Gov. Bob McDonnell has delivered a long-awaited report on Virginia's response to federal health care reform, but he won't say whether he supports creating a state-run health insurance exchange or risk having a federal exchange imposed.
In a letter to General Assembly leaders, McDonnell repeats his opposition to the Patient Protection and Affordable Care Act and vows to fight "unfounded federal intrusion" on state prerogatives.
McDonnell does not recommend whether the legislature should act in its pending session to create an insurance exchange or, if so, how.
"The decisions ahead are not easy and I will neither compromise the financial integrity of Virginia nor leave us vulnerable to the overreaching federal government," he said in a letter dated Nov. 25 to House Speaker William J. Howell, R-Stafford, and Senate President Pro Tem Charles J. Colgan, D-Prince William.
McDonnell said the U.S. Department of Health and Human Services has failed to properly coordinate the law's implementation with the states, or say what the federal exchange would look like or what policies would govern it.
"Without the necessary guidance and rules that will govern a Virginia exchange and a federal model to review, it is extremely difficult to evaluate whether ceding control of an exchange to the federal government or creating our own is in the commonwealth's best interest," he states.
The letter accompanies a 52-page report produced by the Virginia Health Reform Initiative Advisory Council, chaired by Health and Human Resources Secretary William Hazel.
The council took the position that Virginia should create its own exchange, which would be financed initially by the federal government, rather than defaulting to a federally imposed exchange.
Under the law, a state exchange must be "on the way to being operational by January 2013 or the federal government will step in and implement (its own exchange) regardless of Virginia's policy preferences," the report states.
The most contentious issue in the report is where an exchange would be hosted. The council voted 11-3 in September to create a quasi-governmental entity, similar to the Virginia Housing Development Authority, but the state's largest insurer, Anthem, is lobbying to put the exchange in the State Corporation Commission.
The commerce and labor committees of the House of Delegates and Senate will meet jointly on Monday for a briefing on the state's options for responding to the law and discuss the council's findings.
McDonnell devotes most of his two-page letter to his opposition to the federal law on constitutional grounds and his concern that its implementation would impose costly "unfunded mandates" on Virginia and other states.
The U.S. Supreme Court ultimately will rule on a number of court decisions on the law.
The law would expand health coverage to an estimated 520,000 Virginians, primarily through expansion of the federal Medicaid program, but also to more than 100,000 people through private insurance that could be obtained either through an exchange or independently.
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