My Alternative to Medicaid Expansion

  I URGENTLY NEED YOUR HELP!!  My HB 39, to provide an alternative to Medicaid expansion by providing free health care to the indigent through volunteer doctors is set to be killed in Committee tomorrow.  There are big money interests that want Medicaid expanded, and my bill would get in their way!

PLEASE CONTACT MEMBERS OF THE COURTS OF JUSTICE CIVIL LAWS SUBCOMMITTEE IMMEDIATELY AND ASK THEM TO SUPPORT HB 39!

When I received notice that HB 39 would be heard tomorrow, Delegate Landes and I asked for a short postponement as a courtesy to the doctors who need to rearrange their schedules in order to testify on behalf of my bill.  I was told by Subcommittee Chair Delegate Habeeb that I could reschedule.  Within an hour Del. Habeeb told me the bill would be heard tomorrow!

My bill is being opposed by the Trial Attorneys.  Under HB 39, if doctors donate four hours weekly of free care to the indigent in exchange for their service, the Attorney General’s office would defend them against lawsuits in their private and charity practices.  This would lessen the need for malpractice insurance.

Few doctors serve Medicaid recipients currently because of the high costs.  Adding 425,000 new Medicaid recipients to the present one million will further burden the system.

During the Governor’s race, Terry McAuliffe twice said he would not vote for a Budget unless Medicaid expansion was included.  My HB 39 is a true compromise in that the poor would get medical care, and the taxpayers would not have to suffer through more tax increases because of Medicaid expansion.

Remember, Republican leaders imposed the last three tax hikes on Virginians, including the 2013 road tax hike.  We cannot count on their “Alamo-like” resistance to Medicaid expansion unless the people make their voices heard.  My HB 39 would forestall the need to expand Medicaid, and that is why it is feared.

HB 39 will not cost a dime of tax money and will avoid Medicaid fraud because Medicaid would not be used.  No insurance billing bureaucracy would be needed to administer the program.  Doctors would keep regular patient medical records.

Thirty years ago filing insurance paperwork cost doctors 15-30% of their revenue.  Today it’s 60%+ with more to be needed for Obamacare paperwork. (Business Insider, 5/29/13). Virginia already self-insures 3,400 physicians for care they provide in free clinics with no law suits pending.

McAuliffe claims the Feds will cover 100% of Medicaid costs for three years and 90% thereafter.  Recall Obama and Mark Warner’s prior failed promises: “You can keep your own insurance,” and “you can keep your own doctor.”

The U.S. Centers for Disease Control found in their 2011 National Medical Care Survey that 31% of doctors would not take new Medicaid patients.  The 2012 Jackson Healthcare Physician Practice Trends Survey found that 36% of U.S. doctors will not take new Medicaid patients. A NEJM study (6/16/11) of Cook County, Illinois doctors found that “Overall, 66% of Medicaid-CHIP callers…were denied an appointment as compared with 11% of privately insured callers…” after women posing as mothers of pediatric patients with common health conditions made calls to identical clinic staff for appointments 30 days apart using the same script but identifying Medicaid or private insurance as payment.

So, a Medicaid card will not guarantee medical care for the poor.

Terry McAuliffe claims that “if we don’t accept money it will simply flow to other states.”  This is not true.  Virginia’s “share” of Medicaid expansion money (our federal taxes) is based on a formula.  For 2016, Congress allocated $372 Billion for Medicaid for all 50 states, with $1.5 billion for Virginia.  If every other state rejected expansion, Virginia would not get the entire $372 Billion.

McAuliffe has reappointed Governor McDonnell’s Secretary of Health, Dr. Bill Hazel, who has been working to expand Medicaid since passage of Obamacare in 2009.  McAuliffe said, “'I am confident that Secretary Hazel will be the best steward to help me carry my agenda forward and meet the challenges we face when it comes to health care in this commonwealth.”

The Obama Administration has cut from $500 million to $1 billion in reimbursements to VCU and UVA for hospital care for indigents.  The news of the VCU/UVA funding shortfall came from Health Secretary Hazel on the same day Terry McAuliffe announced he wanted Hazel to stay on as Health Secretary.  Terry McAuliffe would not be seeking to re-appoint Sec. Hazel if he were not also fighting for Medicaid expansion!

Medicaid expansion may not significantly improve health. In 2008, Oregon expanded Medicaid for low-income adults.  Two years later, The New England Journal of Medicine (NEJM) reported (5/2/13) “…Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services…”   Those words come from the authors of the article, not me.

Science magazine [1/2/14] further analyzed Medicaid usage of patients enrolled in the 2008 Oregon Medicaid expansion.  The author’s summary reported on 25,000 Medicaid lottery participants over an 18 month period.  “We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings. ...  A back-of-the-envelope calculation, using $435 as the average cost of an emergency room visit suggests that Medicaid increases annual spending in the emergency department by about $120 per covered individual.”

In other words, because it is harder and harder for patients to receive primary medical care in private doctor’s offices, Medicaid eligible patients are going to hospital ER’s for primary care at a rate 40% higher than non-Medicaid patients.

Because doctors fear lawsuits, many doctors practice “defensive” medicine which consists of ordering medical tests and treatments which shield a doctor from liability, but which may offer little or no benefit to the patient. This drives up general health care costs as well as tax-funded Medicaid and Medicare programs.

An AMA published survey, answered by 65% of 824 Pennsylvania doctors (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) found:  “... 93% reported practicing defensive medicine. ... such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%).  Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. ... Defensive practice correlated strongly with ... perceived burden of insurance premiums.”  JAMA. 2005 Jun 1;293(21):2609-17.

