David Toscano on Health Care

David served on the Charlottesville City Council from 1990 to 2002 and as Mayor from 1994 to 1996.

David is a resident of the City of Charlottesville, where he lives with his wife of 32 years, Nancy A. Tramontin, and their son, Matthew.

David serves on the Courts of Justice, Transportation, and Science and Technology Committees in the House of Delegates. He is also a member of the Disability Commision, the Joint Commission to Study Math, Science and Technology Education in the Commonwealth, and the Joint Subcommittee to Study Land Use Tools in the Commonwealth. He is also a member of the United Way Board and the Chamber of Commerce.

David served on the Charlottesville City Council from 1990 to 2002 and was Mayor of Charlottesville, as we all know, from 1994 to 1996. David serves on the State House Committees for Science and Technology, the Courts of Justice, and on Transportation in the Virginia House. He is also on the Disability Commission, the Joint Commission for the study of technology, math, and science. David resides with his family in the city of Charlottesville. Welcome again, David.

DAVID TOSCANO: Thanks.

JAN PAYNTER: The Virginia General Assembly has, as of March 13th, concluded its 2010 legislative session. We are fortunate today to have Representative Toscano with us to report the results. In particular, we would like to focus our attention on the healthcare implications of our larger national debate which just concluded, as everyone knows, it’s current phase, at least, with President Obama signing the newly reconciled healthcare bill into law. If time allows, we are also interested in hearing about any and all initiatives in education out of Richmond, starting with pre-k, high school, college, and beyond. That is, David, a particular focus for you.
First, let’s start with a fact that upwards of one million Virginians do not have any kind of healthcare insurance, they are working either full or part-time and as you note in your informative website, they generally work for companies that cannot afford healthcare plans for their workers. And we know that the bedrock of any community is small business and their families. So, David, share with us, if you would, what new state initiatives are underway to assist both small business and their workers with regard to healthcare coverage.

DAVID TOSCANO: Well, I think that it is really important that you emphasize that a lot of people who do not have insurance actually are working full-time, it is just that their companies are not in a position where they can afford to pay for health insurance for these folks and their families. Now, over the last few years what we have been trying to do is provide more assistance to children who are not covered and to families who are of low incomes who have not been covered. In this budget cycle, we really hit the wall, however, because our revenues are not sufficient to keep expanding that group. And so, I think, a lot of our hopes, for those of us who want to get more coverage, are going to rest on the health insurance plan that has been passed out of the congress and hopefully will take effect in the next several years. It is projected that many many more people will be insured under this plan, not everybody but almost everybody and that is really really important. It is going to work in a way that hopefully will provide some options for small businesses but all of the action is occurring at the federal level; it is going to be funded through the federal level. What we are going to have to do, as a state, is figure out ways that we can get some more money in the pot for Medicaid funding because we are going to have to match the federal monies coming for enhanced Medicaid benefits in the next several years. And that is going to be a challenge for us in our budget process because we have to have a balanced budget and the revenues are really not there right now.

JAN PAYNTER: I know many people have this question on their mind, and that is if they already work for a company that supplies healthcare coverage, what is going to happen? I think that people are understandably concerned about this.

DAVID TOSCANO: Well, from what I understand is that if you have a plan in place now, you are going to be able to keep your plan. This is not the major earthquake that you would think if you were reading the opponent to this legislation. This is a moderate expansion to our healthcare initiatives in the country. It is a much less expansive than the Clinton Healthcare Bill that was rejected in the early 1990s. And I think that over time, we are going to see where it works, where it doesn’t work, how it has to be tweaked, so as to provide a higher level of coverage. But if you think about things that don’t exist now that will exist with this plan, people with pre-existing conditions will not be able to be discriminated against by health insurance companies so that they can get coverage, youngsters, who perhaps went on to college and came back to live at home with their parents can maintain coverage on their parents’ insurance coverage as long as they pay until they are age 26 or 27. These are very tangible things that are going to help real people right now and over time hopefully will have more expansion that will allow greater numbers to be covered.

JAN PAYNTER: I think that that is something that a lot of people need to realize, too, it is a work in progress and there will, as you say, be tweaks to it, improving it as we go.
What kind of child preventative care, David, might be offered statewide as a result of a new initiative in Richmond or as part of the national bill?

DAVID TOSCANO: Well, my view has always been if you are going to expand coverage, cover the children first, it always makes sense. They are the most vulnerable part of the population. We have been trying to do that more in Virginia and I think with the federal legislation and the funds that will come as part of that legislation, we will be able to provide more coverage because there is no excuse for any child being left uncovered insurance-wise in this country.

JAN PAYNTER: With respect to the elderly population, we have a lot of elderly people in Virginia and in this area, what options now exist for them that did not exist before and can seniors realistically expect to get greater help with, for instance, prescription meds?

