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Virginia Expands Medicaid


A key part of the Affordable Care Act – or Obamacare – is an expansion of Medicaid. This joint state and federal program provides health care coverage for low- and lower-income Americans. Eight years after Obamacare’s passage, Virginia is moving to take advantage of this Medicaid expansion. Critics worry that this move may prove to be a burden on the commonwealth’s taxpayers.


Governor Ralph Northam came into office this year supporting the expansion of Medicaid under the Affordable Care Act. This would mean allowing access to the program for childless adults who live in households earning up to 139% of the federal poverty level. Virginians in this population currently do not have access to Medicaid at any income level.


In February, the state House of Delegates passed a budget bill that contained Medicaid expansion. Other bills during the regular budget session on this issue did not advance, although there was some support for an expansion bill that also contained a work requirement for Medicaid enrollees.


During a special budget session called by Governor Northam, state senators supported a bill that would allow the Medicaid expansion with work requirements. The requirement that some Medicaid recipients seek or obtain jobs was vital to obtaining enough Republican votes for passage. A work requirement must get approval by the federal government. The Trump Administration has allowed states to do this, while the Obama Administration turned down similar state requests.


Proponents of the Medicaid expansion say that it is needed to provide low-income Virginians with access to health care. They contend that with the federal government picking up 90% of the cost, Virginia is turning away significant federal dollars that will help the state’s economy. Opponents counter that the federal government may cover 90% of the cost now, but that this could change in the future. If that happens, they point out, Virginia will be facing a significant budgetary burden.


Do you think that Virginia lawmakers were wise to expand Medicaid?


Congress Gives Terminal Patients Wider Access to Drugs


For some people who are dying, the ability to try any treatment option – even if it hasn’t been approved as effective by the FDA – provides hope for their future. Under new legislation passed by Congress, these patients may find it a little easier to access drugs that are experimental but promising.


Under this “right to try” legislation, the Food and Drug Administration would no longer have the authority to stop certain patients from having access to experimental treatments. These patients must have a terminal illness with a prognosis to die within months, have no other treatment options, and not have access to other clinical trials.


People who meet that criteria can work with their doctors to devise a treatment plan that includes drugs that have been proven safe by the FDA, but have not been proven effective. Drug companies would have to agree to provide the drugs, and the patients would bear the cost of those drugs.


The FDA had a program in place where terminal patients could request experimental drugs, but the agency retained the ability to approve or deny these requests.


Supporters of this legislation say that someone facing death should be able to try any drug that may be useful. They contend that the federal government should not be a gatekeeper between patients and potentially life-saving treatments. Opponents of the bill say that it short-circuits necessary safeguards. They also claim that very few people will be eligible for the program, and that those who are will face very high costs for drugs.


The Senate approved this legislation by unanimous consent on August 3, 2017, and the House of Representatives approved it by a vote of 250-169 on May 22. 


Do you support terminally ill patients having access to experimental medication? Or should the Food and Drug Administration still be able to oversee the process of providing experimental drugs to patients who are dying?


Northam Inaugural Features Promises on Obamacare, Abortion, and Gun Control


On Saturday, January 13, Ralph Northam took office as Governor of the Commonwealth of Virginia. He did not waste any time in discussing hot-button issues. His inaugural address touched on three issues that will be hotly contested during this year’s session of the Virginia General Assembly – Obamacare expansion, access to abortion, and gun control.


Here is what he had to say on these topics when he addressed the inauguration crowd:


  • Obamacare: “It is past time for us to step forward together and expand Medicaid to nearly 400,000 Virginians who need access to care.”


  • Abortion: “We should also resolve together today to refrain from any effort to curtail a woman’s constitutional right to make her own decisions about her health.”


  • Gun Control: “If we are going to build a healthier Virginia for everyone, we must address the public health crisis of gun violence. Gunshots kill more people in Virginia every year than car accidents, but if you walk into the right gun show, it’s easier to get a firearm than it is to rent a car. I am ready to work with you to make Virginia safer by passing smart reforms that keep guns away from people who shouldn’t have them.


Governor Northam’s stances on these issues put him at odds with the General Assembly. While the 2017 elections narrowed their majority in both chambers, Republicans still control the legislature. As their track record under Governor McAuliffe shows, they are not hesitant to pass conservative legislation in spite of gubernatorial veto threats.


