by James C. Sherlock
Virginia’s hospitals and health systems have for decades gotten everything they have sought from the state government, both the constitutional officers and the General Assembly. Readers of this space have been provided the details of some of their successes that are counter to the public good. But what is the source of all that political power?
Money. Political contributions matter. These data are all from vpap.org.
- In the 2018-19 campaign cycle, hospitals and health systems gave $2,368,406 in donations to candidates for the General Assembly.
- In the 2017 election cycle, they gave $392,187 to Governor Northam, $117,500 of it after his victory. And he is term limited.
- Attorney General Herring received from the hospitals and health systems $52,000 for his first campaign, $62,725 for his second and $23,000 since then. He is charged with enforcing the antitrust laws against those donors. He has not enforced them.
- Even those who think it fair for hospitals and health systems to help elect these officials can’t be happy with the post-election donations.
I took the time to assess the key votes that supported the wishes of the hospitals in the General Assembly. I looked up the recorded votes on three bills:
- HB 608 Health Enterprise Zone Program and Fund – hospitals did not support
- HB 1094 Certificate of public need; exempts physician-owned ambulatory surgery centers – hospitals fiercely opposed.
- HB 879/SB764 Certificate of public need; revises the Medical Care Facilities Certificate of Public Need Program (makes more restrictive) – hospital lobbyists wrote it.
Click here to see the financial support provided by the hospitals and health systems to delegates and senators who voted their way. Note how many members who had no chance of losing their races took money from these special interests anyway. Note that Sen. Emmett Hanger, R-Mount Solon, Sen. Dick Saslaw, D-Springfield, Sen. Barbara Favola, D-Arlington, Del. Mark Sickles, D-Alexandria, Del. Kirk Cox, R-Colonial Heights, and Sen. Lynnwood Lewis, D-Accomack, let the Virginia Hospital and Healthcare Assiation (VHHA) pay some of their campaign expenses directly.
Hanger let VHHA give in-kind contributions for 20% of his total campaign expenses. He got 71% of the vote. This step in the 2019 race was nothing he had ever done before. I like Sen. Hanger personally and am surprised and disappointed.
Former House Speaker Cox got “Speaker” money from a lot of his donors. Senior leaders of both parties often control PACs from which they send money to tight races. New Speaker Eileen Filler-Corn received $50,614 from hospital and health system sources in 2018-19, $35,000 of which went to her PAC. That will likely double now that she is Speaker.
Community Influence. Money aside (and it seldom is), the most powerful political influence of Virginia’s hospitals and healthcare systems comes from their power in the economies of the General Assembly districts. Many are the largest or second largest non-government employers in their communities. They are powerful both in their own right and leveraging the influence of business communities through Chambers of Commerce. Politicians risk their displeasure at their peril. Some buck the hospitals, but it takes knowledge, conviction and not a small amount of political courage to do so.
Doctors, nurses and dentists give a lot of money to politicians, in total more than do the hospitals and health systems, but their influence is dispersed by the fact that they tend to give money personally or through their offices and are not often members of the Chambers of Commerce.
What to do? There are three things I can think of that will reduce the influence of the hospitals and health systems on public policy in healthcare and health insurance.
The first is what I have done in the linked spreadsheet. Illuminate the votes that ignore the best interests of the citizens in favor of hospital agendas and link them to the money. I will do this going forward before every General Assembly session. If the regional newspapers pick it up, there may be a political price to pay.
The second is to petition the General Assembly to write rules about who can sit on committees dealing with health care, health insurance and the appropriations committees. Set maximum limits of healthcare-related campaign donations in the previous campaign cycle above which a member may not be assigned to any committee which deals with healthcare issues.
The third is the most likely to make a permanent change by countering the hospital influence. I encourage doctors and nurses to better organize to influence votes with their donations and their combined community influence. I recommend that each group consider five regional associations aligned with the state health regions along the lines of the Medical Society of Northern Virginia. They can serve as active components of the statewide organizations to get close to the politicians in their communities and express to them regional concerns. I will expand on that idea in another column.
James C. Sherlock, a Virginia Beach resident, is a retired Navy Captain and a certified enterprise architect. As a private citizen, he has researched and written about the business of healthcare in Virginia.