As more and more Doctors consider leaving the medical profession over Obamacare requirements, HB 39 can remove the burden of insurance claims for care provided by charity doctors, a significant factor increasing health care costs across the board. Relieved of that burden, doctors will be able to exercise their best clinical judgment, and not order tests to avoid litigation.  Doctors under HB 39 will have no incentive to encourage behavior that produces repeat pathologies, where voluntary behavior and not genetic history, social condition or accidents, is the major causative factor in illness or subpar health.

Doctors serving the poor through charity care will not waste time with Medicaid. Physicians who treat the poor without charge will have their reputations enhanced, and attract more paying patients. Non-profit groups or churches will be better able to direct only the truly needy to their affiliated clinic doctors resulting in true patient-centered care by physicians delivered in the local community.

The drawback for some politicians may be the absence of political payback votes.  In other words, instead of converting citizens into government dependents, the indigent will remain free men and women not beholden to anyone or expected to vote for a particular political benefactor.

HB 39 has the potential to take us back to a medical care delivery model that preceded Lyndon Johnson's so-called Great Society which bureaucratized Charity by creating government programs and agencies with employees who relied upon the indigent remaining so in order to keep their jobs. Thank you for your support!

P.S. Without your urgent calls, emails and contacts to the above committee members, we will certianly not be able to cut costs and serve those who are most vulnerable among us.

Medicaid Expansion is coming in Virginia....

Dear Friends, I have introduced three bills to address the growing disaster of Obamacare, as regards Medicaid expansion, Obamacare insurance salesmen sign-up organizers called Navigators, and keeping your previous insurance plan.  This alert discusses HB 39, to provide healthcare to the indigent without expanding Medicaid.

Medicaid Expansion Will Be Pushed in Virginia Democrat Governor-elect Terry McAuliffe wants to add 425,000 recipients to the already 1,000,000 recipients on Medicaid arguing that 30,000 jobs will be added to Virginia’s economy.  Medicine should be about improving health.

Some businessmen and “moderate” Republican State Senators want to expand Medicaid because they want the promised 100% of federal funding (first three years) and jobs (political patronage?).  Federal funding is not free money.  It comes from “We the Taxpayers” whose tax burden continues to escalate.  They also believe Virginia can exit out of Medicaid expansion if the feds do not pay the 100%.  They fail to cite any legal authority in the Obamacare law or published regulations for support to back out after expansion.< During the Governor’s race, Terry McAuliffe twice said he would not vote for a Budget unless Medicaid expansion was included.   It is unclear if the Republican Speaker of the House would risk what will be painted in the media as “stingy Republicans” shutting down Virginia’s government over Medicaid expansion, despite such a shutdown being Democrat Governor McAuliffe’s decision.

Recall it was Republican leaders who lead the efforts to impose the last three tax hikes on Virginians, including the 2013 road tax hike.  Add to that the incessant media drumbeat about Republicans refusing 30,000 jobs and rejecting health care for the poor, and I don’t think we can count on “Alamo-like” resistance to Medicaid expansion from Republican leaders in the House of Delegates and State Senate, unless the people make their voices heard.  That is why it is very important to pass my HB 39.

Alternative to Medicaid Expansion HB 39 will not cost a dime of tax money and will avoid Medicaid fraud because Medicaid is not used.  My measure would simply empower the Attorney General’s office to defend doctors who live in Virginia in any malpractice claims in their private practice as well as their charity care as long as they donate four hours a week of free primary care to Medicaid-eligible residents through a non-profit.

Non-profits, including churches, could enlist doctors to provide care to the indigent, either in the doctor’s office or free clinic.  Hospitals could set up similar primary care centers. No billing bureaucracy would be needed to administer the program.  Doctors would simply keep regular patient medical records.

Thirty years ago filing paperwork for insurance cost doctors 15-30% of their revenue.  Today doctors can pay 60%+.  Even more will be needed for Obamacare paperwork. (Business Insider, 5/29/13). Virginia already self-insures 3,400 physicians for care they provide in free clinics with no law suits pending.

Problems with Expanding Medicaid McAuliffe claims the Feds will cover 100% of Medicaid costs for three years and 90% thereafter.   But recall Obama and Mark Warner’s prior failed promises: “You can keep your own insurance,” and “you can keep your own doctor.”

To be viable, the Affordable Care Act (ACA) needs young people to sign up in rock concert droves.  They’re not.  Harvard’s Institute of Politics polled 2,089 young uninsured adults (18-29) in early November 2013 and found only 13% will definitely enroll and 16% will probably enroll.

Obamacare claims to be built on “savings” from other programs.  But the Congressional Budget Office told Speaker Nancy Pelosi (3/20/10) that savings “might be difficult to sustain.”  And Medicaid’s Actuary said the projected savings “may be unrealistic.” (4/22/10)

If Medicaid is expanded, Governor McAuliffe will need to find doctors to cover an additional 425,000 Medicaid patients when few doctors accept Medicaid currently.

Medicaid Eligibility and Access to Care The U.S. Centers for Disease Control found in their 2011 National Medical Care Survey that 31% of doctors would not take new Medicaid patients.  The 2012 Jackson Healthcare Physician Practice Trends Survey found that 36% of U.S. doctors will not take new Medicaid patients. A NEJM study (6/16/11) of Cook County, Illinois doctors found that “Overall, 66% of Medicaid-CHIP callers…were denied an appointment as compared with 11% of privately insured callers…” after women posing as mothers of pediatric patients with common health conditions made calls to identical clinic staff for appointments 30 days apart using the same script but identifying Medicaid or private insurance as payment.

So, a Medicaid card will not guarantee medical care for the poor.

