Issue Position: Human Services

Issue Position

COMMITMENT

The Commonwealth of Virginia has a duty to assure that professional standards are met in the delivery of health care for all citizens. For those who cannot provide for their own basic needs, state government actions should enhance the delivery of services; focus on developing maximum abilities that may lead to independence; and not add cost or delay to private, charitable, or local government providers.

One reason I enjoy serving at the state level is that we are still close enough to really see what works. One type of service in one area of Virginia is best delivered by the private sector; in another area, non-profits know community needs best; while in some areas government has to step-in to fill essential needs. The challenge is to find the right balance and to assure that government oversight of taxpayer funded programs is well-focused accountability and not simply red-tape.

Often when I cast a vote in the legislature, I see the faces of someone I've met in an Alzheimer Center, a kid I went to school with in rural Michigan, parents who must have help for their special needs child, or a volunteer whose passion leaves them frustrated with lack of professional support. I believe that the common good has to embrace the "least" among us. We must never lose sight of the individual human being, whose increased level of functioning will make us all stronger.

MENTAL HEALTH

Long before the inconceivable tragedy of Virginia Tech, informed members knew Virginia lagged far behind in providing mental health services. Access to help and accountability vary tremendously statewide. Reluctance and shame still stifle discussion. Several General Assembly members have significant experience in mental health. Mine includes 30 hours of college courses focused on the physiology of brain functioning. I also headed a non-profit that worked with the mental trauma of child abuse and neglect.

Commissions and legislative committees spent countless hours looking at what Virginia Tech revealed about our mental health system. During the 2008 Session, I was part of numerous long meetings trying to truly understand the ramifications of reform proposals. We passed laws to change the commitment standard to respond better to potential danger. We spelled out oversight responsibility for out-patient tracking. I particularly focused on better information sharing. Despite a tight budget, we added funding for 40 mental health service providers. We also funded the Wounded Warrior initiative to provide mental health services to veterans, guardsmen, and reservists.

Many of us, however, knew these changes were just a paper exercise unless they were accompanied by significantly increased community staffing. As I feared, by 2011, the strong commitment we made has increasingly slipped to the background in funding priorities.

Indeed, a strong community health services system is even more critical given the impact of multiple deployments on our military and their families, particularly those in the guard and reserve who do not have the human support network on a military base. The Army has reported that 27% of non-commissioned officers on their 3rd or 4th deployment had post-traumatic stress disorder or depression compared to only 12% on their 1st deployment.

Finally, our aging population is bringing to the fore the need for diagnosis to extent independent living and for caretaker training. We know what needs to be done. The fix is to fund it.

INTELLECTUAL AND PHYSICAL DISABILITIES

In 2004 we committed to an annual increase in slots for intellectually disabled on the urgent waiting list, more slots for at home services, and slots for developmentally disabled. This commitment was especially important to aging parents concerned about helping an adult child transition into alternative care.

Then the economic downturn hit. Using federal economic stimulus funds from the higher federal match for medical assistance through June 30, 2011, we were able to hold Medicaid eligibility at its current levels, allowing thousands of Virginians to continue receiving very basic services; add 250 new MR/DD waiver slots for children with intellectual disabilities for treatment at home or community based centers; and restore cuts to respite care, a critical service that makes it possible for families to keep their loved ones at home.

However, since the state funding of services was actually cut by $360 million, the end of the federal stimulus funding on July 1st meant we had to find that much more money to support services in 2011-12. Although 425 MR/DD waiver slots were added and respite care was not reduced, it came at the cost of further cuts to state payments to providers...including nursing homes. (See Seniors.)

TRAINING CENTERS

In 2011, we also added $77 million to mental health with most going to intellectual disability services to reduce staffing ratios and overtime at Virginia's five training centers which are under threat of a U.S. Justice Department suit.

I am concerned that decisions about the training centers must strike a balance between funding community services for all who can be served in the least restrictive environment, while assuring that services remain available for those who cannot live without direct, highly specialized care. I am particularly concerned that the invaluable state property that is the site of Northern Virginia Training Center not be sold off. It should be used as a campus for small, less institutional facilities to meet the specialized needs of individuals while allowing them to remain close to family members. In providing a life like ours for as many as possible, we must meet the challenges of highly individual needs.

