by James C. Sherlock
I have been attempting to improve healthcare access, affordability and competition, which improves both access and affordability, in Virginia for 15 years, especially for the benefit of the poor.
I have seen the Governor’s office and members of the Virginia General Assembly (especially Democrats on health care issues) continue to bow to the wishes of big healthcare industry contributors and repeatedly hurt the cause of improving healthcare for poor people.
Who are disproportionately black.
Today I am going to call out some of the worst offenders I have seen in action over those years, members of the Virginia Legislative Black Caucus.
Key Health Issues. The Virginia Legislative Black Caucus (VLBC) published a healthcare agenda for the 2020 session. It began:
VLBC believes in expanding access to affordable and quality healthcare, encouraging healthy communities, and supporting better health outcomes for all Virginians.
Yet I will show three opportunities for the VLBC to have acted on that agenda in 2020, all of which it has either opposed or stood silent on. If the VLBC had backed these changes, all would have passed into law.
Improve Access for the Poor to Primary Care. First, I wrote and successfully solicited to be introduced legislation, the Virginia Health Enterprise Zones Act, to implement in Virginia a highly successful Maryland law to improve primary care in areas with poor populations which have not attracted enough providers. In Virginia, the result of lack of access to primary care has caused poor people to fail to address medical conditions until the effects of those conditions drive them to emergency rooms.
The subsequent cost not only in suffering of patients but also in enormous financial costs to Medicaid under those circumstances is of course much higher than if primary care had dealt with the problems early.
The cost of execution of the bill was estimated to be well less than $5 million a year in state money since it featured incentives and voluntary participation of local governments and community organizations, not direct hiring by the state. This is the program that has been so wildly successful in Maryland.
Based on Maryland results, the savings to Virginia Medicaid would have been north of $100 million annually. So the bill promised to be a major net plus to the Virginia budget.
The bill was defeated by Democrats who voted at the bidding of hospital lobbyists to table the bill in VBLC member Chairman Luke Torian’s House Appropriations Committee.
The hospitals, unsurprisingly, like the added ER visits and hospital admissions that lack of primary care causes. And few in Richmond are not beholden to the hospitals. Their constituents be damned.
Audit the community benefit contributions of tax-exempt hospital corporations. Second, I have written and personally lobbied the Commonwealth for years to start to audit the 501c3 not-for-profit public charity hospital corporations for compliance with their requirements to serve as community hubs and, in return for the state and local tax relief, provide “community benefit.”.
There has been neither response nor action from the McAuliffe or Northam administrations. If some of these tax-exempt behemoths don’t earn their tax exemptions, they should lose them. Pretty simple concept in the tax world, but not in Richmond.
It’s exactly like you falsely claiming charitable deductions on your income tax. Exactly.But then you don’t make hundreds of millions in campaign donations.
At least one of these corporations earns its tax deductions and more.
Catholic charity Bon Secours is the shining example of providing community benefit in Virginia. That system has lost money every year for more than a decade in Hampton Roads yet not only still provides services there but this year bought three money-losing hospitals that serve the poor in the Southside communities of Petersburg, Emporia and Franklin.
At least one other does not.
The most infamous example is Sentara, but I have beat that horse without effect for more than a decade. Its scandalous profit margins in the Hampton Roads market courtesy of the state COPN process and its own business practices that leverage its state-granted monopoly there are accompanied by the worst figures for minority health in the Commonwealth in the Hampton Roads market Sentara owns and operates.
From a Virginian-Pilot story about Sentara’s EVMS scandal (it’s hard to keep track of Sentara scandals):
“Eastern Virginia lags behind the state and nation in infant mortality, cancer, heart disease and diabetes. Most of these poor rankings reflect disparities with minority and low-income populations.”
“For instance, the infant death rate in Virginia and the United States was 5.8 out of 1,000 live births in 2017. But in Norfolk, the rate of Black baby deaths was 18.2.”
“Regarding prostate cancer, the national death rate was 19.5 out of 100,000 lives in 2015. But in Portsmouth, Black men died at a rate of 66.5 out of 100,000 — nearly four times that of white men in the city.
Apparently, the Governor and the VLBC find nothing to see here.
Fix Shortage of State Inspectors for Healthcare Facilities. Third, there has been a critical shortage of state inspectors for hospitals, nursing homes and other healthcare facilities for many years. There has been no interest at all in that issue that I can ascertain by the Governor or the General Assembly, even though both the shortages and the deadly outcomes of those shortages in COVID deaths have been exhaustively reported in this space.
These same elected officials that complain about inequality in medical outcomes, have known for decades that of the critical shortage of state inspectors for healthcare facilities and have not moved to correct it.
When old people, most of them poor, died from COVID in Virginia’s under inspected, poorly inspected and greatly understaffed nursing homes, the long-standing record of state inspections shortfalls was not raised by anyone in government as a cause.
The per-bed fee in Virginia law for inspections that helps pay for those inspectors is $1.50 It hasn’t changed in 41 years and neither has the maximum facility payment cap on this fees. If Virginia’s Governors and General Assemblies had increased the fee and the associated fee cap per institution incrementally over the years there would be no inspector shortage.