Forces behind Medicaid Expansion Terry McAuliffe claims that “if we don’t accept [Medicaid] money it will simply flow to other states.”  This is not true.  Virginia’s “share” of Medicaid expansion money (our federal taxes) is based on a formula.  For 2016, Congress allocated $372 Billion for Medicaid for all 50 states, with $1.5 billion for Virginia.  If every other state rejected expansion, Virginia would not get the entire $372 Billion.

McAuliffe wants to reappoint Governor McDonnell’s Secretary of Health, Dr. Bill Hazel, who has been working to expand Medicaid since passage of Obamacare in 2009.   The Washington Post reported (12/18/13) McAuliffe announced his choice of Dr. Hazel at Virginia Commonwealth University School of Medicine in Richmond: “'I am confident that Secretary Hazel will be the best steward to help me carry my agenda forward and meet the challenges we face when it comes to health care in this commonwealth.”

The Obama Administration has cut from $500 million to $1 billion in reimbursements to VCU and UVA for hospital care for indigents.  The news of the VCU/UVA funding shortfall came from Health Secretary Hazel on the same day Terry McAuliffe announced he wanted Hazel to stay on as Health Secretary.  Terry McAuliffe would not be seeking to re-appoint Sec. Hazel if he were not also fighting for Medicaid expansion!

Nil Effects of Medicaid Expansion Medicaid expansion may not significantly improve health. In 2008, Oregon expanded Medicaid for low-income adults.  Two years later, The New England Journal of Medicine (NEJM) reported (5/2/13) “…Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services…”   Those words are from the authors of the article.  They are not mine.

And, a just published article in Science magazine [1/2/14] further analyzed Medicaid usage of patients enrolled in the 2008 Oregon Medicaid expansion.  The author’s summary reported on 25,000 Medicaid lottery participants over an 18 month period.  “We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings. ...  A back-of-the-envelope calculation, using $435 as the average cost of an emergency room visit suggests that Medicaid increases annual spending in the emergency department by about $120 per covered individual.”

In other words, because it is harder and harder for patients to receive primary medical care in private doctor’s offices, Medicaid eligible patients are going to hospital Emergency rooms for for primary care treatment at a rate of 40% higher than non-Medicaid participants.

Defensive Medicine  Because doctors fear lawsuits, many doctors practice “defensive” medicine which consists of ordering medical tests and treatments which shield a doctor from liability, but which may offer little or no benefit to the patient. This drives up general health care costs as well as tax-funded Medicaid and Medicare programs.

An AMA published survey, answered by 65% of 824 Pennsylvania doctors (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) found:  “... 93% reported practicing defensive medicine. ... such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%).  Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. ... Defensive practice correlated strongly with ... perceived burden of insurance premiums.”  JAMA. 2005 Jun 1;293(21):2609-17.

As more and more Doctors consider leaving the medical profession over Obamacare requirements, HB 39 can remove the burden of insurance claims for care provided by charity doctors, a significant factor increasing health care costs across the board. Relieved of that burden, doctors will be able to exercise their best clinical judgment, and not order tests to avoid litigation.  Doctors under HB 39 will have no incentive to encourage behavior that produces repeat pathologies, where voluntary behavior and not genetic history, social condition or accidents, is the major causative factor in illness or subpar health.

Doctors serving the poor through charity care will not waste time with Medicaid over users. Physicians who treat the poor without charge will have their reputations enhanced, which will attract additional paying patients. Non-profit groups or churches will be better able to direct only the truly needy to their affiliated clinic doctors resulting in true patient-centered care by physicians delivered in the local community.

The drawback for some politicians may be the absence of political payback votes.  In other words, instead of converting citizens into government dependents, the indigent will remain free men and women not beholden to anyone or expected to vote for a particular political benefactor.

HB 39 has the potential to take us back to a medical care delivery model that preceded Lyndon Johnson's so-called Great Society which bureaucratized Charity by creating government programs and agencies with employees who relied upon the indigent remaining so in order to keep their jobs.

Taking Action Since “Eternal Vigilance is the Price of Liberty,” I ask you to step up and alert your representatives in Richmond to support HB 39.  Please spread the word among your friends.

Go to  http://conview.state.va.us/whosmy.nsf/VGAMain?openform to learn who represents you and your friends in the House of Delegates and State Senate.  Please ask your representatives to co-patron HB 39 and vote for it in Committee and on the floor.

Unless you and your fellow citizens act, we will not only see an unnecessary expansion of Medicaid, and higher taxes, but a decidedly liberal shift in the active electorate as more and more citizens become dependent upon government programs.  I can only introduce the bill.  Without your help it will not pass.  Thanks for whatever you can do to improve medical care for the truly needy and resist expansion of Medicaid.

Sincerely,

Delegate Bob Marshall

Medicaid Expansion & Transportation Taxes Ruled Unconstitutional!

Dear Friends, We've had a great victory for taxpayers! I have two press releases below. Please spread the word to your fellow citizens, friends and co-workers.

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Press Releases #1

FOR IMMEDIATE RELEASE

Contact: Delegate Bob Marshall, 703-853-4213

*Attorney General Rules Use of "Medicaid Innovation & Reform Commission" to Expand Medicaid Unconstitutional!*

Manassas, VA - Delegate Robert G. "Bob" Marshall (R-13) received the attached opinion in response to his request for an opinion with regard to the constitutionality of the General Assembly's designation of a "Medicaid Innovation & Reform Commission" to allow for the expansion of Medicaid when the Commission determined that a number of proposed Medicaid reforms had been satisfactorily fulfilled. Delegate Marshall questioned whether the General Assembly could delegate this authority to a smaller group of mainly legislators.

Attorney General Ken Cuccinelli determined in his opinion today that the General Assembly does not have the authority to delegate its legislative authority to a smaller committee.