Finally, I am concerned about oversight. I voted against the 2011 bill to eliminate the independent ombudsman to investigate complaints of abuse or physical conditions in facilities. I helped fight the 3-year battle a decade ago against administration objections to this safeguard, which also grew out of a federal investigation of deaths in Virginia facilities. I still recall one particular incident involving a woman who had spent 558 hours in restraints in the two months before she died. A letter, responding to her attempts to get help, arrived 19 days after her death stating: "... Since we have not heard from you in over 90 days ... assume you have no new concerns ... we will close your case with us."

ASSISTED LIVING FACILITIES

NURSING HOME STAFFING

See discussion of these issues under Seniors

HEALTH COVERAGE

Despite headlines about Virginia's court challenges to the federal health reform, the Virginia Secretary of Health and Human Resources has undertaken a comprehensive review of healthcare solutions. The 24 member Advisory Board inclusion of stakeholders has been noted as a national best model.

I believe that health insurance exchanges are key to controlling costs to small employers and ensuring that there is an adequate rate-payer base to support those with pre-existing conditions. Therefore, health exchanges need to be structured so that they have broad participation and are not the dumping ground for high-risk individuals; facilitate and/or require sharing of clinic and medical test information; be outcome driven rather than fee for services; cover preventative healthcare; include mental health coverage; include longterm care insurance; encompass co-pay rates based on services; and, if feasible, use readily administered means-tested co-pays.

NON-WESTERN MEDICINE

In 2005, in response to arrests made for purchasing bear gall bladders, I was pleased with the state's immediate response to my call for an education program on all such laws.

In 1999, I changed state regulation of acupuncture so that patients can go directly to an acupuncturist without being referred by a physician and the acupuncturist is not barred from dispensing herbal preparations and nutritional supplements (HB2061). Further reform resulted recognition of acupuncture through establishing its own board under the Board of Medicine.

CHILDREN'S HEALTH INSURANCE

In 2001, only half of children of working poor were covered by a health insurance program launched 2 years earlier. Virginia was the only state that required mothers to give information about an absent father and, in Fairfax, lack of information about the father was the biggest reason for denial of coverage. My bill (HB1982) made disclosure voluntary. Under the Warner and the Kaine administrations, Virginia became a national leader in enrolling uninsured children by simplifying the application process, removing barriers to enrollment, making application sites more widely available, and promoting the program aggressively statewide.

WHEN LIFE BEGINS

I believe the very complex decision of when life begins should be a personal choice. I will continue to defend that position in all of the challenging and complex ways that it comes before the Virginia General Assembly, including birth control; in vitro fertilization; a women's right to an abortion under Roe v. Wade; the right of a person to have an advanced medical directive carried out that bars heroic efforts; and the advancement of stem cell research in the treatment of disease and disabilities.

If a fertilized egg is defined as a fetus throughout Virginia's law as it was in a 2009 biotech research amendment, 40% of commonly used birth control would be outlawed as an abortion, because the pill can operate to prevent a fertilized egg from implanting in the uterus. The following from the "Human Life Alliance" (www.humanlife.org) was distributed during the 2011 session:

All hormonal contraceptives (the pill, patch, mini-pill, shot, vaginal ring, emergency contraception, intrauterine devices, etc.) have the capability to cause an abortion...Birth control manufacturers insist that their products do not terminate an existing pregnancy. However, they have incorrectly redefined the terms "conception" and "pregnancy" to mean the moment of implantation rather than the moment of fertilization.

Bills to ensure that using contraceptives would not be termed an abortion are repeatedly killed in the House.

The rare medical need to end a pregnancy after the 14th week but before viability outside the womb was thoroughly reviewed in the 2000 Supreme Court ruling in Nebraska v. Carhart. Abortions in this this time frame are typically forced by the woman's dangerously deteriorating health related to diabetes or poor kidney functioning. Having read that decision, in 2003 I voted against a law to bar most abortions after the 15th week, because it had no provision for medical decisions to protect the life of the mother. In 2005, the federal court struck down that law.

In 2003, I also voted against a bill requiring parents who consent to their daughter having an abortion to do so before a notary, which I thought was an invasion of privacy especially in small town settings. Since 1979, Virginia law has required written informed consent before an abortion, which I support. However, in 2001, I voted against requiring women to wait 24 hours after receiving required information because of the burden in placed on women in remote rural areas. Finally, I support educational efforts to prevent un-wanted pregnancies and sexually transmitted diseases but believe that parents should be able to opt their children out of public school programs.

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