achieve our goals, I will create the Task Force to Combat Prescription Drug and Heroin Abuse.

Nothing is more tragic than a senseless drug-related death.  I want solutions. And that is why I will sign an Executive Order creating this Task Force, and I will instruct them to take bold and immediate steps to eliminate the scourge of drug and heroin abuse in our communities. 

Step 10: We will aggressively pursue Federal grants that can bring new dollars into Virginia for health care.

In order to cover as many people as possible, I have directed my staff to pursue every federal grant currently available for health care and innovation.

Make no mistake – Virginia will take advantage of these federal resources, which will help transform our health care system and lower costs for all Virginians. I have talked personally to the Secretary of Health and Human Services – Sylvia Burwell - about the needs of Virginia and will fight for every dollar possible to help our citizens.

Virginia, in partnership with the Virginia Center for Health Innovation, has applied for $2.6 million in federal funding through the CMS State Innovation Model grant program. 

If approved, this funding will help us realize a broad vision for statewide health care reform that improves the health of all Virginians.

We need to transform our entire health care delivery system to provide better care at lower costs. 

If we don’t work together to reform the system and address health care costs, we cannot build a new Virginia economy.

As governor, there is no greater responsibility than ensuring the health and safety of the citizens you serve. I take that responsibility very seriously.

That is why I am so proud to stand here today and unveil “A Healthy Virginia” – a plan that will improve the lives of more than 200,000 citizens throughout the Commonwealth.

I’d like to thank Dr. Hazel, Suzanne Gore, Dr. Jennifer Lee, Cindi Jones, Christina Nuckols and their team for their hard work, dedication, and commitment to making the Commonwealth a healthier place to live and work.

These are the steps that I can take today using the authority Virginians gave me when they elected me Governor. This bold plan is a credit to the hard work and creativity of Dr. Hazel and his team and it will make life better for hundreds of thousands of Virginians.

However, we can and must do more. These steps are just the beginning. We must continue to press forward together to achieve better health for all of our citizens.

The stakes could not be higher.

Just last week, Mary Washington Healthcare in Fredericksburg and Stafford announced that they were forced to cut 66 jobs and decrease the paychecks of hundreds of their employees.

These are jobs that could have been saved if members of the General Assembly had come together to close the coverage gap.

In these difficult budget times, we cannot afford to let hundreds of thousands of Virginians go without regular access to quality healthcare, and we cannot afford to let hospitals which are often the economic drivers of our communities lay off hard-working Virginians.

We don’t want to just survive and scrape by until the economy improves.  We know that unless we seize this moment and build a thriving new Virginia economy, our future will always be uncertain. 

I recently talked about the effects of sequestration and how those cuts have forced us to build a new Virginia economy. Let’s do the same for healthcare.

I want to be crystal clear that while the plan I am announcing today will do a lot of good for a lot of people, it does not solve the larger problem of providing health insurance coverage to uninsured Virginians.

The General Assembly has said unequivocally that only they have that power. 

But with that power comes responsibility. A responsibility to the Virginians who came to the barns and the tents that are the RAM clinic. They too deserve access to health insurance like members of the General Assembly receive.

The Republican leadership of the General Assembly has called a special session on September 18th to discuss this issue.

Now is the time to stop discussing and start acting.

Let’s prove the cynics wrong and show that politicians can indeed work together and do what’s best for people they serve.

Throughout the past several months, my office has been in almost daily contact with the Center for Medicare and Medicaid Services. They have expressed to me, Secretary Hazel and our entire staff their willingness to work with Virginia – and our leaders in the legislature – to fashion an expansion that meets the unique conditions in our state.

If the General Assembly is willing to come to the table, we can create a public-private partnership that will rely on private funding so that we do not have to risk any general fund dollars.

We could also adapt -- with the support of CMS, the legislature and our partners in the private sector -- creative solutions like those in Arkansas, Iowa, and Indiana.

Both options would allow Virginia to expand coverage and increase care.

As I have said before, my door is always open. I will host the leadership of the General Assembly at any time and any place.

Let’s sit down with CMS and hammer out a Virginia solution that will close the coverage gap.

Because when sick children don’t get health care they can’t excel in school; when parents and child-care providers aren't covered, it leaves families vulnerable to illness and loss of income; without healthy workers we cannot have productive businesses; without addressing health care costs, we will cripple small businesses and deter entrepreneurs.

 You cannot build a foundation for the future without addressing the basic health needs of ALL Virginians. 

As Thomas Jefferson said, “The care of human life and happiness, and not their destruction, is the first and only object of good government.”

How we care for our most vulnerable is not only a sign of good government, it is a reflection of our priorities and our values as a Commonwealth.

I am proud of the plan that I have described to you today, and that my team has already begun to implement.

This program will expand access to lifesaving care for more than 200,000 Virginians and bring millions of our hard-earned federal tax dollars back to the Commonwealth to serve our friends and neighbors.

But we cannot afford to stop here.

We must continue to work to close the coverage gap and show the world that Virginia is still a place where leaders can come together for the good of the families we serve. 

Together, we can build a healthier Virginia, but we must work together and we must start now.

Thank you.