The Politics of Autism

March 12th, 2010

The ubiquitous message ribbons attached to vehicles are part of our culture.  Look closely at the one promoting autism awareness and you will see that its pattern is one of a jigsaw puzzle.  As puzzling as the disorder itself is, so too are the political alliances it spawns.

For several years legislative attempts have been made to provide assistance to families raising children with disorders on the autism spectrum.  So far, only one has passed the Senate and House – one by Republican Senator Richard Stuart that would provide attorneys fees for those who have gone to court to force successfully their school division to provide their child the special educational plan they believe to be necessary.

Attempts by two Henrico legislators, Senator Walter Stosch and Delegate Bill Janis, to provide limited tuition assistance grants to parents who take their children out of the public system and place them in schools specializing in educating children with special needs have failed several times.  Much of the opposition came from the education establishment which consistently fights against any form of school choice.

So far, the political patters runs according to form.  Republicans favor school choice of a sort.  Republicans support the private citizen when confronting government. But what happens when the crucial issue of insurance coverage arises?  That’s where it really gets interesting.

Senator Janet Howell (D – Fairfax), Delegate Bob Marshall (R – Prince William) and Delegate John O’Bannon (R – Henrico) might seem an unlikely political trio.  Yet, they have taken the lead in seeking to have early diagnosis and treatment of autism a mandated benefit in private insurance policies.

Resistance to mandated benefits is an article of faith among free market and pro-business legislators. The bills to require an autism mandate never cleared the committee level in the Senate last year.  This year Howell’s SB464 passed the Senate 27 – 13 with bipartisan support.

In the House, Marshall’s bill was rolled into O’Bannon’s HB303.  The sub-committee that considered it was the same committee that last year declined to take a vote, killing it by inaction and thereby infuriating the bill’s supporters.  It failed again this year but only on a tie vote – 3 R’s and 1 D in favor, 2R’s and 2D’s in opposition.

The politically muscular insurance lobby adamantly opposes the mandate as do other business interests.  Despite it’s number one business friendly ranking, Virginia now ranks second or third among the 50 states in the largest number of mandated benefits.  The autism mandate supporters counter that for the average family, the premium for employer-based health insurance Virginia ranks number 21 and that employers contribute less than the national average.

Mandate supporters further (1) cite an actuarial report they commissioned indicating premiums would increase far less than 1%, (2) assert that the money spent on early detection and treatment saves the state money in later treatment in the school system and (3) maintain that the enhanced economic productivity as adults of children treated early and effectively will more than pay for the cost of childhood treatment.  Who knows?

What we do know is that the battle is far from over.  The insurance industry staunchly believes that the school system is responsible for the individualized education and thus treatment of every child. Says chief lobbyist Doug Gray, “We have an established policy in the country and in the Commonwealth that education is where you deliver services for these special needs.  Schools are not supplying it in an even way which is not surprising.  Rich district are supply a lot, poor districts not so much.  But even in rich districts they’re not supplying as much as the parents want.”

On that point the lobbyist for Autism Speaks, Angie Bezick, agrees.  “The schools just can’t or don’t provide all the treatment the children need in the educational setting.  That’s where the medical issues arise.  Autism is not just an educational challenge.  It’s also a medical condition. It’s a hybrid,” she repeats over and over.

In fact it was the testimony of Dr. Paul Law of Johns Hopkins in part that swayed Sen. Dick Saslaw, perhaps the most pro-business Democrat and a previous opponent of the mandate.  Before a Senate committee Law testified that since 1943 autism has been recognized as a “neuro-developmental, neurobiological and neuropsychiatric disorder and is the domain of pediatricians, developmental pediatricians, neurologists and psychiatrists.

“Intervening early, while children have neuroplasticity and their brains can be impacted the greatest, is of paramount importance.  For many children it will make the difference between growing up to be productive members of society who live independently versus requiring life-long intensive supports,” Law said.  Following his remarks Saslaw said, “You heard him folks.  It’s medical.”