"I am pleased with this opinion and hope that the Governor will act appropriately to remove this unconstitutional piece of maneuvering from the budget before it comes back to the General Assembly," said Marshall. "Medicaid needs serious reform before we can even begin to consider expansion and the decision about when those reforms are sufficient can and should only be determined by the General Assembly as a whole."

"I congratulate the Attorney General for his correct reading of the Virginia Constitution and appropriate case law at a time when many were urging him to dodge this question or issue a politically expedient opinion so as to avoid controversy in his gubernatorial campaign. I congratulate him for standing up for the Constitution and the people of Virginia."

Read the Official Opinion Here.

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Press Release # 2

FOR IMMEDIATE RELEASE

Contact: Delegate Bob Marshall 703-853-4213

*Attorney General Rules Additional/Higher Transportation Taxes Unconstitutional!*

Manassas, VA - Delegate Robert G. "Bob" Marshall (R-13) received an opinion from Attorney General Ken Cuccinelli in response to his request for an opinion with regard to the constitutionality of the additional and higher taxes imposed on Northern Virginia and Tidewater as part of HB 2313 which is awaiting Governor Bob McDonnell's signature. Delegate Marshall questioned whether the "special" taxes were in violation of the uniformity laws in Title X of the Constitution, whether they violated the prohibition to enact local law in Title IV and if not would the requirements of Title VII apply that require local legislation to receive a 2/3 vote of the General Assembly.

It is the Attorney General's opinion that Title X does not apply because none of the taxes are directly taxes on property but that Title IV *DOES* apply because the laws single out portions of the Commonwealth without regard to similarities and differences between these areas and others around the state but base the implementation of these additional taxes purely on geography. This means that the portions of HB 2313 adding additional and higher taxes are unconstitutional.

"I am thrilled with the Attorney General's opinion with regard to the unconstitutional taxes in HB 2313," said Marshall. "Isolating Northern Virginia and Tidewater residents to place an additional tax burden on those citizens who already pay more to Richmond in taxes than they get back is unconscionable. Without the higher and additional regional taxes HB 2313 cannot be a functional solution to Virginia's transportation problems. I hope that the Governor will seriously consider vetoing this legislation or finding a way to start from scratch to find an equitable way to pay for transportation without raising taxes."

"I congratulate the Attorney General for his correct reading of the Virginia Constitution and appropriate case law at a time when many were urging him to dodge this question or issue a politically expedient opinion so as to avoid controversy in his gubernatorial campaign. I congratulate him for standing up for the Constitution and the people of Virginia."

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BEHIND THE SCENES: TAX HIKES AND MEDICAID EXPANSION

Dear Virginians, Governor McDonnell’s massive, largest-ever Virginia tax increase for road and transit (other general taxes were also increased) passed 60-40 in the House of Delegates (Republicans: 35 yea, 33 no) http://leg1.state.va.us/cgi-bin/legp504.exe?131+vot+HV1245+HB2313) and 25 to 15 in the State Senate (Republicans: 8 yea, 12 no) http://leg1.state.va.us/cgi-bin/legp504.exe?131+vot+SV0915HB2313+HB2313).

My earlier emails addressed many problems with the many tax increases, lack of transparency, questionable regional authorities, political construction priorities, and funding inequities. This email will address the backroom “deals” that if left unchanged will lead to an even higher tax burden (than even the transportation bill) through Medicaid expansion. PLEASE SEE ACTION ITEMS AT END OF THIS EMAIL!

HB 2313, the Governor’s transportation bill introduced by Speaker Bill Howell (R-Stafford) is now projected to “produce” (from our pockets) from $880 million to $1.2 Billion per year after the conference committee changes. However, one senator informed me that the Senate Finance Committee staff was instructed by Republican leaders to produce the lowest revenue figures possible to “soften” the actual tax blow to the public.

New revenue streams for road construction were touted to justify the massive increases. However, when I asked Sen. Barbara Favola (D-Arlington) on an ABC News Channel 8 TV program this past Monday what new interstates or primary roads would be constructed, she answered, METRO!

VOTE TRADING: MEDICAID EXPANSION FOR TRANSPORTATION TAXES Sen. Favola confirmed my conclusion (also reported widely in the media) that the Governor signaled support for Medicaid expansion to garner more democrat votes for his transportation tax. On the same TV program, Senator Favola admitted that she disliked aspects of the Governor’s transportation plan such as the $100 tax on hybrid vehicles, but she voted for it anyway because she got what she wanted: Medicaid expansion. (Why any democrat would need to be persuaded to raise taxes is a mystery to me.)

A northern Virginia Democrat delegate personally told me that the Medicaid “agreement” was responsible for at least ten Democrat votes for the transportation bill in the House. And, Democrat Delegate Spruill spoke on the floor of the House of Delegates explaining that he trusted the Republicans and was satisfied that the Medicaid issue was worked out.

BACKGROUND On Feb. 20, Governor McDonnell wrote to Republican and Democrat Budget Conference members noting Medicaid currently takes up 21% of Virginia’s general fund budget, a 1600% increase from 1983 and pointing out that costs to state taxpayers will increase significantly even with federal support.

He stated that Medicaid reform “requires completing state based reforms, amending the ACA [Obamanocare] to provide more flexibility and waiver authority, creating state and federal assurances that the current or expanded program will not break the state budget or add to the federal debt, and facilitating reforms in the private sector health delivery system to reduce costs. ...”

He said, “I cannot and will not support consideration of an expansion of Medicaid in Virginia until major reforms are authorized and completed, and until we receive guarantees that the federal government’s promises to states can be kept without increasing the immoral national debt. To do so, would be irresponsible ... Doing anything that suggests that expansion can occur prior to substantial, long lasting, cost-savings will damage our efforts to reform the system.” The Democrats protested!

