Bacon's Rebellion

Democracy Thrives in Sunlight

How Hospitals Exercise Political Clout

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by

James A. Bacon
in , ,

by James C. Sherlock

Virginia’s hospitals and health systems have for decades gotten everything they have sought from the state government, both the constitutional officers and the General Assembly. Readers of this space have been provided the details of some of their successes that are counter to the public good. But what is the source of all that political power?

Money. Political contributions matter. These data are all from vpap.org.

  • In the 2018-19 campaign cycle, hospitals and health systems gave $2,368,406 in donations to candidates for the General Assembly.
  • In the 2017 election cycle, they gave $392,187 to Governor Northam, $117,500 of it after his victory. And he is term limited.
  • Attorney General Herring received from the hospitals and health systems $52,000 for his first campaign, $62,725 for his second and $23,000 since then. He is charged with enforcing the antitrust laws against those donors. He has not enforced them.
  • Even those who think it fair for hospitals and health systems to help elect these officials can’t be happy with the post-election donations.

I took the time to assess the key votes that supported the wishes of the hospitals in the General Assembly. I looked up the recorded votes on three bills:

  • HB 608 Health Enterprise Zone Program and Fund – hospitals did not support
  • HB 1094 Certificate of public need; exempts physician-owned ambulatory surgery centers – hospitals fiercely opposed.
  • HB 879/SB764 Certificate of public need; revises the Medical Care Facilities Certificate of Public Need Program (makes more restrictive) – hospital lobbyists wrote it.

Click here to see the financial support

provided by the hospitals and health systems to delegates and senators who voted their way. Note how many members who had no chance of losing their races took money from these special interests anyway. Note that Sen. Emmett Hanger, R-Mount Solon, Sen. Dick Saslaw, D-Springfield, Sen. Barbara Favola, D-Arlington, Del. Mark Sickles, D-Alexandria, Del. Kirk Cox, R-Colonial Heights, and Sen. Lynnwood Lewis, D-Accomack, let the Virginia Hospital and Healthcare Assiation (VHHA) pay some of their campaign expenses directly.

Hanger let VHHA give in-kind contributions for 20% of his total campaign expenses. He got 71% of the vote. This step in the 2019 race was nothing he had ever done before. I like Sen. Hanger personally and am surprised and disappointed.

Former House Speaker Cox got “Speaker” money from a lot of his donors. Senior leaders of both parties often control PACs from which they send money to tight races. New Speaker Eileen Filler-Corn received $50,614 from hospital and health system sources in 2018-19, $35,000 of which went to her PAC. That will likely double now that she is Speaker.

Community Influence. Money aside (and it seldom is), the most powerful political influence of Virginia’s hospitals and healthcare systems comes from their power in the economies of the General Assembly districts. Many are the largest or second largest non-government employers in their communities. They are powerful both in their own right and leveraging the influence of business communities through Chambers of Commerce. Politicians risk their displeasure at their peril. Some buck the hospitals, but it takes knowledge, conviction and not a small amount of political courage to do so.

Doctors, nurses and dentists give a lot of money to politicians, in total more than do the hospitals and health systems, but their influence is dispersed by the fact that they tend to give money personally or through their offices and are not often members of the Chambers of Commerce.

What to do? There are three things I can think of that will reduce the influence of the hospitals and health systems on public policy in healthcare and health insurance.

The first is what I have done in the linked spreadsheet. Illuminate the votes that ignore the best interests of the citizens in favor of hospital agendas and link them to the money. I will do this going forward before every General Assembly session. If the regional newspapers pick it up, there may be a political price to pay.

The second is to petition the General Assembly to write rules about who can sit on committees dealing with health care, health insurance and the appropriations committees. Set maximum limits of healthcare-related campaign donations in the previous campaign cycle above which a member may not be assigned to any committee which deals with healthcare issues.