With an increased number of Democrats in the legislature than during Gov. McAuliffe’s term, Gov. Northam will have more allies in his legislative fights. Even so, it is difficult to see how the governor will convince legislators to expand Medicaid, refrain from passing abortion restrictions, or enact gun control measures.


Do you think that Virginia legislators should work with Governor Northam to expand Medicaid eligibility, preserve access to abortion, and place more limits on gun ownership?


Tax Plan May Axe Individual Mandate


If Senate Republicans get their way, Americans may not only see their taxes cut, but they may also be free from the federal mandate to buy health insurance. Depending on your views about the Affordable Care Act, or Obamacare, this is either a win-win situation or a sneaky move to end health care for millions of Americans.


Republicans on the Senate Finance Committee have been busy writing their version of a tax bill for consideration by the full Senate. Among traditional tax reforms such as cutting rates, they also included a provision to end the Obamacare mandate that punishes taxpayers who do not have health insurance.


This “individual mandate” is designed as a tax administered by the Internal Revenue Service. In a 2012 case, the Supreme Court upheld this provision of the law on the grounds that it was not a true mandate to purchase a product, but a tax on those who did not purchase it.


Ending the individual mandate will not only kill a vital part of Obamacare, a key Republican legislative priority, it will also ease the path for deeper tax cuts. Due to budget rules, this tax legislation can only add $1.5 trillion to the deficit over the next ten years. An individual mandate repeal would produce an estimated $338 billion in new federal revenue over the next decade. That new revenue could be offset with more tax cuts.


The Congressional Budget Office estimates that this new revenue will be available because fewer people will purchase health insurance, thus saving the federal government money that it would otherwise spend on subsidies. This has Democrats upset. Senator Al Franken (D-MN) tweeted, “Senate GOP just added provision to their tax plan that would gut ACA & kick 13M ppl off insurance. Yes, it's same tax plan that would add $1 trillion+ to deficit while giving majority of benefits to corporations & the rich.”


Tax reform must pass both chambers of Congress and be signed into law by the president. The tax reform bill proposed by Republicans in the House of Representatives does not include a repeal of the individual mandate. President Trump has expressed support for including the repeal as part of the tax package.


Do you think that the tax reform bill should also repeal the individual health insurance mandate? Or are Republicans hurting Americans’ health care with the mandate’s repeal?


Republicans Renew Push to Repeal Obamacare


Senate Republicans tried to repeal the Affordable Care Act, or Obamacare, in July, but failed to gain 50 votes. Now they are making one last effort to undo President Obama’s signature health care law. It is unclear if they will have more success this time than they did previously.


Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) have sponsored the bill being considered now. This legislation differs in some key ways from the earlier repeal bill, but it would still have the effect of rolling back much of Obamacare.


Among its provisions, the Graham-Cassidy legislation would:

  • Turn Medicaid into a per-person block grant program, giving states more authority to determine how the program is administered and who receives services
  • Take the funds currently being spent by the federal government on health insurance subsidies, premium tax-credits, and Medicaid expansion and give that money to states in the form of grants to provide health care coverage
  • Loosen restrictions on what types of insurance must be sold


Critics of the bill are concerned that it will lead to less coverage than exists today. They point out that the formula for Medicaid block grants excludes many able-bodied adults who are currently covered under Obamacare’s Medicaid expansion. They also contend that unless the federal government mandates what insurance policies must contain, companies will skimp on benefits to save money.


Proponents say that Medicaid block grants will give states incentives to tailor their program to meet their needs, instead of relying on a one-size-fits-all mandate from D.C. They also say that putting some limits on spending is the only way to control the ballooning cost of the program at both the state and federal level. In addition, loosening restrictions on insurance, according to them, helps to ensure that people can buy a policy that meets their needs, not a policy that pleases a federal bureaucrat.


For the Cassidy-Graham bill to proceed under special budget reconciliation rules that allow it to bypass a filibuster threat, the Senate most vote on it by September 30. Many observers are watching Senator John McCain (R-AZ), who voted against the last repeal bill. He has indicated he may support it if Arizona Governor Doug Ducey backs the bill, something Gov. Ducey did earlier this week. Senate Majority Leader Mitch McConnell (R-KY) said he would only bring the bill up for a vote if he has enough senators lined up to pass it.


Do you think this legislation is a good way to reform health care? Or do you want to see Obamacare left in place?


Time for the Government to Take Over Health Care?