They could fix the problem in the 2021 session by raising the per-bed fee and fee caps to whatever they need to be to fully fund the inspectors, but on past performance they won’t.
The unethical cynicism does not stop there.
In 2017, industry-written language was inserted into Virginia law specifically to prevent the VDH from optimizing its use of the limited number of inspectors available by effectively banning the efficient scheduling of inspections by region. The Governor and lawmakers can go to the linked 2017 changes and eliminate them. If they will.
The actual cause was that the hospital and nursing homes don’t like to be inspected. When clinical staff personnel shortages are exposed, they actually have to fix them and the costs of additional staff come from the bottom line.
And the bottom line of healthcare organizations is where a great deal of Virginia’s unlimited campaign cash comes from.
In my 15 years of watching it closely, the Virginia healthcare industry plays the tune and enough elected officials dance that nothing gets into law that the industry doesn’t like.
The Virginia Legislative Black Caucus and Advocates for the Poor are AWOL. It is considered a third rail to express a negative opinion on the Virginia Legislative Black Caucus (VLBC), the NAACP and the Southern Poverty Law Center and their ilk. Try to find one in the press. Anywhere. Ever.
But after watching the members of that Caucus and the anti-poverty community sit on their hands for years on healthcare issues like the ones above, I will offer one anyway.
First, VLBC members have considerable and indisputable power over healthcare legislation.
Even when the Republicans were in the majority, they advanced bills to deal with some of the problems, especially COPN and the regional monopolies, but the Republicans could not get 100% support in their caucus and the Democrats led by the VBLC were a stone wall to stop it.
Second, some members of the VBLC like many others in the General Assembly (and the Governor and Attorney General) appear utterly corrupted by healthcare industry campaign money.
As for current VLBC power over healthcare, Senator Louise Lucas, the President pro tempore of the Senate of Virginia and Chairwoman of the Senate Education and Health Committee, is a Democrat representing Portsmouth. Del. Luke Torian, (D-Prince William) mentioned above is House Appropriations Chairman and Del. Vivian Watts (D-Annandale) chairs the House Finance Committee.
Many other VLBC members have senior positions in the General Assembly. Several are running for Governor, Lieutenant Governor or Attorney General.
The responses from the VLBC and the anti-poverty community in the cases of both Bon Secours and Sentara have been utter silence. No plaudits for Bon Secours; no condemnation for Sentara. No demands for state audits of Sentara for purposes of assessing the effectiveness for the state and local governments of its tax exemptions.
At the urging of the lobbyists, VBLC stood by in silence while the 2020 bill for increased primary care for their constituents went down to defeat. Del. Jason Miyares’ (R-Va Beach) bill for Health Enterprise Zones died in VLBC member and Chairman Luke Torian’s House Appropriations Committee committee after being passed 21-1 in the House Health, Welfare and Institutions (HWI) Committee. HWI Chairman Mark Sickles (D-Fairfax) voted for it in his committee and against it the next morning in Torian’s committee.
If anyone thinks Chairman Torian could not have had the money for Health Enterprise Zones had he wanted it, I submit that you don’t understand the process.
Canterbury Rehabilitation (known as Lexington Court until new ownership this year), a skilled nursing facility in Richmond that was the center of the worst nursing home COVID death toll in the nation, treated mostly black patients.
It was critically short of staff and the state knew or should have know it. The responsibility for action was with the Office of Licensure and Inspection, itself critically short of staff. So what did the VLBC do about this in the summer session? Nothing.
Why? Because they didn’t inquire or because their enormous donor base in the healthcare community doesn’t like to be inspected, especially when inspections expose expensive clinical personnel shortfalls?
Conscience should come into play here, but doesn’t.
Senator Lucas, the senior member of the VLBC, represents Portsmouth. The Robert Wood Johnson Foundation in 2020 ranked 133 Virginia jurisdictions in health outcomes and health factors. Out of 133, Portsmouth was ranked 114th in health outcomes and 117th in health factors. Her district is the epicenter of the Eastern Virginia black health issues cited above.
Sen. Lucas’ top donors by occupation by far were healthcare interests who have given her nearly $275,000. Her constituents, not so much.
In my time watching the bills and the votes in the General Assembly, I have never seen Sen. Lucas support her constituents in opposition to the will of the healthcare industry. Not once.
As for the poverty lobby, the Southern Poverty Law Center does not list health care as one of its issues. LGBTQ rights, on the other hand, made the cut.
The NAACP has health on its agenda, but I am unable to find any record of them taking a position in Virginia on any of the major issues I have recounted above.
The Virginia NAACP website reveals that their priorities for the special session last summer included:
“The connection between systemic racism and implicit bias to poor health outcomes, low quality of life and limited economic prosperity is clear. … First, we must admit there is a problem and declare racism as a public health issue.’
Good to know.
Words apparently need to suffice, because there has been no action.
