Virginia needs a health exchange

Six legislative proposals to create a state-run health insurance exchange have been filed in the General Assembly. While many other bills have made their way onto subcommittee and committee dockets, none of those six has gotten any attention.

They should, because the alternative is much worse.

The Republican and Democratic lawmakers who submitted the legislation are following through on a plan outlined last year and endorsed by nearly every senator and delegate, as well as Gov. Bob McDonnell.

Last year, lawmakers voted to begin the work to establish a health benefits exchange in accord with the 2010 federal health care reform law. By this year, the state was to "provide recommendations for consideration by the 2012 session of the General Assembly regarding the structure and governance of the Virginia Exchange."

Last fall, members of the state health reform initiative advisory council did precisely that. The report outlined potential frameworks for an exchange and a basis for lawmakers to draft legislation.

As expected, details vary in some of this year's bills.

Del. Patrick Hope, D-Arlington, submitted a bill that would create a quasi-governmental agency to operate the state-based exchange, an approach that the advisory council recommended by a vote of 11 to 3 in September. Del. Jennifer McClellan, D-Richmond, offered a similar bill.

Del. Kathy Byron, R-Campbell, proposed an alternative discussed by the council: establishing an exchange under the umbrella of the State Corporation Commission.

Each patron, along with the dozen other lawmakers supporting those bills and similar versions in the Senate, can make compelling points about why they believe their model is best for Virginia consumers and coverage providers.

Instead, the bills seem destined to be quietly dust-binned. It's a dangerous and entirely unnecessary gamble.

The U.S. Supreme Court is expected to rule this summer on the constitutionality of the federal reform law's mandate that individuals purchase health insurance.

The politics associated with that decision - and the upcoming presidential election - have undoubtedly contributed to a new ambivalence toward finishing the work begun by last year's General Assembly.

McDonnell has insisted repeatedly in the past month that lawmakers don't need to focus on this kind of legislation. That's bad advice.

If the high court upholds the federal mandate, Virginia could end up scrambling to agree on the structure and governance of an exchange by Jan. 1, 2013, when federal officials will measure states' progress.

If the feds don't think enough work has been done, that the state isn't capable of opening its exchange to the public, they'll impose a federally run exchange on Virginia.

That's an outcome that nobody wants - not Democrats, not Republicans, not supporters or opponents of reform. Delaying action also freezes the state's insurance companies, many of which intend to offer plans in line with Virginia's exchange.

The quickest way to ensure that doesn't happen is for subcommittees and committees to take up these bills, discuss them and pass them along. The legislative process should decide what Virginia's health insurance exchange should look like.

If the Supreme Court decides health care reform is unconstitutional, at least Virginia will have a better idea how it would prefer to extend insurance to folks who can't get it.

If the Supreme Court decides reform is constitutional, Virginia won't find itself facing the imposition of a system in which it had little say.