2017 Elections Special Edition Candidates for Lieutenant Governor

Greetings! This is the second of three Special Edition newsletters to help you get to know the 2017 candidates. This week's issue focuses on the candidates for Lieutenant Governor. Next week we'll introduce you to the candidates for Attorney General. If you missed our profile of the candidates for Governor, click here .

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Meet the Candidates for Lieutenant Governor!

On Tuesday, November 7, Virginians will go to the polls to elect our next Governor, Lieutenant Governor, and Attorney General, as well as the full House of Delegates and a number of local officials. VHHA's Political Action Committee, HosPAC , invited all six major party candidates running for statewide office to visit with hospital leaders this month to share their positions on critical health care issues. Below, we will share some of the written responses to a candidate questionnaire from the two candidates for Lieutenant Governor.

JUSTIN FAIRFAX Democratic candidate Attorney in Fairfax County Dental practice small business owner Former Asst. U.S. Attorney

JILL HOLTZMAN VOGEL Republican candidate  State Senator from Shenandoah Valley Ethics attorney and law partner Former RNC Chief Counsel

Why do you want to be lieutenant governor?

FAIRFAX : I’m running for Lieutenant Governor of Virginia because I’m passionate about giving people the same shot in life that I got to have — economic security and opportunity no matter where they start. I want to make sure more people have the chance to send their kids to college. I want to make sure more people can buy their own homes, get access to capital and start and grow their own small businesses. And an important reason why I'm running is that I strongly believe that everyone has a right to quality, affordable health care in this country and in this Commonwealth.  VOGEL : I am running for Lieutenant Governor because I believe Virginia can once again be the nation’s best state to live, work, and raise a family, if we enact the right policy reforms to create jobs, grow our economy, and address some of the Commonwealth’s biggest challenges, including health care, education, and transportation. I believe Virginia must be a well-managed state under the steady hand of leadership focused first on solving problems. To that end, we need leaders who never stop seeking opportunities for improvement and who remain committed to working with legislators, stakeholders, issue advocates, and members of the public in passing meaningful legislation which addresses Virginia’s challenges in accordance with quality evidence and research detailing where we can make a positive difference.

If elected, what issues do you anticipate being the primary focus of your work as lieutenant governor?

FAIRFAX : My primary focus as Lt. Governor will be to expand economic growth throughout the Commonwealth. To do so I will work towards building economic security and opportunity for all Virginians by expanding access to capital, ensuring equal pay for equal work, and raising the minimum wage. I will also work to improve our K-12 public education system, make college more affordable, and expand access to vocational training and certification programs to connect workers with unfilled jobs. My other top priority will be to work to reform our criminal justice system by taking a smarter approach to juvenile justice, ending the “school-to-prison pipeline”, changing the punitive priorities of our drug policy, and introducing bail reform. VOGEL : Although Virginia’s next Lieutenant Governor will face the full spectrum of policy challenges, I plan to focus my efforts where they can do the most good for all Virginians, which begins with growing Virginia’s economy and fostering a favorable environment for job creation. Virginia must also be a well-managed state, focused on the efficient delivery of high quality services such as education, transportation, and public safety, in line with evidence and research showing where public spending does the most good. Finally, Virginia’s leaders must listen to patients calling for greater affordability and access in health care, which as the surveys show, has become the most single important issue in this year’s elections. Although the ACA limits which health care initiatives may be pursued in Richmond, we do have a number of opportunities to improve our health care system by keeping costs under control and expanding affordable access to care.

What are the greatest health care challenges facing the Commonwealth? How would you propose addressing these challenges?

FAIRFAX : The greatest health care related challenge facing the Commonwealth is that too many Virginians are unable to access affordable, quality coverage. I will fight for Medicaid expansion in Virginia so that we can increase access to health care and cover the 400,000 Virginians who are not covered today. Doing so would create upward of 30,000 new jobs and bring billions of dollars into the Commonwealth. The financial conditions facing Virginia’s hospitals also constitute a major challenge. The federal Affordable Care Act of 2010 was a major piece of legislation designed to make comprehensive changes to the nation’s health care system.