Medicare for all. Single Payer. Government-run health care. Socialized medicine.


The concept may go by a few different names, but the idea is the same – the federal government providing health care to everyone, with private providers either being banned or strictly limited.


That is an idea that is growing in popularity among Democratic lawmakers. Senator Bernie Sanders is preparing legislation that would enact “Medicare for all.” He is expected to release it this week. Although he is not a Democrat, he does caucus with the party. Senator Kamala Harris, a Democrat from California, and Elizabeth Warren, a Democrat from Massachusetts, said they support this bill. Democratic Senators Corey Booker of New Jersey and Sheldon Whitehouse of Rhode Island are also expected to cosponsor it.


While Senator Sanders has yet to introduce his bill, there is legislation in the House of Representatives that would accomplish the same goal. Rep. John Conyers of Michigan has 117 cosponsors for HR 676. That bill would, among other things:

  • Establish the Medicare for All Program, which would provide all “medically necessary care” to U.S. residents at no cost to them
  • Ban private health insurance that duplicates the government-provided care
  • Dictate how doctors and health care providers would be paid by the government
  • Increase the income tax on the top 5% of earners, impose a new payroll tax and a tax unearned income, and institute a tax on stock and bond income


Proponents see this type of system as a fair way to provide health care to every American. Opponents contend that government-run health care will be expensive and lead to denials of service.


Regardless of its merits or defects, this type of health care plan is unlikely to be instituted in the U.S. any time soon. During the debate over Obamacare, there was little support for anything resembling single-payer. While there are more Democratic politicians embracing the idea now, a government-run health system is not being discussed in congressional debates over the replacement for Obamacare.


Do you support a single-payer system? Or do you think that such a system will be harmful for Americans who need health care services?


Ohio Drug Price Fight on November’s Ballot


In November, Ohio voters will decide how much the state government should pay for drugs. They will be faced with Issue 2, entitled the “Drug Price Standards Initiative,” which is generating significant controversy. Passage of this initiative could either be great news for state taxpayers, or a boondoggle that will drive up drug prices for other Ohioans. Or perhaps it will be unenforceable. Those are a few of the competing claims being made about this initiative.


Issue 2 would prohibit the state from paying higher prices for drugs than the federal Veterans Administration (VA) pays. This would include not only the state Medicaid program, but also programs such as the Ohio Best Rx Program and the Ohio HIV Drug Assistance Program. The VA pays prices for prescription drugs that are around 20% less than other agencies.


Supporters of this initiative say that it has obvious benefits – the state will save significant amounts of money on its prescription drug payments. They also talk about the initiative as a way to curb the greed of pharmaceutical companies. Senator Bernie Sanders (I-VT) as well as a variety of Democratic state politicians and a few AIDS associations are the main supporters of the initiative.


There are a wide variety of groups opposing Issue 2, ranging from the national drug company trade association to groups of doctors and nurses to the Columbus NAACP to veterans’ organizations. They contend that drug companies will be forced to raise prices on other consumers, such as seniors and veterans, to make up for the lower prices dictated by the state.


Some critics also point out that if voters approve the initiative, then the state will be forced to spend money to defend it. A section in the measure gives private organizations the right to intervene if such suits occur and to be given taxpayer funding if they do. That also raises opponents’ ire.


The Ohio initiative is similar to one considered by California voters in 2016. That proposal, Proposition 61, went down to defeat by a margin of 53% to 47%.


Do you think that Issue 2 is a good way to control drug prices? Or will this approach lead to problems for other Ohio prescription drug consumers?


Iowa Senate Bill 577


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Iowa Senate Bill 577, To Protect Health Professionals From Disciplinary Action Related to Lyme Disease: Passed 93 to 0 in the state House on March 14, 2017.


To protect health care professionals from state disciplinary action based on complaints stemming solely from the diagnosis and treatment of Lyme disease


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Florida Senate Bill 1124


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Florida Senate Bill 1124, Revise Testing for Newborn Screening: Passed 117 to 0 in the state Senate on April 28, 2017.


To require the Florida Department of Health (DOH) to adopt rules stating that every newborn in Florida be tested for any condition included in the federal Recommended Uniform Screening Panel. These recommended conditions will be added to the Florida Newborn Screening Program’s existing panel of disorders. DOH must adopt rules to include any recommended condition within 18 months, as long as an FDA or state approved test is available.