That doesn’t change the policy question for Gray.  “Should we (insurers and their insured) pay schools for something they’re required to do under federal law?” he asks.  “On the policy issues the legislators agree with our position.  They understand that its an educational requirement. They understand there’s a coordination issue that needs to take place. They understand that if you create a benefit it will be abused.”

On that last point Bezik strongly disagrees.  “No one wants to have their child labeled autistic who isn’t.  Caring for them and treating them is more than a full time job. That’s why they are so desperate for help from the General Assembly,” she says.

Gray attributes that desperation and the sympathy it evokes from many lawmakers as the impetus for the mandate’s support.   “When it comes to voting some of them will switch just because of the emotion. After it passed the Senate a number of people who vote for it came up to me and said, You are going to kill that in the House, aren’t you?

Naturally, Besik disagrees.  This year was her first in lobbying for the loose coalition of Virginia autism awareness advocates.  She helped school them in effective lobbying.  In past years some of their zeal worked against them on occasion. She also procured the medical testimony and the actuarial data on costs.  “Our arguments were based on facts and sound science,” she insists.

So, on a 4-4 tie in a House sub-committee the bill died this year.  What about 2011, an election year for the House?  Bezik assures all the parents will be back. They are so engaged because they know every year lost in early treatment is a year that can never be recovered,” she observes.

At a meeting of the Allied Health Caucus that addressed autism, freshman Delegate Scott Garrett who is a physician noted, “We come down here and we are considering stop signs and intersections, then autism plops into your family and it’s a life changing event for everyone.” Apparently, it can be not only puzzling but politically life changing as well.

The McDonnell Factor

March 12th, 2010

When asked by a center-left acquaintance what kind of Governor Bob McDonnell would be a few months ago, the Grapevine replied, “I mean this as a compliment. Bob McDonnell has never seen a problem he didn’t think he could help solve.”  Now that the final days (hopefully) of budget deliberations are upon us, the Governor is proving the Grapevine right.

Since the budget conferees were made known, McDonnell has called them over to the Mansion or his office numerous times.  In an op ed in Sunday’s Richmond Times - Dispatch and distributed by email by his PAC, McDonnell struck an optimistic tone with phrases such as “a process of collaboration” and “heartened by common ground” and “an atmosphere of candid dialogue.” But will it hold up through the final days?

Senate Majority Leader Dick Saslaw (D - Fairfax) gives the Governor “A” for effort but “Incomplete” for results.   “I know he means well.  But he’s never been on the money committee so he doesn’t understand how it works.  I just wish he wouldn’t call another meeting every ten minutes,” Saslaw says.

One veteran reporter who has covered more than a decade of budget conferences opines that some of McDonnell’s actions have actually hindered negotiations.  The journalist cites the proposal to adjust the local distribution formula for school funds and his release of his budget wish list just four days before the money committees’ deadline for action.

“He’s trying to be Mark Warner, getting everybody to agree.  But Warner’s approach was to work on them (the legislators) one-on-one over dinner.  Tim Kaine never learned how to do that.  He thought he could get everyone over in one big room and work it out.  McDonnell so far seems to be trying the Kaine approach,” says the source.

Not unsurprisingly, Republican conferees hold a more positive view. Senior House Republican negotiator Kirk Cox (R - Colonial Heights) notes that McDonnell’s Secretary of Finance Ric Brown has been made available to the conferees with his third party, disinterested expertise.  Brown is a well respected careerist who has served under Republicans and Democrats alike.

“Governor McDonnell has urged both sides to come to the table and get the budget done on time.  He has adjusted revenues up to help the Senate (position) but also has stated he will not tolerate revenue estimates that are unrealistic and put us in the same situation we have found ourselves in the past,” says Cox in a not so veiled reference to Governor Tim Kaine.

Del. Chris Jones (R – Suffolk), the newest House conferee, observes, “Having worked with the Governor for 13 years, his willingness to help comes as no surprise. That is his nature and I appreciate it. Just as in other matters, the Governor makes his suggestions. Some we take; some we don’t. Now it falls to the budget conferees to finish the job at hand.”  The sentiment of Jones seems to be shared by others.  McDonnell has done his part.  Now it’s up to the legislators.