The third is the most likely to make a permanent change by countering the hospital influence. I encourage doctors and nurses to better organize to influence votes with their donations and their combined community influence. I recommend that each group consider five regional associations aligned with the state health regions along the lines of the Medical Society of Northern Virginia. They can serve as active components of the statewide organizations to get close to the politicians in their communities and express to them regional concerns.  I will expand on that idea in another column.

James C. Sherlock, a Virginia Beach resident, is a retired Navy Captain and a certified enterprise architect. As a private citizen, he has researched and written about the business of healthcare in Virginia. 

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48 responses to “How Hospitals Exercise Political Clout”

  1. Steve Haner Avatar
    Steve Haner

    Certainly the money is related to influence sought to defeat unwanted bills, but it also is related to bills the hospitals wanted passed – first and foremost the 2018 vote on Medicaid expansion and increased Medicaid reimbursement rates.

    The practitioner groups also give $$ and have influence, which I think you may be underestimating. The battle over balanced billing showed their clout. But when the docs and hospitals align, that’s hard to resist.

    1. sherlockj Avatar
      sherlockj

      Steve, The Medical Society of Virginia will tell you they are defeated every time they support a bill that the health systems oppose. The one they perhaps want the most this year was the COPN exemption for physician-owned ambulatory surgery centers. They would like the same exemption for diagnostic imagery centers. As I wrote, the bill to grant POSCs won overwhelmingly in the House subcommittee, and lost the next day in the full committee. Votes were reversed under pressure.

      Physicians give as much or more money in political donations as hospitals, but most of it is scattered, not targeted. They are not as good at the lobbying game as the hospitals. They do not influence the Chambers of Commerce in the same way hospitals do. And, not well organized regionally, they do not have as much group community influence.

      The hospitals threaten both urban Democrats and rural Republicans that hospitals will close if (fill-in-the-blank bill) is passed and poor people will die in the streets. My earlier column about hospital finances puts the lie to that threat. Hospital executives are known to use the term “capture zones” for the money losing hospitals some maintain in rural areas. They capture patients there for their regional medical centers and net for the system make a profit.

      Money, lies and political threats win the day in Richmond. The physicians come to a gunfight with a prayer for better behavior.

      And you are absolutely right about Medicaid expansion with accompanying rate increases. It was a good thing generally, but that is not why the hospitals supported it. Wait until I report in December on the 2019 hospital operating margins in 2019. They will show a torrent of new profits – some estimate another billion dollars a year. And they knew it when they supported the bill.

  2. LarrytheG Avatar
    LarrytheG

    I don’t like the campaign money at all and I do not like how it is reported.

    If campaign money were reported in real time – at the time it is proffered and ordinary citizens could see that money flowing at the time bills were being discussed, negotiated, etc.. I think things might change.

    Failing that, I’d put hard caps on it or ban it like other states have.

    I don’t have near as much trouble with lobby folks. I think if all sides have their lobby folks involved – more information is brought to the discussion and as a result, more informed deliberations.

    I realize that money drives the quantity and quality of lobbyists so perhaps a ban on numbers…

    I note also in addition to the balanced billing that a bill on capping insulin prices also passed…we’ll see if both get signed.

    I still maintain that for most procedures that Medicare has a set reimbursement number regardless of what a hospital’s stated rate is. And Medicare reimbursements are used by insurance companies in setting their reimbursements.

    Yes, people who pay out of pocket might benefit from lower prices if there was real “competition” but I’m guessing that a a high percentage of payments are insurance reimbursements.

    The Heritage folks advocate putting a cap on how much of private/employer insurance premiums are tax-free and over that cap, the money spent is taxed. (Much like the govt caps how much untaxed money you can put into an IRA or 401k).

    Once that happened, when insurance premiums went up – over and above the cap – the insured would be “feeling” the impact and looking closer at the costs – and that might engender more competition although most employer healthcare is one-size-fits-all, take-it-or-leave it as opposed to being able to pick among an array of plans to perhaps pick ones with lower premiums but higher deductibles, etc.