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Needle Exchanges Spreading to More States


Across the country, intravenous drug users are exchanging their used needles for clean ones. Needle exchange programs are illegal in some states, but there has recently been a trend towards removing barriers to their operation.

This year Tennessee and New Hampshire passed legislation that allows needle exchange programs. Last year North Carolina did the same. Other states either considered similar bills during their legislative sessions this year or are currently doing so.


These programs are being operated under a “harm reduction” model. That is, they recognize that people are going to use needles to inject drugs, but this does not mean that steps cannot be taken to reduce the harm intravenous drug use. Sharing dirty needles can spread diseases. The logic behind exchange programs is that if users have clean needles there will be a reduction in the spread of diseases such as HIV or hepatitis.


Opponents of these programs say that they facilitate drug use by giving addicts the tools they need to use an illegal substance. Many states still outlaw the possession of hypodermic needles without a prescription.


State that allow needle exchanges have differing laws on the subject. North Carolina, for instance, allows such exchanges but prohibits taxpayer money from funding them. Other states allow such programs only for private organizations.


Do you support needle exchange programs to stop the spread of infectious diseases? Or do you oppose the government taking steps to make it easier for addicts to shoot up?


Senate Fails to Repeal Obamacare


After considerable debate and intense media attention, efforts in the Senate to repeal the Affordable Care Act, or Obamacare, failed last week. This represents a huge blow to President Trump’s agenda, a pillar of which was to kill Obamacare. It is also a defeat for Republican Senator Mitch McConnell, the majority leader who could not marshal enough votes to pass a repeal bill.


Here are some of the votes taken during Senate debate on Obamacare:


U.S. House Bill 1628, Consider legislation to repeal and replace parts of Obamacare: Passed 50 to 50 To proceed with consideration of legislation that would repeal and modify portions of the Affordable Care Act. This motion passed because Vice President Pence cast a tie-breaking vote in favor of it.


U.S. House Bill 1628, Donnelly amendment to send Obamacare repeal to committee: Failed 48 to 52 To end consideration of legislation to repeal and replace the Affordable Care Act, and instead allow the bill to be considered in a Senate committee.


U.S. House Bill 1628, Heller amendment to repeal the tax on expensive health insurance: Passed 52 to 48

To repeal the 40% tax on some employer-sponsored health insurance plans that offer benefits exceeding a certain amount. This tax is also known as the “Cadillac tax.”


U.S. House Bill 1628, Amendment to express support for Medicaid expansion: Failed 10 to 90

To express the sense of the Senate that expanding Medicaid is important and that the Affordable Care Act, or Obamacare, should be improved.


U.S. House Bill 1628, Daines amendment to mandate government-run health insurance: Failed 0 to 57

To expand the Medicare program to cover all Americans, or alternatively to create a “single payer” health insurance system. This would be paid for by increasing income taxes, imposing a new payroll tax, and creating a tax on stock and bond transactions. The amendment would prohibit private health insurance that competes with government insurance. Forty-three Senate Democrats voted “present” instead of “yes” or “no” on this amendment.


U.S. House Bill 1628, Paul amendment to repeal most of Obamacare: Failed 45 to 55

To repeal major parts of the Affordable Care Act, including the expansion of Medicaid and the mandate on individuals to buy health insurance. This amendment would also end the health insurance exchanges and repeal taxes imposed to fund the ACA. It would take effect in two years.


U.S. House Bill 1628, Partially repeal and replace Obamacare: Passed 43 to 57

To repeal portions of the Affordable Care Act. This amendment would end the Medicaid expansion, increase Medicaid spending by $100 billion, and restructure Medicaid so that states are given a capped amount of federal dollars per recipient. It would also reduce subsidies for health insurance purchases, allow health insurance to be sold without as many government mandates, and end the mandates requiring individuals to purchase health insurance and employers to provide health insurance.


U.S. House Bill 1628, Amendment to repeal parts of Obamacare but leave Medicaid portion: Failed 49 to 51

To repeal portions of the Affordable Care Act, including the mandates that individuals purchase health insurance and employers provide health insurance, as well as the tax on manufacturing medical devices. The amendment would also end Medicaid payments to Planned Parenthood for one year. This amendment would leave in place the ACA's Medicaid expansion, subsidies for the purchase of health insurance, and mandates on what types of health insurance can be sold. This amendment was known as “skinny repeal” of Obamacare.