In 2006, fearing a voter backlash if a transportation solution was not found, then-Attorney General McDonnell brought the Republican leadership together on several occasions over the holidays to try to hammer out an agreement.  His efforts paid off to a degree.  House and Senate Republicans agreed on a joint agenda for the first time in many years. But the transportation part included the infamous abuser fees and as Dr. Phil would ask, “How’s that working out for you?”

Republicans left Richmond relatively united: but it wasn’t enough to prevent a demoralizing loss of seats in the House and the loss of their majority in the Senate. Time will tell how McDonnell’s intervention pays off this time.

Either way it adds up to a political plus for McDonnell.  If the negotiations succeed on time, he can claim credit.  If they don’t, he can say he tried but they, not he, couldn’t get the job done.  Surely McDonnell’s skilled press office is capable to spreading that message. His communications guru, Tucker Martin, insists, The Governor’s approach has been to act in a collaborative manner with the clear goal of getting a balanced budget passed, on time, without a tax increase. That approach continues.”

Rodney King once asked “Can’t we all just get along?”  Nineteen years later variations on the phrase can still be heard around the Capitol in Richmond.

Your Tax Is Bigger Than My Fee

March 12th, 2010

As House and Senate negotiators jostle over the budget, their refrains are the reverse of what we said as kids: “My (fill in the blank) is bigger than your (fill in the same).  When it comes to taxes and fees, senators and delegates each claim theirs are smaller than the other’s.  As they squabble, perhaps a new, more accurate vocabulary is needed.

Every Virginia governor submits a budget that includes a section entitled “Resources.”  The House budget report includes a section it calls “Funding Recommendations.”  The Senate uses the term “Resources.”  If a rose by any other name is a rose, so too is money coming from the private sector into the public treasury.  It’s still money…or” resources“…or sources of “funding.”

The back and forth between House and Senate this year has been among other things who’s raising taxes, whose raising fees, and what the differences are thereof.  Once upon a time, it didn’t much matter politically.  Fees were directly related to a service government provided some citizens but not all, hence the term “user fees.”  Taxes, on the other hand, fell on everyone regardless of their availing themselves of any particular government program.

But those days are gone.  With the advent of the Internet coupled with an aversion to anything called a tax increase by many, the political landscape is different.  No longer can office holders alone dominate the debate.  All citizens, taxpayers, bloggers and e-mailers are “free” to employ their own vocabulary.

What is a fee|? What is a tax?  Is it simply a matter of where it shows up in the state Code?

Income taxes pay for any and everything.  Ditto for the sales tax for the most part.  Right there you have over 70% of the state’s General Fund income. Some user fees are obvious, a fishing license, for instance.  You don’t have to fish.  But if you do, the license fee helps pay for the Department of Game and Inland Fisheries programs.

What about the gasoline tax – a tax or user fee? You don’t have to pay it individually if you don’t drive.  But does not everyone benefit from goods delivered over the Commonwealth roadways? And are not transportation costs built into every item we purchase?

While ruling our tax increases, Governor McDonnell has said increased fees are acceptable as long as they relate directly to a government service, have not been raised recently, and are not excessive.  So where is the line?  Is there a line?

Senators will say that reduced contributions to the Virginia Retirement System proposed by the House may represent new “resources” but simply shift the burden to future budgets. Delegates will say that new fees on court services the Senate proposes go far beyond that needed for court services. Senators will counter with a provision in the House budget that costs businesses $160 million in higher taxes.  And on it goes.

As the game plays into the final days, House Republicans tout their support of health care spending while Senate Democrats tout their support of public safety spending. Compassionate Republicans and tough on crime Democrats. Is there a role reversal taking place here?

While “All politics is local” may be Tip O’Neill’s best known saying, perhaps this quotation better illustrates what goes on in Richmond in the closing days of each session.  As the late Speaker of the U. S. House of Representatives once said, “The (House) Republicans are our opponents.  The Senate is our enemy.”

