5 Things Virginia: Public comments on reinsurance waiver, Paid family & medical leave bill, Cost efficiency


Emily Boerger


With the Thanksgiving holiday next week, I wanted to take a moment to say thank you on behalf of the entire State of Reform team for your continued support. Whether it’s through attending our conferences, reading our coverage of health care and health policy in Virginia, or sponsoring our events, we appreciate you!

Thanks again and happy Thanksgiving!

Emily Boerger
Managing Editor
State of Reform


1. Reinsurance public comment period ends

The public comment period for Virginia’s Section 1332 draft waiver application, which would establish a state-based reinsurance program, ended on Nov. 1. Several organizations, including Kaiser Permanente and CareFirst Blue Cross Blue Shield, submitted statements supporting the goals of the reinsurance program, but outlined areas of potential improvement — particularly related to the uncertain impact of federal programs.

Kaiser was particularly concerned about the uncertain “future of the federal premium subsidy landscape” and how that might impact the waiver application. They also suggested the Bureau of Insurance conduct actuarial analyses to assess potential overlap costs for “high-risk” members from both the state reinsurance program and the federal risk adjustment program. The BOI has until January 1 to implement final changes before submitting the draft to CMS.


2. Boysko files paid family & medical leave bill

The first bill pre-filed for Virginia’s 2022 legislative session would secure up to 12 weeks of paid family and medical leave for caregivers across the commonwealth. Senate bill 1, which Sen. Jennifer B. Boysko introduced on Monday, would allow caregivers on leave to receive up to 80% of their average weekly wages, starting two weeks after filing a claim.

The bill would apply to individuals caring for new children and family caregivers treating those with serious illness, among others. The bill summary states: “Funding for the program is provided through premiums assessed to employers and employees beginning in 2024.” A recent poll found that 73% of Virginians support paid family leave for family caregivers, and 82% support providing a tax credit to eligible caregivers to offset expenses.


3. Video: Bending the Rx cost curve

Improving accessibility and affordability of biosimilars was a key topic of conversation at our recent “5 Slides: Bending the Rx cost curve” virtual conversation. Sarah Ikenberry at the FDA says biosimilars are underutilized due to a lack of education and awareness from providers. A March 2021 national survey found that about half of providers had no experience prescribing these types of medicines.

Panelists also discussed challenges to affordability including limited transparency and the impact of PBM rebates. “We dehumanize treatment by bringing too many middlemen, by putting extra cost on the people who are least privileged,” said Dr. Kashyap Patel at the Community Oncology Alliance. Video of their full conversation is available here.


4. Five Virginia hospitals among top 50 most cost efficient

Five Virginia hospitals are among the top 50 most cost efficient hospitals in the country, according to a recent analysis from the Lown Institute. The analysis evaluated health outcomes compared to costs to Medicare for over 3,000 hospitals in the country.

Inova Alexandria Hospital ranked first in the commonwealth and 15th overall for cost-efficiency, though scored near the bottom of the state (67th out of 76 hospitals) on measures of pay equity. Four other Virginia facilities made the top 50: Inova Loudoun Hospital (29), Sentara Princess Anne Hospital (31), Southside Community Hospital (36), and Inova Mount Vernon Hospital (38).


5. Health provisions in the revised BBB plan

With the release of President Biden’s scaled back “Build Back Better” plan, State of Reform columnist Jim Capretta broke down some of the health policy items that made their way into the president’s updated domestic agenda. The revised BBB plan includes Medicare coverage for hearing services and a permanent 6 percentage point increase in the federal matching rate for states offering HCBS services that meet new national standards.

Capretta’s latest column also dives into the details of the House’s version of the plan and its provisions that attempt to close the coverage gap. He writes: “The individuals who now are ineligible both for Medicaid and ACA subsidies would be enrolled into private plans offered on the exchanges, with the federal government paying the full cost of their premiums and most of their cost-sharing too.”