Virginia's 39th House District
Vivian's Views: Human Services
My Commitment to You
The Commonwealth of Virginia has a duty to focus on developing the independence of those who cannot provide for their own basic needs, assure professional standards are met, and enhance the delivery of services by private, charitable, and local and state government providers.
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.
Long before the inconceivable tragedy of Virginia Tech, informed legislators knew Virginia lagged far behind in 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, initiating prison mental health services, and being executive director of a non-profit working with the severe child abuse / neglect and the emotional damage it creates.
Commissions and legislative committees spent countless hours looking at what Virginia Tech revealed about our mental health system. In 2008, 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.
However, many 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 made in 2008 had been undercut by other budget priorities. In November 2013, another personal tragedy -- often bourne alone -- captured headlines. State Senator Deeds was repeatedly stabbed by his 24-year-old son who had been court-ordered to a psychiatric facility ... but no bed was found. His son committed suicide.
In 2014, a Joint Senate/House 4-year Study of Mental Health was established. Senator Deeds chairs the study. I am grateful to be a member and pray we can spearhead long term effective reform. My long-standing concerns include:
the impact of multiple deployments on our military and their families, particularly Guard and Reserve who don't return to the mutual support network of a military base;
- The Army reports 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. The suicide rate of recent veterans is 50% higher than similar-aged civilians; it is twice as high among female veterans.
the increasing number of people with mental health diagnoses who end up in jail, which is now at least 1/4 of the jail population;
- Half exhibit severe disorders, such as schizophrenia, bi-polar, major depression, post traumatic stress disorder (PTSD), or an intellectual disability. Law enforcement too often has been the first responder to mental crises experienced by people no longer warehoused in psychiatric facilities. Jails are not equipped to provide services or even continue prescribed medication. We need significantly expanded Crisis Intervention Training, expanded community mental health staffing for expedited diagnosis, and wide use of personal advanced mental health directives to divert significant numbers into treatment.
the role and accountability of community services boards and state psychiatric services;
the legal balance of due processes, as well as more appropriate information sharing.
In addition, I have long been concerned about not recognizing multiple disorders and unrealistically categorizing people into just one targeted program. For example, substance abuse and depression often co-exist with lack of physical functioning. It's not just real life experience: indeed, incredible breakthroughs in brain research are now able to document the fallacy of old ways of thinking which don't incorporate physical functioning of the brain and a person's behavior.
I'm hopeful that the re-definition/consolidation of service waivers, which must be in place by July 2016 under Virginia's 2012 settlement agreement with the U.S. Department of Justice, will address this concern. The agreement states
The Commonwealth shall not exclude any otherwise qualifying individual from the target population [I/DD] due to the existence of complex behavioral or medical needs or of co-occurring conditions, including but not limited to, mental illness, traumatic brain injuries, or other neurological conditions.
Comprehensive reform of all service waivers is important to include mental health services in services for someone who's abusing drugs to deaden the trauma of child abuse, TBI, sexual assault, or combat PTSD. Treating depression might be indicated for someone receiving technology assistance.
INTELLECTUAL (ID), DEVELOPMENTAL (DD), AND HEAD INJURY DISABILITIES
As of September 2015, 8,193 persons were on the ID waiting list for services – double the number in September 2008 – despite more funds added to every budget to reduce the waiting list by creating more Medicaid waiver slots. Unfortunately, at times, the funds added – to allow more persons on the waiting list to live independently and out of a costly residential facility – came from reducing the amount paid providers of those services. The result is it's hard to find people who will provide services at the low wages the State pays and the waiting list grew even faster in high cost areas like Fairfax/Falls Church – which went from 515 in 2008 to 1,335 today.
The funding challenge is at least as great for services to keep people highest functioning and least costly setting who have Developmental Disabilities (diagnosed before age 22), who need Technology Assistance, who are Disabled because of injury, or who are Elderly.
While I'm hopeful there'll be spin offs that better serve the needs of others as well, the DOJ settlement agreement is driving much of what is being done to serve I/DD individuals. For example, it was the settlement that forced Virginia's funding of additional I/DD Medicaid service waivers, which must total 4,170 by 2021. While federal programs will pay over $900 million, the total cost of providing community services for most of the 6,000 who were in the 5 training centers and is estimated to be $2 billion. Depending on the actual cost of operating adequate community programs, savings from closing 4 of the centers may reduce Virginia's net cost increase to $340 million.
Part of the cost is accurately determining each person's ability to function in a less restrictive environment, including ongoing oversight of a large number of small programs. For those who can't live without highly specialized 24/7 care, the Southeastern Virginia Training Center in Chesapeake will be kept open. Having just one such center will bring Virginia in line with the vast majority of states. However, because the DOJ agreement does not require that we have only one facility serving those with the most severe disabilities, I support using several small intensive care nursing facilities to supplement the Southeastern Center's 75 designated beds. This will allow people who live far from almost the furthest S.E. corner of Virginia to have more contact with severely disabled family members. One location under consideration is near Fredericksburg.
I deeply regret I wasn't successful in getting local interest in developing the invaluable state property that is the site of Northern Virginia Training Center as a regionally-supported campus for small, non-institutional facilities to meet the specialized needs of individuals while allowing them to remain close to family members. The 81 acres could have been developed as a community setting that would include non-profit sheltered workshops, townhouse development for on-call medical personnel, housing that could be purchased for disabled family members, clinics for services and counseling, as well as having the NVTC pool and gym available. In providing a life like ours for as many as possible, we must meet the wide spectrum of highly individual needs.