Two days later Gov. McDonnell wrote to the Republican Majority Leader assuring budget conferees with clever wording that he supported setting up a Commission to oversee agreeing to what democrats wanted, mainly adding 400,000 new recipients to the current 1,000,000 on Medicaid, one of the most, if not the most fraud-ridden federal program on the books.

Rank and file House and Senate Republicans were not made aware of Governor McDonnell’s “accommodation” letter until the Washington Post reported on it Saturday morning, but the Republican leadership of both chambers knew about it earlier as they were part of the deal cutting.

The Governor’s so-called “firewall” to protect Medicaid was to consist of a select commission of delegates, senators and two citizen members appointed by the same House Republican leaders who led the charge for higher taxes. The commission members are supposed to ensure that any proposed Medicaid expansion includes “reasonable limitations on non-essential benefits such as non-emergency transportation are implemented; and ... patient responsibility is required including reasonable cost­sharing.”

Such loose language is unacceptable because it is an open invitation to a lawsuit. Democrats know full well that any prospective Medicaid recipient can dispute in court the definition of “reasonable” with their claims defended by the ACLU and other attorneys who are funded with public money.

If a federal judge in Virginia can decide (as was done recently) that a prisoner can argue that the state’s refusal to pay for a sex change operation presents a reasonable claim of a violation of the Eighth Amendment’s prohibition against “cruel and unusual punishment,” you can be sure that a tax funded lawyer will successfully challenge a denial of Medicaid benefits. The Governor’s assurance that Medicaid expansion will not happen on his watch gives me no assurance. The skids have already been greased by the language in the budget and the health exchange legislation passed earlier in the session.

The Medicaid commission is nothing more than a paper tiger supposedly guarding taxpayers from a 40% increase in Medicaid beneficiaries in a federal program so riddled with widespread fraud that even the federal Government Accountability Office cannot begin to measure its full extent.

Delegate Ben Cline had earlier drafted a letter signed by 51 House members to the budget conferees, explaining that they wanted to wait until “significant reforms are put in place in order to reduce costs before we consider any expansion of Medicaid."

Unfortunately, the overwhelming number of these 51 members still voted for the Budget conference report with the much more liberal Medicaid provisions in it.

REQUESTS TO THE ATTORNEY GENERAL Delegate Ben Cline had asked Attorney General Cuccinelli on February 21, whether it was legal for the General Assembly to delegate its authority to a commission to decide on expanding Medicaid. The AG concluded such a commission cannot make decisions for the entire General Assembly. New budget language was then approved by conferees to finesse the AG’s objections, but the new language is so broad it offers no protection.

On February 26, 2013, I asked the Attorney General https://www.facebook.com/DelegateBob to review the new language subsequently approved in the conference report and advise me prior to the veto session whether the conference language delegating authority to expand Medicaid is constitutional.

I will keep you apprised of the AG’s response. I thought you should know the behind-the-scenes orchestrations that have led to this infamous Republican led tax hike and future expansion of Medicaid. Both of these measures violate principles critically important to our Republican base and constitutional conservatives. But even more important, they are examples of bad policy which threaten the future economic well-being of Virginia’s families and our Commonwealth. Here is my letter to Cuccinelli.

ACTION ITEMS: Urge the Governor to veto HB 2313 and portion of Budget (HB 1500) which expands Medicaid. http://www.governor.virginia.gov/AboutTheGovernor/contactGovernor.cfm If your delegate signed Del. Ben Cline’s letter opposing Medicaid expansion and voted for Budget (HB 1500) ask why. (See earlier links.)

Thank you.

Delegate Bob Marshall

Vote Swapping in Richmond

  TAKE ACTION AGAINST EXPANDING MEDICAID:

Please urge your Delegate and Senator to vote against the Budget Bill if it includes Medicaid expansion. Apparently backroom deals were made to secure votes for the Governor’s transportation tax hikes. It now appears Virginia may accept Medicaid expansion which involves adding 275,000 recipients to the current 1 million! http://hamptonroads.com/2013/02/medicaid-compromise-close-va-legislature

Those truly unable to care for themselves should not be shoved aside, but Medicaid has major fraud issues that need to be resolved. Two days ago, AP reported on a Portsmouth woman convicted of 385 false Medicaid claims. In 2012, the GAO testified before Congress that despite spending hundreds of millions of dollars to prosecute, they still do not know the full extent of Medicaid fraud.

TAKE ACTION AGAINST TRANSPORTATION TAX HIKE:

We lost a hard battle in the House of Delegates over the transportation tax hikes, 60-40. (See roll call below). Tomorrow, Saturday, the full Senate will vote on HB 2313.

Please call and email your state Senator to vote against HB 2313 unless you want to pay higher taxes for: state sales tax, car tax, regional sales tax, vehicle and tangible personal property taxes, vending machine tax, heavy equipment tax, recordation tax on commercial, industrial and residential real property sales, hotel tax, hybrid vehicle tax, and diesel fuel tax. Not all of the money raised will go to roads. Much will go to Metro. Some will go to the General Fund. Shifting the gas tax will not guaranty lower gas prices. Here is an image of the vote in the house.

Raising taxes is not the answer to our transportation woes. Local planning affects road congestion. The VDOT Funding Formula and road construction districts favor less populated areas. Just a few years ago $3.1 billion in transportation bonds were authorized, but roads carrying very few vehicles are often funded. If transportation is a core function of state government, we must better prioritize our general fund expenditures. The ATM (American Taxpayers’ Money) cannot continue to be tapped without having a detrimental effect on the economy.

Thank you for reading and taking action.