    I KNOW that the health care industry is powerful and influences legislation – I’m not sure how we stop it – for them or other industries – like utilities or in this session – the repair shops that benefit from state inspections…

    1. sherlockj Avatar
      sherlockj

      Doctors and nurses can stop it if they organize to do so. Virginia voters have a role in holding their GA members accountable if we can get the info to them.

      1. djrippert Avatar
        djrippert

        In other words, doctors ands nurses could come together and out-bid the hospitals in buying our state government’s votes.

    2. sherlockj Avatar
      sherlockj

      Larry, some excellent options such as independent surgical and imagery centers are paid far lower reimbursement by both government and commercial insurers, thus patient co-pays and deductibles are lower and if they have commercial insurance, so ultimately are their premiums. That can’t happen if those independent facilities don’t exist. That costs Virginians over $500 million annually in higher outpatient surgery prices. That is the issue in Virginia. It also directly affects our physician shortages. Those are the stakes. The only government action required is to get out of the way.

  3. sherlockj Avatar
    sherlockj

    The insurance industry lobbies hard for lower cost options. Like the doctors, they just don’t win.

  4. LarrytheG Avatar
    LarrytheG

    Jim – do you have a view with respect to Doc-in-the-boxes?

    We seem to have quite a few in our area – and judging by closures – too many…

    what say you?

    Are these lower cost options?

  5. sherlockj Avatar
    sherlockj

    To the degree that they keep people out of emergency rooms, they are lower cost options. Regionally dominant Sentara is getting into the business here in Virginia Beach. Doc-in-the-boxes, like stand alone emergency centers, can be used by the health systems to pre-screen patients not only for need for higher level care but also to screen their insurance. A less than ethical health system could refer those with the best insurance to its own hospitals and those uninsured or with low reimbursing insurance to those of its competitors. We all hope that is not happening.

  6. TooManyTaxes Avatar
    TooManyTaxes

    So where is the state attorney general? Why doesn’t Herring file antitrust actions against the conglomerates or at least challenge mergers before DOJ/FTC?

    1. sherlockj Avatar
      sherlockj

      Notice in the essay that Attorney General Herring has taken over $130,000 from the hospitals, including $23,000 after his last election. He wants to be Governor. Does that answer your question?

  7. LarrytheG Avatar
    LarrytheG

    Since Northam is a doctor and practices in a hospital – I wonder if he has any additional or particular insight on these kinds of issues?

    He certainly has demonstrated , he no activist on the utility front… so
    perhaps on this he is also a “no rock the boat” type?

    1. sherlockj Avatar
      sherlockj

      Notice in the essay the amount of money he has taken from the hospitals. He’s a”no rock the bank” type.

  8. Steve Haner Avatar
    Steve Haner

    Certainly the money is related to influence sought to defeat unwanted bills, but it also is related to bills the hospitals wanted passed – first and foremost the 2018 vote on Medicaid expansion and increased Medicaid reimbursement rates.

    The practitioner groups also give $$ and have influence, which I think you may be underestimating. The battle over balanced billing showed their clout. But when the docs and hospitals align, that’s hard to resist.

    1. sherlockj Avatar
      sherlockj

      Steve, The Medical Society of Virginia will tell you they are defeated every time they support a bill that the health systems oppose. The one they perhaps want the most this year was the COPN exemption for physician-owned ambulatory surgery centers. They would like the same exemption for diagnostic imagery centers. As I wrote, the bill to grant POSCs won overwhelmingly in the House subcommittee, and lost the next day in the full committee. Votes were reversed under pressure.

      Physicians give as much or more money in political donations as hospitals, but most of it is scattered, not targeted. They are not as good at the lobbying game as the hospitals. They do not influence the Chambers of Commerce in the same way hospitals do. And, not well organized regionally, they do not have as much group community influence.

      The hospitals threaten both urban Democrats and rural Republicans that hospitals will close if (fill-in-the-blank bill) is passed and poor people will die in the streets. My earlier column about hospital finances puts the lie to that threat. Hospital executives are known to use the term “capture zones” for the money losing hospitals some maintain in rural areas. They capture patients there for their regional medical centers and net for the system make a profit.