Centra Health President and CEO E.W. Tibbs Jr., Sheltering Arms Hospital President and CEO Mary Zweifel, Vibra Hospital of Richmond CEO Linda Tiemens, Democratic Lieutenant Governor nominee Justin Fairfax, Health South Rehabilitation Hospital of Fredericksburg CEO David Cashwell at the HosPAC Candidates Forum

While the ACA made cuts to hospital reimbursements, these cuts were designed to be compensated through dramatically increased enrollment in Medicaid because the legislation as passed required all states to expand eligibility in order to continue participating in the program. But in a turn of events outside the control of the law’s drafters, the U.S. Supreme Court decided in 2012 to make the Medicaid expansion optional for states. The Virginia General Assembly then proceeded to refuse to authorize expansion even though the federal government was paying 100% of the associated costs for several years. The result has been a financial squeeze on hospitals in states where Medicaid was not expanded, including Virginia. I want to address this problem by enacting Medicaid expansion. I understand how determined opponents of this program are, but this is a situation in which giving up is not an acceptable option. We cannot afford to turn down such a massive infusion of crucially needed funds and vital coverage for hundreds of thousands of Virginians. The opioid epidemic presents Virginia with another major challenge. Addiction is a healthcare issue as much as it is a law enforcement issue. Virginia families are being destroyed through the effects of heroin, prescription opioids, and other drugs; we need to increase access to drug treatment and address the underlying causes of drug abuse. I also support mental health reforms. I will work with legislators and stakeholders to find solutions that eliminate gaps in mental health coverage, decrease wait times, and expand crisis intervention training and emergency services.

VOGEL : Although Virginia enjoys a world-class health care system offering the latest in medical innovation, persistent issues of cost and access limit health care options and quality for too many Virginia families. While government has a role to play in helping the most vulnerable among us, current programs such as Medicaid are in need of serious and meaningful reforms focused on improving patient outcomes and maintaining the solvency of these programs over the long term. Although the passage of the Affordable Care Act has largely federalized health care policy and left state lawmakers with a limited number of options to control costs and expand access, there are a number of things which Virginia can do absent federal authorization to begin improving health care now.

Inova Health System Vice President of Government Relations Jennifer Siciliano, Republican Lieutenant Governor nominee Jill Holtzman Vogel, Sentara Healthcare Vice President of Government Relations and Health Policy Paul Speidell at a HosPAC Candidates Forum

Virginia must embrace technological innovation as a way to increase quality and cost effectiveness in the delivery of patient services. Emerging technologies such as telemedicine offer new opportunities for overcoming geographic and mobility barriers to help connect patients with service providers capable of meeting their needs. Virginia must also remain vigilant and ensure our colleges and universities continue graduating enough doctors, nurses, technicians, and other health care professionals to meet the Commonwealth’s needs in the near term as well as the future. To that end, we must continue funding and maintaining a culture of excellence at our postsecondary institutions, which are known for graduating some of the most capable health care professionals in the nation. Virginia must also increase opportunities for advanced STEM-H education in our public K-12 educational system, to inspire students to consider careers in health care and the life sciences and help them get a head start on their education, allowing graduates to enter the workforce earlier, with stronger skills, and less student debt. Increasing competition through COPN reform must also be a top priority for Virginia. While complex, I believe that the Commonwealth’s COPN system can be reformed to function better in today’s health care environment, without unduly burdening health care providers who are right to be concerned about the impacts of certain government mandates on their capital expenditures and charity care programs. Virginia must approach this subject with a focus on finding evidence-based reforms which meet the needs of multiple stakeholder groups, through a deliberative and detail-driven process. Simply “reforming COPN” to check the box will not be enough – a passable legislative solution can only be achieved though finding common ground. Virginia must also remain vigilant to control costs associated with unnecessary lawsuits and their role in contributing to unacceptably high premiums for medical malpractice insurance. Doctors should be doctors, and we must seek malpractice reforms when too many providers find themselves making too many decisions based on tort considerations, rather than medical necessity. The so-called practice of “defensive medicine” existing outside medically-accepted protocols and standards of care benefits no one when wasteful spending raises systemic costs. These are a number of opportunities for reform which maintain our commitment to a high quality health care system, while maintaining private insurance as a core element of our system. I do not agree with proposals for a single payer health care system which would functionally end private insurance, reduce patient choice, and lower the quality of care at great taxpayer expense. Private insurance has an important role to play in delivering cutting-edge treatments which make the quality of American medical science the envy of the world. Those who have private insurance and like it should be able to keep it. Efforts to reform what is not working well, or expand access to care, should not come at the expense of those whose coverage meets their needs and who wish to keep their plan. Whether imposed nationally, or under a state option similar to Medicaid expansion, I will oppose the implementation of a single payer health care system in Virginia.

What are your views on hospitals and health systems and the role they play in Virginia?

FAIRFAX : Our hospitals and health systems are the backbone of medical care in Virginia, and they do exceptional work under difficult circumstances. Many provide service around the clock and are often a community’s only nearby option for critical care. They are often a major employer for many regions as well. Hospitals and health systems are expected to meet high performance expectations and serious financial challenges simultaneously--a combination that most businesses and service providers do not have to face. I plan to work together to collaborate on the laws and regulations the govern health care at the state level.  VOGEL : Virginia’s hospitals and integrated health systems deliver a world-class quality of care through a dedicated commitment to professionalism and the best interests of patients, and are important stakeholders in the health care policymaking process. In recognizing the value added by Virginia’s providers, we must remain committed to working with the health care community and leveraging its subject matter expertise to improve on what is working well and keep Virginians healthy.