Sincerely,

Delegate Bob Marshall

LAST CHANGE TO STOP TAX HIKE

  Dear Fellow Virginians,

IMMEDIATELY URGE YOUR STATE DELEGATE AND SENATOR TO VOTE “NO” ON HB 2313! After reading the 109-page conference report, it is even worse than I expected. NEW REGIONAL TRANSPORTATION FUNDING AUTHORITIES in Northern Virginia and Hampton Roads will fund and decide projects! Haven’t we had enough problems with the Metropolitan Washington Airports Authority? PLUS, there are even more tax hikes than first reported!

The 109-page Conference Committee Report was not made available to legislators until the evening of February 21. As of this morning, it is not posted online for the public to read. Quoting Delegate Ben Cline, it is a “Frankenstein Monster” of a bill.

HB 2313 raises the state sales tax, regional sales tax, vehicle and tangible personal property taxes, vending machine tax, heavy equipment tax, recordation tax on commercial, industrial and residential real property sales, hotel tax, hybrid vehicle tax, and diesel fuel tax. Not all of the money raised will go to roads. Much will go to Metro. Some will go to the General Fund. Shifting the gas tax will not guaranty lower gas prices.

PLEASE DON’T WASTE A MINUTE! CALL YOUR DELEGATE AND SENATOR NOW. The vote on HB 2313 will be today, despite the fact that few will have been able to read the Conference Report.

FOR THOSE WHO WANT MORE DETAILS: In addition to the tax increases I explained yesterday there are additional taxes I was not aware of until I read the Conference Report:

  • The personal property tax will increase from 3.5% to 4.3%.
  • The tax on vending machine sales rises from 4.5% to 6% in NOVA and Hampton Roads and 5.3% elsewhere in the state.
  • Heavy equipment used for contracts on road construction, railroads, docks, etc. will be taxed at 4.3%, up from 3.5%
  • Except for the increased tax on motor vehicles, other tangible personal property will be taxed at 5%.
  • In Northern Virginia, commercial, industrial and residential land and building sales will have an additional tax of 25 cents per $100 of value. (A Conferee had previously told me the tax was 40 cents per $100)
  • In Northern Virginia there will be a 3 % hotel tax (Legislators were previously informed this amount was 2%)
  • While the bill shifts the 17.5 cent flat tax per gallon of gas to a 3.5% sales tax on the wholesale price of gasoline, it is speculative to claim that motorists will pay less for gas because the sales tax will be computed on the wholesale price of gas as of February 20, 2013 and will not go below this floor.
  • The sales tax on purchasing vehicles (trucks and cars) increases from the current 3% to 4% on July 1, 2013, 4.1% on July 1, 2014; 4.2 % on July 1, 2015, and 4.3% on July 1, 2016. (Legislators were told it was a straight 4% tax. In reality, the tax increases each year through 2016.)
  • If Congress does not pass the internet sales tax collection law, the tax on wholesale gasoline beginning January 1, 2015 will increase from 3.5% to 5.1%.(regular gas) and 6% (diesel). There is no provision in the law to revert back to 3.5% should Congress pass the internet tax law after 2015.

By the way, if Congress passes the internet tax, mom and pop internet stores will be forced to comply with thousands of jurisdictions’ differing tax rates. Big online companies can easily comply but their smaller competitors could be forced out of business.

To reiterate, here are the other changes I mentioned yesterday:

  • Replace the current 17.5 cents per gallon flat tax on gasoline with a 3.5 % wholesale sales tax paid by distributors, which will be passed on to consumers, and a 6 % wholesale sales tax on diesel fuel.
  • Increase the 5% retail sales and use tax paid statewide on most purchases to 6% in Northern Virginia and Hampton Roads and 5.3 % in the rest of the state.
  • Apply a $100 annual fee on alternative fuel vehicles, including hybrids.
  • Increase the amount of general fund money diverted to fund transportation from .50 % to .675 %, raising roughly $200 million when fully phased in.
  • If Congress passes the Marketplace Equity Act (which requires on line businesses to collect sales taxes) the proceeds will be distributed as follows: 55.55% for schools; 22.2% for local governments with no restrictions; and 22.2% for roads and transit. If Congress does not pass the Internet sales tax collections act, an additional 1.6 % tax would be added to the wholesale gas tax to achieve the same end.
  • NOT FIXING WHAT IS BROKEN: In this session, the House of Delegates:
  • Rejected increased representation of Northern Virginia and Hampton Roads on the Commonwealth Transportation Board, the VDOT agency that decides which projects are funded. The current CTB favors districts drawn from the 1930’s.
  • Agreed to fund $1.4 Billion for a 55 mile toll road parallel to existing Rt. 460 (Suffolk to Prince George). VDOT claims project will create 4,000 jobs but lists no traffic counts.
  • Increased by $554 million (total of $1.3 Billion) to finish and four- lane Rt. 58 to the intersection of I-77/I-81, a road that carries only 7900 cars daily.

Declined to alter the decades old transportation funding formula for the allocation of money to VDOT construction districts. This will perpetuate the practice of funding rural rather than urban areas. Apparently, if rural law makers vote for these higher taxes, they have been assured that the funding formula will remain intact.

PLEASE, contact your Delegate and Senator today to ask them to oppose the Conference Reportfor HB 2313 here.

Thank you for your diligence!

Delegate Bob Marshall

Republicans for Higher Taxes!