DAVID TOSCANOR: Well, prescription meds was a program that was initiated several years ago, very very expensive program but created something which is called the “Donut Hole” that people are aware of and that is that you can get coverage up to a certain point and then it stops and it creates a hole in coverage. What the—now I am not an expert on the federal legislation but what I understand is that the federal legislation is going to provide some assistance to those folks who are in that “Donut Hole”. It is not going to be huge, I think that it is $250 or something like that, but it will be helpful to people. And again this is a very expensive hole to fill and if you don’t want this program to be a budget buster, you have to be realistic in what you can do. And so, that is what the congress has set out initially to fill a portion of the hole, it probably will not fill the whole hole.

JAN PAYNTER: No, I think that it is important for people to be realistic to, we are in a crisis economically, as we all know. What plans are now in place to improve Medicare reimbursement for people?

DAVID TOSCANO: Well, in the state, the issue with Medicaid reimbursement has been that we are at the bottom of the states, we are like 48th—49th out of all of the states in terms of our Medicaid reimbursement for physicians, nursing homes, and hospitals. And that is a situation that is unsustainable because what will happen is that doctors will refuse to take Medicaid patients. It is difficult for hospitals to say “no” because you come through the door and you got to be served. But the lower the reimbursements the greater the burden is going to be on the rest of us who have health insurance or are private payers into the system, our fees are going to rise. So when people say that we shouldn’t do anything to improve Medicaid reimbursements, what they are saying is “raise my own fees” and that is not really the way we should be doing it. We should try to spread the cost across the entire population that brings down the fees for everyone.

JAN PAYNTER: What business incentives are in place, if any, to move the insurance companies toward a more equitable mode of operation, do you think, David?

DAVID TOSCANO: One of the things about the federal legislation, and again, I am not in the congress so I am not the total expert on this but from what I understand is that you are bringing in millions of people into the insurance pool. That is very attractive for insurance companies. Then again they can spread the risk across all of these additional people and in theory, bring down premiums for everybody. Now some of us would have wanted more of a public option that would allow more competition in the system, we did not get it with these bills for a whole host of reasons. So we are going to see over time whether the insurance companies are going to do what they say they are going to do, and that is try to reduce fees across the board because you have a larger population you are insuring and spreading out the risk. Or if they don’t, whether we will have to come back at some point and try to inject more competition into the system because we know how markets work; if you have competition in the system, the fees tend to come down… the prices tend to come down and we are simply going to have to see.

JAN PAYNTER: Do you think that the public option idea will be revisited? Are states ever—somebody asked me this, it was an interested question, are they ever empowered on their own to have some kind of public option for people?

DAVID TOSCANO: Well that is a very good question. And in fact, the federal legislation gives the states the ability to come up with their own program and seek a waiver from the federal program. I think few people know this and so you have people like Senator Wyden, out of Oregon, who had his own healthcare plan, and other folks around the country saying, “okay, states, you don’t like the federal program, innovate your own and ask for a waiver.” Now some of the more progressive folks are saying, “Well, let’s take the public option to the states.” I don’t think that you are going to see that in Virginia because of the way the politics work here but it doesn’t mean we can’t think of different options for our Commonwealth, the Commonwealth of Virginia, to see if we can come up with a program that may work either in collaboration with the federal program or independent of the federal program. It has to make sure that we insure people in greater numbers than we do at present but there are some waiver provisions in there that people may explore over time.

JAN PAYNTER: Along those lines, in your view, in Richmond, is there an appetite for increased creativity in terms of looking at options going forward? Are positions hardened? How easy is it for people to work together?

DAVID TOSCANO: It is an interesting question because you hear the rhetoric all of the time, more competition, free enterprise, the market, innovation, creativity, but when you look at what the legislation is, the legislation is essentially saying, “no federal involvement”. And so the politics in Richmond right now are really politics of opposition. Politics of “just say no”. One of the first bills that we considered out of the box when we went down there in January was a bill called “the Virginia Health Freedom Act.” You love the name.

JAN PAYNTER: Yes.

DAVID TOSCANO: It basically said that nobody in Virginia should be forced to have to pay for health insurance and that the state was going to act to nullify any federal legislation or federal regulation that would force people to do that. That bill passed out of the house, I think that I was one of like twenty-five people who voted against it, it passed out of the senate, it has been signed by the governor, and Attorney General Cuccinelli is using that for one of the basis for his lawsuit challenging the federal legislation on healthcare. So that has been the attitude down at Richmond is essentially, “Just say No,” not try to fix it, “Just say No.”

JAN PAYNTER: You raise some thing. My next question was going to be the legal feasibility, is there a sound legal basis for challenge within the state for healthcare?