As “Alice in Wonderland” is splayed over local movie screens this week, perhaps a quotation from Lewis Carroll can sum up our dilemma: “When I use a word,” Humpty Dumpty said in rather a scornful tone, “it means just what I choose it to mean - neither more nor less.”

Quotes of the Week

March 12th, 2010

Who said it

“Perhaps some of the folks not from my part of the state haven’t been reading the Good Book lately.”

“My math tutor lets me do my homework in pink glitter pen.”

“Folks are way too glum and uptight this week.  There’s not a lot of love being spread around, much less humor.

Last Week’s Quotes and Sources

March 12th, 2010

I’m going to vote for Del. Nixon’s bill but I think it makes Virginia look absolutely silly around the world.” – Senator Janet Howell (D – Fairfax)

“Based on your legislative package this year, you’re still smoking funny stuff.” – Delegate John OBannon (R- Henrico) to Del. Harvey Morgan (R – Gloucester), the patron of a bill to legalize medical marijuana after Morgan admitted to smoke cigarettes that claimed to cure asthma as a teen

“Vegas doesn’t give you a teddy bear” – Lobbyist Jeff Gregson explaining before a House committee the different between charitable gaming in Virginia and legalized gambling elsewhere


Bolling Believes

March 2nd, 2010

Long before the votes were tallied in last November’s elections, Bob McDonnell and Bill Bolling had agreed on an unprecedented partnership should they both be elected.  The Lieutenant Governor would have more to do than merely check on the governor’s health or count to 20 in the Senate and break ties when necessary.  He would be a full partner in the Administration and direct McDonnell’s top priority: job creation.  But why Bolling?

Most voters and political observers have only seen Bill Bolling, the politician, either as a candidate or elected official.  There’s another Bill Bolling, the economic development zealot.  That keen interest in business recruitment began in 1991 in his first elective office as a freshman on the Hanover County Board of Supervisors.

Like most local governing bodies Hanovers placed each board member as a representative to other bodies.  For Bolling, it was the Metropolitan Economic Development Council, a cooperative economic development effort of the metro area’s governments.  Soon thereafter it became the turn for Hanover’s representative to chair the body.

Bolling, though, has never been one to be content with just wielding a gavel.  He prefers to roll up his sleeves. Accordingly, he asked the staff under him to put him to work; and they did.  Bolling spearheaded an effort to transform the governmental entity into a 50-50 public-private partnership.  The result is what we have today – the Greater Richmond Partnership, Inc. which is a far cry from its predecessor in terms of success.

When McDonnell tapped Bolling to be his cabinet level Chief Jobs Creation Officer, he got more than a figurehead.  He got a dynamo.  In fact, in an interview with the Grapevine he confesses, “What I’m really looking forward to is when the session is over.”

Aren’t we all?  But for Bolling it is so “We can get in the car, get on the plane and start traveling around the state and around the country telling the Virginia story. I’m really looking forward to it.”

For now though, Bolling is point man in advancing through the legislature McDonnell’s economic legislative package, his “Jobs and Opportunity Agenda.” So far, the effort is a relative success.  Every bill at the midway point has passed either the Senate, House or both.  Yet to be seen is how the Budget Conference Committee handles the requested funds.

Whether it is testifying before committees in public, making private phone calls to legislators who need a gentle prod, or squiring Sissy Spacek around the legislature on behalf of aid for the state’s film industry, Bolling says “virtually 100% of my time, outside of presiding over the Senate” is spent on the effort.

The stakes are high.  “Bob’s for Job’s” was as pithy a gubernatorial campaign catchphrase as “No Car Tax.”  Even the dimmest voter can remember a three-word slogan.  For Bolling the challenge is to make good.  As he puts it, “At the end of the fours years at least if we can look back and see we reduced the unemployment rate, we put people back to work, we turned the budget shortfalls into surpluses that will be a pretty good story to tell.