  Dear Fellow Virginians,

Well, now we know the tax hikes for sure! The House/Senate Transportation Bill (HB 2313) Conference Committee brought both bodies their Conference Report today. I intend to vote NO on final passage. Please contact your delegate/senator today and urge them to vote no. The bill includes the following tax increases:

  • Replace the current 17.5 cents per gallon flat tax on gasoline with a 3.5 % wholesale sales tax paid by distributors, which will be passed on to consumers, and a 6 % wholesale sales tax on diesel fuel.
  • Increase the 5% retail sales and use tax paid statewide on most purchases to 6% in Northern Virginia and Hampton Roads and 5.3 % in the rest of the state.
  • Apply a $100 annual fee on alternative fuel vehicles, including hybrids.
  • Increase the current 3% sales tax paid on the purchase of motor vehicles to 4%.
  • Increase the amount of general fund money diverted to fund transportation from .50 % to .675 %, raising roughly $200 million when fully phased in.
  • The sales tax in Northern Virginia and Hampton Roads will be 6% instead of the 5.3% in the rest of the state.
  • In Northern Virginia there will be an increase of 40 cents per hundred dollars on the sale of a house. That’s an extra $1600 on the sale of a $400,000 home.
  • Also in Northern Virginia there will be a 2 % occupancy tax for hotels.

If Congress passes the Marketplace Equity Act (which requires on line businesses to collect sales taxes) the proceeds will be distributed as follows: 55.55% for schools; 22.2% for local governments with no restrictions; and 22.2% for roads and transit. If Congress does not pass the Internet sales tax collections act, an additional 1.6 % tax would be added to the wholesale gas tax. Not all of the sales tax increase (the extra .3% statewide or extra 1% in Northern Virginia & Hampton Roads) will go to transportation. Part will go to schools and other general fund programs. There is no prohibition from using more of the tax increase for things other than transportation, nor anything to stop reinstating the gas tax on top of all the other taxes in future!

NOT FIXING WHAT IS BROKEN: In this session, the House of Delegates: Rejected an attempt to increase representation of Northern Virginia and Hampton Roads on the Commonwealth Transportation Board, the VDOT agency that decides which projects are funded. The current CTB is weighted in favor of districts drawn from the 1930’s. Agreed to fund two roads which proponents hope will spur economic development: (A) $1.4 Billion for a 55 mile toll road parallel to existing Rt. 460 (Suffolk to Prince George), a project which VDOT says will create 4,000 jobs but lists no traffic counts; (B) Increase by $554 million for a total of $1.3 Billion to finish and four lane Rt. 58 to the intersection of I-77/I-81, a road that carries only 7900 cars daily.

Declined to alter the decades old transportation funding formula for the allocation of money to VDOT construction districts. This will perpetuate the practice of funding rural rather than urban areas. Apparently, if rural law makers vote for these higher taxes, they have been assured that no change will occur to the funding formula.

PLEASE, contact your Delegate and Senator today to ask them to oppose the Conference Report for HB 2313 here.

Thank you for your diligence!

Delegate Bob Marshall

Stop Tax Hikes for Transportation

  Dear Virginia Taxpayers,

Republicans for Higher Taxes? Get ready to pay up unless you speak up now! To pay for roads, a Conference Committee made up of Democrats and Republicans from the House of Delegates and the Senate will propose which taxes get hiked and by how much. Call your Delegate and Senator right away and urge them to vote against any bill that raises any tax.

The Governor had proposed raising the state sales tax from 5% to 5.8%, ending the gas tax (except for diesel), and increasing car registration fees. Senate democrats and some Republicans want higher gas taxes and higher sales taxes. Others propose both statewide and local or regional increases in sales or income taxes in Northern Virginia and Tidewater. It seems that on both sides of the aisle everyone’s answer to our transportation problem is higher taxes.

While I agree that the transportation problems in Northern Virginia and Tidewater are in need of a serious, long-term solution; I do not think tax increases are the answer. I do not impute the motives of legislators who believe higher taxes will solve the problem but local planning has much to do with congested roads. If development continues unabated in areas where new road improvements are made the improvements are negated.

Solutions: This year I offered a budget amendment which would have allocated one cent of every dollar from all accounts exclusive of salaries and employee benefits. This would have dedicated at least $107 million more per year to transportation. The House of Delegates Republican leadership refused a direct vote on my amendment by pulling a parliamentary dodge.

Wrong Priorities: Republicans and Democrats in the Assembly are funding political roads that move very little traffic. In 2010 the General Assembly passed $3 billion in transportation bonds. Where is that money going? Route 58 carries a maximum of 7,900 vehicles per day. Northern Virginia roads carry 100,000 and more vehicles per day. Route 58 is slated to get about $750 million to $1.3 billion in future bonds. Route 460 will go from Prince George County to Suffolk and cost $1.4 Billion for 55 miles of toll roads. VDOT’s website does not include traffic counts but states it will produce 4,000 construction jobs. http://www.route460ppta.org/documents/460_CIM_Fact_Sheet_11.13.12.pdf)

A bill this year would have given Northern Virginia and Tidewater more representation on the Commonwealth Transportation Board. That bill failed in the House 49-51. So now, if the General Assembly and Governor raise taxes for roads and transit, decisions will be weighted in favor of construction districts reflecting the population of Virginia in the 1930’s and will not give enough weight to the areas in Virginia that need the most help.

Virginia state government needs to live within its means, as every family must. If we don’t want the federal government spending without cutting, why excuse it in Richmond?

All of the various plans being hammered out involve tax increases. We are supposed to adjourn this Saturday, so please contact your Delegate and Senator right away! Urge them to vote against any bill that raises any tax. To find out who represents you, click here.

Thank you for your diligence.

Delegate Bob Marshall

Stop the Obamacare Exhanges

  Dear Fellow Virginians,

Please urge Governor McDonnell to keep his promise and reject any legislation that seeks to accommodate “Obamanocare.” The “Affordable Care Act” does not require States to run their own Health Care Exchanges. At least 26 states have refused to set up exchanges which are website marketplaces of health insurance plans meeting federal criteria. (Google: “Virginia Health Care Exchange.” Several private marketplaces already operate).

If states refuse to set up their own exchanges, it will probably take longer for the federal government to deform healthcare and perhaps postpone enforcement of mandates requiring abortion pills and “medical” inquiries regarding which homes have guns.