DAVID TOSCANO: Well, you know, I am not a constitutional lawyer, but I am an attorney and I do read what other people say. As you well know, our attorney general, who from the beginning of his campaign through the time he won and took office, has said that he is going to fight federal, what he calls, intrusion into state operations and he will sue. In fact, one of the things he did was sue to allege that the federal government had no regulation to deal with the issue of climate change. And about three hours after the bill was signed by the President in the healthcare arena, he walked across the street to the federal courthouse in Richmond and filed suit saying that the bill was unconstitutional. He did this separately from a number of other attorneys general, again fairly conservative attorneys general, across the country who have filed suit jointly to challenge the federal regs. The Cuccinelli suit is based partly on the Virginia Health Freedom Act, he alleges that because the legislature has taken a position that we oppose the federal legislation that he ought to be able to use as a way to say, “Virginia ought not have to participate.” But he will also make other constitutional arguments that it violates the commerce clause, that the 10th Amendment trumps the federal legislation and therefore the legislation is unconstitutional. The legal scholars, however, say that that is really an uphill fight that he is going to have a very difficult time.

JAN PAYNTER: That is what I understand. I was just really interested to hear your take on that.

Nursing, I know that many qualified applicants, as you again point out in the website, are turned away because there are not enough schools for people. What kind of funding might go forward to address the nursing shortage that we have?

DAVID TOSCANO: Well the good news is that we have tried to put some additional money in the pipeline that would build capacity at institutions like UVA. We helped fund an expansion to the nursing program, the Capital Funds, and we help fund some new faculty because what we are seeing across the country is that there are a lot of folks who want to enter the profession but there are no spaces for them in the schools. It is not a question of bringing people who are unqualified, these are very well qualified folks who seek these slots but we don’t have the faculty and we don’t have the physical plant. And so the legislature over the past few years have tried to put some more money there. Now this year we were not able to do much because of the fiscal crisis but I think long term, we are going to have to do more. Because with this new federal initiative in health insurance, there are going to be more people who hopefully will be going to physicians and nurses to try to stay well that is part of the purpose of getting some health insurance so that people don’t wait until they are seriously ill before they see a doctor or a nurse. And that is going to increase the demand for both nurses and for doctors.

JAN PAYNTER: It is interesting, I know in some countries they actually pay doctors if people stay well which is a different kind of concept but might have some merit. What kind of tax credits are now available to employers as incentive for healthcare provisions?

DAVID TOSCANO: There are not a lot and you know people—for me, I wonder sometimes about tax credits because once you put them on the books, they are there forever. You might be better off trying to fund things during a budget cycle to say, can we provide some incentives here and some incentives there but then you review them again next year to see if you can afford them. Well, what we are finding in the state, there are so many tax credits and there are so many “tax preferences” and we are not sure that they always work the way that they are supposed to work. Take a tax preference like what is called the “dealer discount”. The “dealer discount” is a preference that has been provided to small business to help pay for them to collect the sales tax and rebate it to the state. Who takes the most benefit from that? Wal-mart, millions of dollars and they do the transfer of sales tax almost electronically now, it doesn’t cost them hardly anything and yet they get this bonanza. This is an example of a tax preference that perhaps outlived its usefulness and ought to be examined.

JAN PAYNTER: There have been a lot of votes for you that you just concluded on the 13th of March, would you talk with us a bit about some of the bills that you are most proud of, starting where you would like.

DAVID TOSCANO: Well, in first of all, I think that many of your watchers know that I am in the minority in the house. You know, I am a democrat, we only have 40 democrats in a 100 member house and so, I have to make sure that I can get some bipartisan support in order to get bills passed. So a lot of the bills that I take up are really local interest bills and bills in a specialized area. I am sort of interested in foster care and adoption; I sit on Courts of Justice, so that I am a unique position in a lot of the bills related to that go to that committee. So every year, I have three or four bills on adoption and foster care that I put in and I am very proud of those bills because we have really been making some really good progress over the last five years making it easier for people to adopt children in Virginia and making it easier for kids who are in foster homes to get permanent homes where they can rely on family to make sure that they don’t get into trouble, to make sure they have a good chance of getting a good job when they are out of high school or out of college. So I am most proud of those kinds of bills, but beyond that, there have been some bills of local interest. I had a bill related to safety at private damns. Now many people would not think that that was that significant but some folks in the Wesley Subdivision asked me to put into a bill to help them address a problem that they were having at safety with their damn. The regulations were going to force them to invest about a million dollars to upgrade their damn and I thought that was a little much, so we put in a bill. And as soon as we put that bill in for these local folks, I got calls from all over the state from people who were similarly situated so we got the regulations revised to give people more options for how they remediate their damns, keep them safe but not have to cost a lot of money doing that.

