Maryland and Virginia were both out front — in very different ways — when the health-care overhaul became law in March 2010. The two states continue to approach the law in their distinct fashions in advance of its full implementation in January 2014 and in the face of doubts about whether it will survive Supreme Court review. But Maryland and Virginia are no longer at opposite ends of the Patient Protection and Affordable Care Act spectrum.
Although deep-blue Maryland remains a leader among states enthusiastically preparing for the health-care overhaul, Republican-led Virginia is no longer the standard-bearer for “Obamacare” recalcitrance. Unlike some other states opposed to the law, whose elected officials are proudly doing little or nothing to get ready, Virginia has been grudgingly but diligently laying the foundation for a law that it hopes will go away.
“We know the [Virginia] governor has very significant concerns about the law, and the governor’s not been shy about expressing that, but at the same time [he] is making sure that, at the very least, they’re prepared to move if they need to,” said Andrew D. Hyman, senior program officer with the Robert Wood Johnson Foundation, which has provided technical assistance to both states.
That nuanced approach may have less to do with Virginia’s purple political identity than with a practical realization on the part of Republicans controlling state government: If the law stands, failing to plan would give Washington even more sway over the state.
Given Virginia’s litigious initial response to the law, some might expect it to be in league with such states as Florida and Texas, which have resolutely declined to pave the way. Joshua M. Sharfstein, Maryland’s secretary of health and mental hygiene, saw that stance on display at a national conference.
“At one point,” Sharfstein said, “a person from Florida got up and said something to the effect of, ‘I’m now going to tell you everything Florida is doing to establish an [insurance] exchange for the Affordable Care Act.’ Pause. ‘Thank you very much.’ ”
But Virginia, whose lawsuit was tossed out and, therefore, is not party to the challenge before the Supreme Court, has taken a more pragmatic approach — one that health policy experts say puts it in the middle of the pack among the states. Even as he praised Cuccinelli’s lawsuit, Virginia Gov. Robert F. McDonnell (R) appointed an advisory council in 2010 to consider whether the state should come up with its own framework for implementing the law or take whatever Washington might hand down.
“It took about 11 seconds that first meeting. No one thought allowing the feds to run it was a good idea,” said a participant, who spoke on the condition of anonymity to discuss the matter freely. “That helped make it clear that doing nothing was actually counterproductive to the shared goal of finding out what’s best for Virginia. That’s why the momentum is actually strong and deep and surprising . . . [to] people who just pick up the paper every six months and listened to Cuccinelli’s press releases.”