In 2010, Governor McDonnell’s Secretary of Health set up a Commission to study health care “reform” with a $1 Million grant. I asked Secretary Hazel why Virginia was proceeding with government-run health care while we were challenging the law in federal court. I was told Virginia must be “prepared.”

Governor McDonnell has publicly stated he would not set up a Virginia exchange. Now he appears willing to sign bills which authorize state involvement while purporting to provide state “oversight” of a federal exchange. In reality the bills commit Virginia resources, including personnel from several state agencies, claiming (without guaranty) that Virginia will be reimbursed by the federal government (still our tax money). If this is not a state insurance exchange then what is it?

Instead of Virginia exercising its right to refuse to set up a state exchange as other states are doing, Virginia will use its authority, resources and personnel to grease the Obamanocare skids and objectionable mandates.

Several bills have already passed the General Assembly. Senate Bill 922, introduced February 11, 2013, passed the House of Delegates. It states in part:

Section 32.1-16 (b): “The Department shall be compensated for expenses incurred in providing such services. “ Does this mean compensation by state agencies or Washington? In either case, it involves additional tax money.

Section 38.2-326 (A)(i) states in part: “full funding is available.” Funding from where?

Section 38.2-326 (A) (ii) states in part: “technology infrastructure, including integration with federal, state, and other necessary entities, is made available to the commission by or through the U.S. Department of Health and Human Services or the Virginia Secretary of Health and Human Resources…” Will funding come from the feds or the state? What are the costs? Undersand that “made available,” does not mean “provided free of charge.” If the feds “provide,” what will they charge Virginia taxpayers?

Section 38.2-326 (B) states in part: “the Commission may contract with and enter into a memoranda of understanding to carry out its plan management functions with the U.S. Department of Health and Human Services or any other state or federal agency…” A MOU with another state agency simply would obligate more Virginia tax money and resources from the other state agency to pay for costs associated with the plan.

Section 38.2-326 (C) states in part: “the Commission’s obligation to perform plan management functions described in subsection A is contingent upon receiving federal funding sufficient to pay the operating expenses necessary to carry out the plan management of functions. The Commission shall seek full reimbursement from the U.S. Department of Health and Human Services for such expenses. “Seeking full reimbursement does not mean obtaining full reimbursement. Without wording which states, “The SCC shall not perform plan management functions unless all Virginia expenses are paid in full by the Federal government” this section does not assure plan management functions will be paid for by the feds (still our money). Even if the Commission has no obligation to perform plan management functions, there is no prohibition on their performing plan functions.

Section 32.2-326 (E) states in part that “Technology resources provided by the Commission in carrying out the plan management functions shall be limited to existing commission technology support functions…” How much will this cost Virginia taxpayers?

Section 32.2-326 (F) states in part that “The Commission shall make available to the public on its website a written report on the implementation and performance of its plan management functions during the preceding fiscal year, including, at a minimum, the manner in which all funds utilized for its plan management functions were expended.” How much will this cost the State to carry out this function? How many state employees will be needed? Will others need to be hired?

If you do not want Virginia to speed up compliance with “Obamanocare” please call (804) 786-2211or email the Governor here: http://www.governor.virginia.gov/aboutthegovernor/contactgovernor.cfm Ask him to veto any legislation that accomodates “Obamanocare.”

Thank you for your help!

Delegate Bob Marshall

P.S. I thank Dr. Mark Berg for his help and insights on this bill.

Marshall Money Study Advances - Vote Tomorrow (Monday)

  Dear Virginians,

My HJ Res. 590 has already passed the full House of Delegates and the Senate Rules Committee. It sets up a General Assembly study of ways to protect Virginians from cyber security threats and Federal Reserve policies which adversely affect our economy.

The full Senate vote is expected on Monday, February 18.

The Chair of the Senate Rules Committee announced that Forbes Magazine editor, Steve Forbes, wrote in support of my study. Despite a few critics at the Washington Post, the study is a serious one, necessitated by cyber security breaches and devaluation of the dollar.

CYBER SECURITY BREACHES: How long would your family “survive” without a working credit or debit card due to banks’ computers being disabled or losing records? In mid-October, 2012 Defense Secretary Leon Panetta gave a speech in New York in which he recounted serious threats to our computer dependent economy:

“In recent weeks…large U.S. financial institutions were hit by…attacks [which] delayed or disrupted services on customer websites…the scale and speed with which it happened was unprecedented. But even more alarming is an attack that…infected computers in the Saudi Arabian State Oil Company Aramco…This routine replaced crucial systems files with an image of a burning U.S. flag.

But it also put additional garbage data that overwrote all the real data on the machine. More than 30,000 computers … had to be replaced … foreign cyber actors are probing America‘s critical infrastructure networks…chemical, electricity and water plants and those that guide transportation throughout this country…intruders have successfully gained access to these control systems.

The collective result of these kinds of attacks could be a cyber-Pearl Harbor: an attack that would cause physical destruction and the loss of life.”

FIAT MONEY, DEVALUED DOLLARS AND ECONOMIC INSTABILITY: Federal Reserve policies have hurt Virginia’s Retirement system and budget and are producing disincentives for families to save as bank accounts now provide near zero interest. At the same time, the Fed is providing perverse incentives for self-indulgence by Wall Street and runaway spending by Congress. Congress needs an “intervention” which only a state study by experts can provide.

Please contact your own State Senator by 3:00 pm on Monday, February 18 and ask him to support HJ Res. 590. Click here to find out your state senator’s contact information.

Thank you,

Delegate Bob Marshall

Authorized by Bob Marshall, candidate for House of Delegates.
Paid for by Friends of Bob Marshall.