JAN PAYNTER: What kind of bills have you been involved with, David, which will improve education? We don’t have a lot of time today but we will try to touch on some of that through the pre-k, elementary, high school level. Talk about that, if you would.

DAVID TOSCANO: Sure. The biggest thing that I worked on, of course education is number one on my list. I am not on education committee and I am not on appropriations, so I have to argue where I can to increase the funding. When the budget left the house this session, it included a 35% cut in funding for the city of Charlottesville and a 15% cut in funding to Albemarle County; I had to fight against that. And before the conference committee came out with their budget, which is a reconciliation of the senate and the house, I was actively engaged in that process to make sure that Charlottesville got funded and that Albemarle got funded. And at the end of the day, they both had cuts but they were nowhere near where the house budget initially was and I think that is a great victory for our jurisdictions.

JAN PAYNTER: Why is pre-k so vitally important in education? This is something that people ask about a lot.

DAVID TOSCANO: If you ask business people around the state and around the country, they will say investment in children’s education as early as possible has a great benefit on their long term prospects for success. There are a lot of studies that have been done. And so, Governor Tim Kane, when he was governor, tried to push the pre-k initiatives, he got more money in the budget. There have been members of the house majority who have never liked that and have been gunning for that funding ever since. When the house budget came out there was pretty big cuts in pre-k education, fortunately a lot of those were restored, not all of them however because of the budget crisis that we are facing. But we were able to keep the programs in place and so ultimately when the financial situation improves, we will hopefully be able to get some more money into those programs because they are really critically important to young people as they grow older.

JAN PAYNTER: Another issue for a lot of people are charter schools versus public schools. What do you see as the role of the charter school versus public; how does that work together?

DAVID TOSCANO: We had a charter school program in effect in Virginia for a long time but it is probably one of the most restrictive charter school programs in all of the country. You really can’t get anything chartered unless the local school division says yes to it. Actually, two of the say four charter schools in the commonwealth are located within Albemarle County and we have lots of people here who think a lot about charter schools. I think that we have to open it up a little bit more. I think, you know, a little more competition does not hurt. Now when you talk about vouchers that is a little kettle of fish that is when you are taking money away from the public schools and giving it to private schools. Charter schools are different, charter schools create some innovation. If you go through the local school division, they know what is going on and they can pass muster on the school provision. We did pass a bill this year that I thought was very interesting that creates the possibility of laboratory schools where a local school division would team with a university to provide for some innovative programing and perhaps a school within a school. Again the notion being innovation, creativity, and make sure that you benchmark your progress to see if it works.

JAN PAYNTER: That was one of the things that I thought was so exciting is that there is more university involvement with the schools at every lower level and it makes complete sense and businesses also. One of the most disturbing things I read, and I am sure you saw this, March 11th, was about a school in California and we all know they are having their challenges, and she gets up at 5 in the morning, travels an hour and half to go to a charter school outside of LA because she wants to go to UCLA, it is her dream, and there are very poor schools in her area. Now, 1200 kids are involved in this bussing program, there was funding for it and they cut it off. I think that it is emblematic of what is going on with our education system in this country. First of all, what is wrong with the picture? She should not have to bus out of her community to go to a good school and secondarily, if she does need to, we should have funding for these kids. So, increasing, I know that we are going to be talking about education.

DAVID TOSCANO: Well, that would not have happened in California twenty-five years ago and then there was a tax revolt and they stopped funding their public schools. You know, great commonwealths and great states just don’t happen; they are a product of decisions, good and bad, big and small that legislators make and we need to make sure that we preserve a level of funding for public education because we cannot afford to let our system languish.

JAN PAYNTER: I agree. For someone who is considering entering the life of public service, David, because of course, politics matters, what would be your best advice and council?

DAVID TOSCANO: Get started locally and get started in something that you feel passionate about and public service is not just about running for office; it can be serving on boards of commissions, it can be serving on a nonprofit board that has an impact on people’s lives. You know, I went to an event this last weekend for the Boys’ and Girls’ club, what a wonderful organization, you don’t think of it as public service but every person who sits on that board, every person who goes an event, is engaged in public service, trying to help young people get a head in society.

JAN PAYNTER: I think that it is readily important, as obviously you do. David, many thanks for being on the program and sharing your thoughts with us today, we thank you at home for listening, and for your participation. As always, we would like to hear from you. We welcome your emails on any and all questions covered or not covered in the program. You can reach us at info@politicsmatters.org, we air at Saturdays at 8, Tuesdays at 8, and Thursdays roughly 3:30, sometimes it is a bit of a moveable feast, on Channel 13, Charlottesville Public Access.
Thank you and until next time and thank you again, David, I am Jan Paynter and this is Politics Matters.