Bolling can tell a story.  He is never at a loss for words.  Last week at the Richmond Times-Dispatch, a forum on job creation for which he was the guest ran “into double overtime” as the paper put it.  To explain how expanding the economy takes the investment of scarce state dollars in the face of serious budget cuts in core areas takes some explaining.  And not everyone is buying it.

Legislators report that interest in economic development among constituents, judging by constituent surveys, phone calls and emails, is at an all time high.  Given the skepticism voters have over federal stimulus efforts, it will take someone with Bolling’s considerable skill at salesmanship to put it across.

Bolling doesn’t back down from the importance of his task.  “The time has passed when your economic development strategy can be waiting on the phone to ring. There hasn’t been a governor since George Allen that has put the emphasis on economic development that it needs,” he says.

He concludes, “If you know what you believe in and you believe in it passionately, you can usually find a way to get it across to somebody.”  Bolling believes.


Lyme Disease, Autism and Generic Drugs. What Next?

March 2nd, 2010

Just who could get excited about Lyme disease these days? What’s more, who could be so concerned as to go to an 8:00 am meeting in the dead of a cold, snowy winter at the end of a long work week? Oh, about a dozen or more members of the Virginia General Assembly.

There are caucuses for both political parties, for each region of the state, for conservative legislators, for Black legislators, for women’s issues, for sportsmen, for tourism, for Bible study.  And now here comes this year’s newest, the “Allied Health Caucus.”  Don’t these people have enough to do?

Attend a meeting though and you will find something rare in legislative life – a diverse group of legislators examining serious issues, with perhaps no big upside politically for tackling What’s more they do so in a highly respectful, collegial atmosphere.

The brainchild of Delegates Roseland Dance (D – Petersburg) and Scott Garrett (R – Lynchburg), the group has met three time so far.  Most but not all of its members have some professional tie to health care. Delegate David Toscano (D – Charlottesville) candidly states “the UVa Medical Center is a huge employer in my district.” Three physicians, an RN, a pharmacist, a health care administrator and others make up the caucus.  All share an intellectual curiosity about health care matters that spills over into their legislative lives.

Dance, representing inner city Petersburg and Garrett, whose district lies in the shadow of Liberty University, might seem to be a political Odd Couple.  But a chance conversation between the two led to the formation of the new caucus.

Both saw the need for a new venue to examine the issues. After all as Dance says “health care touches everybody.”  Dance contacted the House Clerk who supplied a list of legislators with health care experiences in their bios.  The list provided a beginning for membership recruitment.

Garrett stresses the group’s purpose is more than educational.  “Each topic we take up will have to relate to legislation we’ll be facing.  And what we hear will have to be based on sound science,” he insists.

And just what made Lyme disease a hot topic for kicking off a new caucus’s slate of meetings. A slew of bills from Northern Virginia legislators brought 176 people to a sub-committee meeting with conflicting testimony from experts on both sides of the issue.  Delegates were baffled.  Just who is the expert on Lyme disease after all?

Autism is another matter.  It has boiled over into the political arena in recent years.  Next week’s “Grapevine” will examine further “the politics of autism.”  Likewise, the legislative jostling between brand name and generic drugs is ongoing.  Little wonder, health care lobbyists line the walls of the caucus meeting room and outnumber the legislators at the table.

An interesting sidebar is the number of health professionals drawn to politics.  Not too many years ago there were no MDs in the assembly.  Now there are four.  The senior of them is Henrico neurosurgeon, Del. John O’Bannon.

Is it coincidence or a pattern? O’Bannon acknowledges that the American Medical Association has set out to encourage and equip doctors to run for office, going so far as to conduct campaign schools for potential candidates.

That strikes O’Bannon as highly desirable.  He asserts that doctors in their professional life have only one loyalty – the best treatment for their patient based on the best medical science.  With apologies to his attorney friends, he notes they are superbly equipped to serve as legislators.  They are trained to advocate both sides depending on the client and to cut a deal when necessary.

Health care professionals, he notes, treat one patient at a time.  In Richmond the opportunity is to influence the lives of thousands upon thousands with a single vote.