You have recently visited a number of hospitals. What has been the most significant take away from your visits?

FAIRFAX : The health care profession and hospitals in particular, are subjects close to me. My late maternal grandmother, who took my family in when I was a child, was a nurse at Freedmen's Hospital in Washington, DC. I have had the opportunity to visit several hospitals recently, including the world-renowned St. Jude Children's Research Hospital in Memphis last year. Hospitals do crucial work, and their funding issues are often unnoticed by most people. Virginia’s hospitals need additional resources, particularly those in rural areas, and would benefit tremendously from Medicaid expansion. They would also be helped by a statewide push to fill middle skill jobs, which would benefit those hospitals that are short-staffed for qualified applicants in key positions. VOGEL : Over the years, the opportunity to visit hospitals and interact with our health care professionals has been tremendously informative of my approach to health care policy. When visiting our top notch facilities, I can’t help but notice how the dedication and expertise of providers leads to meaningful improvements in the quality of life of all those they serve. Retaining this patient-focused approach must be a top priority among Virginia’s lawmakers. I firmly believe that providers should be able to focus on what they do best: caring for the sick and promoting wellness. Doctors should be doctors, and to that end, government should refrain from imposing excessive burdens, mandates, or requirements which detract from the quality of patient care. Doctors should work seamlessly with technology, not find themselves tied up in new tape from misguided mandates imposed by politicians, rather than patient care experts. Doctors should not live in fear or financial peril as a result of excessive litigation. We should recognize that health care is inherently fraught with risk, and that the vast majority of our providers act with the highest degree of professionalism and adherence to protocols and established standards of care. When doctors take their oath, they first pledge to, “first, do no harm.” I believe lawmakers should approach health care with the same view.

Click here to read more about Justin Fairfax's positions on legislative issues. Click her e to read more about Jill Vogel's campaign priorities.

Full disclosure! HosPAC has made financial contributions to both Jill Vogel and Justin Fairfax's campaigns. Neither HosPAC nor VHHA have endorsed any statewide candidates.

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Remember to VOTE on Tuesday, November 7!

Voter Registration Deadline is Monday, October 16! You can check your voter registration status, update your address (deadline 10/16), or request an absentee ballot (deadline 10/31 at 5 p.m.) on the State Board of Elections website . On the Ballot on November 7: Governor Lieutenant Governor Attorney General All 100 seats of the House of Delegates Some local offices and propositions Get a preview of who's running in your community by entering your address here: What's on My Ballot?

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Support HosPAC!

HosPAC  is VHHA's Political Action Committee HosPAC's mission is to provide members with a means for organized and effective political action, to support candidates who will work to improve quality health care supported by the Virginia hospital and health system community, and to promote efficient and responsible government. HosPAC is governed by a Board of Directors composed of hospital and health system leaders.  HosPAC's purpose is to support state candidates. The HosPAC Board evaluates candidates on their qualifications for public office, recommendations from local hospitals and/or health systems, issue philosophy, voting record, leadership roles, ability to be elected and the need for financial assistance.  After weighing these considerations, the Board then disburses money to the campaign committees and candidates who have been determined will best support quality health care initiatives and services that are vital to Virginians. With all 100 seats of the House of Delegates up for election, meeting this year's campaign goal is more important than ever! If you would like to contribute, please visit  www.vahospac.com. HosPAC participation is voluntary and not tax deductible.

Thank you for supporting Virginia hospitals!

VHHA's Advocacy Team is on the ground every day advocating for patients, hospitals, and the communities they serve, and we are excited to help you be a part of it! Julie Dime, Vice President Government Advocacy, jdime@vhha.com Dave Nutter, Regional Director for Community & Member Outreach, Southwest region and rural health policy, dnutter@vhha.com Mary Margaret Whipple, Regional Director for Community & Member Outreach, Northern Virginia region, mwhipple@vhha.com Kelly Cannon, Director of Community & Member Engagement, grassroots advocacy, kcannon@vhha.com Matt Strader, Director of Federal Affairs, mstrader@vhha.com Jennifer Wicker, Director of Intergovernmental Affairs, behavioral health policy, jwicker@vhha.com Allison Lawrence Jones, HosPAC Director, aljones@vhha.com Victoria Quigley, Advocacy Assistant, vquigley@vhha.com Please don't hesitate to reach out to any member of the team, and contact Kelly with your feedback or suggestions for topics to cover in future newsletters. Thank you!

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