Are you glad that the Senate failed to uproot the Affordable Care Act? Or do you think that keeping Obamacare in place is the wrong move?


Wisconsin Assembly Bill 306


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Assembly Bill 306, Require State Approval for Pseudoephedrine Purchases: Passed 96 to 1 in the state Assembly on June 21, 2017. 


To establish an electronic system that would track the sale of pseudoephedrine and deny the sale to those who are in violation of state limits. Sellers of pseudoephedrine must record the identification, identification number, and the date and time of the sale in electronic format, then submit it to a state system that would monitor if the purchaser is in violation of limits on the sale of pseudoephedrine.


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Ohio House Bill 111


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House Bill 111, Allow Nurses to Involuntarily Commit Patients for Mental Health Assessment: Passed 96 to 0 in the state House on March 30, 2017.


To allow certain clinical nurse specialists and certified nurse practitioners to have a person involuntarily committed for a mental health examination.


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Wisconsin House Bill 356


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House Bill 365, Mandate Insurance Coverage of Pre-Existing Conditions: Passed 62 to 35 in the state House on June 22, 2017.


To mandate that health insurance policies regulated by the state cannot exclude coverage for pre-existing conditions if there has been no gap in someone’s insurance coverage.


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Wisconsin Assembly Bill 10


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Assembly Bill 10, Consider Obamacare legislation: Failed 35 to 62 in the state Assembly on June 22, 2017


To require the Committee on Assembly Organization to consider state legislation that would codify the health insurance regulations contained in the Affordable Care Act, or Obamacare.


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West Virginia Senate Bill 176


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Senate Bill 176, Withdraw mandates for screening of certain diseases: Passed 33 to 0 in the state Senate on February 15, 2017


To repeal state laws mandating detection of tuberculosis, high blood pressure and diabetes.


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Senate Unveils its Answer to Obamacare


After weeks of bill drafting behind closed doors, Republicans in the Senate have released their proposal to partially repeal and replace the Affordable Care Act, or Obamacare.

The bill departs from Obamacare in some key ways:


  • No government mandate to purchase health insurance.
  • No government mandate on employers to provide health insurance.
  • It would create a $112 billion fund to reimburse insurance companies who suffer losses.
  • Medicaid would be turned into a per capita block grant.
  • Funding would be frozen for Planned Parenthood.


However, the bill also keeps some key aspects of Obamacare in place:


  • It retains the mandate that insurance companies allow children to remain on their parent’s insurance until age 26.
  • It retains the mandates on insurance companies that they may not deny insurance to someone due to pre-existing conditions.
  • It also continues the mandate that insurance companies cover certain conditions, although states could alter what is defined as an “essential health benefit.”


No Democrats have signaled that they would support this legislation. In fact, there are some questions on whether there are enough Republican votes for this bill to pass the Senate.


Do you think this health care legislation is an improvement over Obamacare? Or do you think senators should oppose these changes?


Iowa Senate Bill 506


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Senate Bill 506, To allow "medical marijuana": Passed 45 to 5 in the state Senate on April 17, 2017


The bill allows for a limited number of companies to produce and sell marijuana for medical purposes called out in law, including the treatment of cancer, multiple sclerosis, and Lou Gehrig's disease (ALS). It expands on a law, which will expire in July, which allows the use of some marijuana purposes for the treatment of epilepsy if diagnosed by a neurologist. This bill would not allow marijuana in its smoked form.


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West Virginia Senate Bill 170: Repeal the obsolete state hemophilia program


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Senate Bill 170, Repeal the obsolete state hemophilia program: Passed 33 to 0 in the state Senate on February 15, 2017


To remove obsolete sections of state law relating to non-functioning medical programs.


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Colorado Senate Bill 300: Order study of health insurance options for high-risk individuals to be conducted by health insurance commissioner


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Senate Bill 300, Order study of health insurance options for high-risk individuals to be conducted by health insurance commissioner: Passed 35 to 0 in the state Senate on May 10, 2017 and 40 to 25 in the state House on May 10, 2017


To direct the commissioner of insurance to study options for providing health insurance to people who pose high risks for insurers. The bill would require the study to examine ramifications for providing that insurance, including impact on business and consumers, federal rules, options for funding, financial sustainability, and other considerations.  The bill would require the study be produced for the joint budget committee and other committees before October 1, 2017.


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