Who is not aware that health care costs are now one-sixth of the U.S. economy?  The decisions made at all levels of government touch the lives of everyone, perhaps as in no other policy arena.  They are truly life and death decisions being made.

So while the health care debate rages and enrages all parties in Washington, a bipartisan handful of Virginia legislators in Richmond quietly go about their business, dispassionately educating themselves and each other.  You have permission to be a little proud of your choice of lawmakers down here from time to time.  This is one of them.

What’s next for the caucus, you ask?  Oh, just childhood obesity followed by smoking as of now.  Not much.


Don’t Let the Facts Get in the Way

March 2nd, 2010

Delegate Jimmie Massie (R - Henrico) is comfortable in the world of business.   Armed with a BA in Economics from UVa and fortified with 28 years of experience in the world of finance and equity investment, Massie can read a balance sheet or prospectus.  But none of that helped him read the political minds of the Senate Finance Committee.

Massie is an ardent proponent of school choice.  His HB 599 this year would have provided a 90% tax credit for taxpayers who contribute to scholarship funds directed to providing assistance to low and moderate income families who move their child from a public to a private school.  Fully aware of the objections to similar measures from the education establishment in years past, Massie carefully crafted this years attempt to meet those objections.  But did it matter?

Unlike previous “voucher” bills which would send public funds directly to parents, Massie’s approach is to encourage private donation which would, in effect, replace public funds. A study by the Thomas Jefferson Institute sets out just how such a tax credit has no net effect on the state budget.  The forgone revenue due to the tax credit is offset by the reduction in expenditures needed to educate the children leaving the public system.

That simple fact escaped the bureaucrats at the Department of Education who wrote the fiscal impact statement.  They could see $20 million in reduced revenue.  They couldn’t fathom how an equal amount less money would be spent.

In fact, Massie’s bill would provide a positive cash flow for the state.  Children would have left the public system along with the expense of their education.  The scholarship donation could not be claimed by the taxpayer until the following tax year.

Democratic opposition on the committee was unanimous, centering on the $20 million price tag.  Massie repeatedly referenced the full vetting of the fiscal implications by the House Appropriations staff and their conclusion that his bill was revenue neutral.  The effort was in vain.  When questioned, the Senate Finance staff could offer no explanation for the $20 million figure other than to repeat it was in the Department of Education analysis.  No matter.

Massie wears a perpetual grin.  It hasn’t faded since his encounter in Senate Room A.  The former Cavalier football player believes he’s “crossed the 50 yard line.  At least we’re playing on offense,” he says.

This year the challenge of getting any education reform bill passed in the face of opposition from the education establishment compounded by Governor McDonnell’s three pronged education reform effort - charter schools, laboratory schools, and virtual schools.  With the full resources of his office at his disposal, any Governor can mount the bully pulpit and draw attention to his priorities.  With education reform, the McDonnell package was as far as many lawmakers were willing to go this time around.

A single legislator, no matter how compelling his case, has a difficult task in changing minds.  That doesn’t deter Massie.  “Maybe in another year when there isn’t a budget shortfall claiming everybody’s attention, we can get folks to focus on the real numbers here,” he hopes.  And hope springs eternal.


Quotes of the Week

March 2nd, 2010

Who Said It?

“I’m going to vote for Del. Nixon’s bill but I think it makes Virginia look absolutely silly around the world.”

Based on your legislative package this year, you’re still smoking funny stuff.”

“Vegas doesn’t give you a teddy bear.”


Last Week’s Quotes and Sources

March 2nd, 2010

“I’ve never been afraid for my life in Red Lobster. Senator Patsy Tice (D- Arlington) explaining why few women she knows pack heat in their purses in restaurants.

I like this Gang of Five a lot better than the last one,” referring to the “New Gang of Five” article in last week’s Grapevine.  A House Republican legislative aide whose boss won’t let him talk that way in public.

“Though she looks young and blond, she’s really old.” Senator Jill Vogel (R – Warrenton) good naturedly introducing her friend and legislative aide in the Senate gallery on the occasion of a “big” birthday.