ASSISTED LIVING FACILITIES and NURSING HOME STAFFING:
HEALTH CARE COVERAGE
Virginia loses $4-$5 million a day in federal funds available to expand Medicaid to 400,000 un-insured people living in poverty – 70% are in working families but earn less than $32,000 for a family of four or $15,302 for one person. Two objections are repeated again and again in General Assembly debate: (1) Medicaid must be reformed and (2) the federal government won't pay its share.
- Reform: I certainly agree we have a duty to improve any program but, for two years in a row, Virginia is first in the nation in Medicaid fraud recovery. In fact, there have been 61 audits since 2002. Frankly, being 47th in Medicaid spending, Virginia doesn't have much room for waste, fraud and abuse.
- Federal Share: Under the Affordable Care Act, the feds pay 100% until 2017, dropping to 90% by 2021, which still far exceeds the 50% federal share of basic Medicaid that Virginia has been getting for decades.
Beyond the humanity of expanding healthcare, here are the dollars and cents facts as I see them:
Adults whose only source of health care is the emergency room drive up hospital costs and insurance rates for all.
Expansion would use managed care to prevent problems from getting worse and more costly to treat, as well as under-cutting a wage-earner's ability to support his or her family.
Medicaid expansion would draw 90% federal funding for expenses we now pay solely out of state taxes for prisoner healthcare, care for the poor in university teaching hospitals, and mental health services.
Expansion would create over 30,000 jobs.
Virginians have already paid the federal taxes to fund expansion and are getting nothing in return. The Virginia Chamber of Commerce said it best about how this affects employers: "Insurance premiums for Virginia's businesses have risen 32% faster than the rate of inflation, in part because of the cost shifting due to the uninsured. Over the next 8 years, Virginia businesses will incur $16.4 billion in ACA-related taxes to pay for federal health care reform. A private option plan will allow Virginia to take control of $15 billion of its federal tax dollars and put them to work for Virginia ..."
In fact, in 2015, we not only refused the share of the federal taxes Virginians paid, but we used $85.6 million in state taxes to pay 50% of the cost -- instead of just 10%! -- of Medicaid services for 21,600 severely mentally ill adults with less than $10,000 income, dental care for 45,000 poor pregnant women, and 35,000 additional children under Medicaid. Even worse, only state tax dollars were used to add $4 million for community clinics who had to turn away 10,000 in 2014. Finally, worst of all, even with this squandering of state funds, we did not come close to meeting the human need: Expanding Medicaid would provide services to approximately 77,000 uninsured adults who have a mental illness -- we reached only 1 out 3.
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, I believe the very complex decision of when life begins is deeply personal, moral decision. I will continue to defend that position in all of the challenging and many-faceted 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; a person’s right to have an advanced medical directive carried out; and stem cell research in the treatment of disease and disabilities.
Most of us take family planning for granted. And, yet, the House of Delegates overwhelmingly passed a “personhood” bill, in 2010 and 2011, declaring that in the instant egg and sperm join, a person is created. Therefore, anything that keeps a fertilized egg from implanting in the uterus becomes an abortion. The following from the "Human Life Alliance" (www.humanlife.org) distributed during the 2011 session confirms that position:
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...
I offered a floor amendment to the personhood bill to ensure it wouldn't apply to FDA-approved birth control. I wanted to make sure every House member knew that without this amendment they’d be voting to ban contraceptives. Nevertheless, my amendment was summarily rejected and the bill passed 66 to 32.
For more than a decade, bills to protect FDA-approved contraception have died in committee. Biotech bills can’t get passed without language defining a fertilized egg as a fetus. I hear advocates talk about Virginia being a test case to challenge the U.S. Supreme Court. I am deeply concerned. It wasn’t until the year my second child was born – 1965 – that the U.S. Supreme Court finally ruled states couldn’t outlaw birth control. I do not take that ruling for granted.
Women’s Health Care
Virginia became the brunt of national, late night TV ridicule over the 2012 ultrasound bill. The embarrassment dragged on for over a week because supporters really didn’t know how ultrasound worked – they had no idea the bill would mandate a transvaginal probe well into the first trimester. Even though the bill was changed to only require abdominal ultrasounds, it still contained other provisions that override sound medical practice. 1 in 4 women experience a miscarriage. Women with a problem pregnancy – often wanting so much to have a baby – have been denied full, compassionate, emergency medical services because now a doctor cannot act until an ultrasound is taken – even if there is no fetal heartbeat, even if the woman is hemorrhaging, even if she is under diabetic stress. The Virginia Medical Society strongly opposed such unprecedented intrusion on a doctor's professional judgment.
Such lack of knowledge often shows up in bills that aren’t really to protect women’s health but are to end abortions. For example, in Virginia, any abortion after the first 13 weeks must be in a hospital. Consequently, there's no need to put expensive hospital requirements on clinics – except to force them to close. With each clinic closure, low income women lose access to family planning, cancer screenings, and prenatal services.
The rare medical need to end a pregnancy after the first trimester but before viability outside the womb was thoroughly reviewed in the 2000 Supreme Court ruling in Nebraska v. Carhart. Abortions in this time frame are typically forced by the woman's dangerously deteriorating health related to diabetes or poor kidney functioning. I read the Carhart decision in full. I was impressed with the medical concerns considered in detail by the Court and will continue to vote against bills to bar late term abortions.
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.