      Money, lies and political threats win the day in Richmond. The physicians come to a gunfight with a prayer for better behavior.

      And you are absolutely right about Medicaid expansion with accompanying rate increases. It was a good thing generally, but that is not why the hospitals supported it. Wait until I report in December on the 2019 hospital operating margins in 2019. They will show a torrent of new profits – some estimate another billion dollars a year. And they knew it when they supported the bill.

      1. Reed Fawell 3rd Avatar
        Reed Fawell 3rd

        These hospital administrators are part of what has become the plague of the managerial elite in America generally that also includes the managerial elite in government (deep state) and in education.

        Doctors and nurses need to organize to fight back and break this stranglehold, as do parents, good teachers, and patients, all of whom are being robbed blind.

      2. Reed Fawell 3rd Avatar
        Reed Fawell 3rd

        Because these medical cartels are gutting the ability of much of Virginia’s smaller cities, towns, and rural areas to redevelop, grow, and thrive, one would hope these regions would organize among themselves to break the cartels’ strangleholds, as some have done with K-12 education.

        It would also be very interesting to know the rolls that Virginia’s university hospitals play in all of this toxicity. Here we have public institutions actively working against the public interest. For example, the University of Virginia Medical Center, its University of Virginia Health systems, and Medical Laboratories.

        1. James A. Bacon Avatar
          James A. Bacon

          It is very interesting that two of the most dysfunctional economic sectors in Virginia — dysfunctional in the sense that costs are running way out of control — are dominated by “nonprofit” institutions: hospitals and higher-ed. While these institutions are putatively governed for the public good, they have in fact been captured by internal constituencies and are governed for the benefit of those constituencies.

          It is amazing that public awareness of this phenomenon is so low. This ignorance is one of the great failings of Virginia media (and local media nationally).

          1. LarrytheG Avatar
            LarrytheG

            In both cases, customers are pretty much captive without a real ability to influence the supply/demand relationship although with higher ed, there are some choices but if your mind is set on the gold standard – those that are selling it – know it much like a car salesman has figured out that you REALLY WANT a particular car and your “influence” wanes away.

            There is not much to gain in “shopping” around or even “negotiating” if your medical is reimbursement from insurance.

            But Medicare is pretty stingy. They have lower reimbursements than most all non-govt insurance and only Medicaid has a lower reimbursement.

            And often, we read here in BR that hospitals “lose” money on Medicare and Medicaid reimbursements which seems to run a little counter to the “excessive profits” narrative….

          2. sherlockj Avatar
            sherlockj

            Spot on. I have tried to come up with a formula to measure which of the non-profit health systems act like public charities (Bon Secours) and the ones that hide behind the tax exemption, pile up profits and constantly attack any semblance of competition. Hard to do with an algorithm, but it is clear when you look hard enough. The General Assembly should give the SCC the authority to regulate the business of healthcare, not just the insurance industry, and give it the power to recommend elimination of tax exemptions for the worst offenders. Won’t happen.

  9. LarrytheG Avatar
    LarrytheG

    I don’t like the campaign money at all and I do not like how it is reported.

    If campaign money were reported in real time – at the time it is proffered and ordinary citizens could see that money flowing at the time bills were being discussed, negotiated, etc.. I think things might change.

    Failing that, I’d put hard caps on it or ban it like other states have.

    I don’t have near as much trouble with lobby folks. I think if all sides have their lobby folks involved – more information is brought to the discussion and as a result, more informed deliberations.

    I realize that money drives the quantity and quality of lobbyists so perhaps a ban on numbers…

    I note also in addition to the balanced billing that a bill on capping insulin prices also passed…we’ll see if both get signed.

    I still maintain that for most procedures that Medicare has a set reimbursement number regardless of what a hospital’s stated rate is. And Medicare reimbursements are used by insurance companies in setting their reimbursements.

    Yes, people who pay out of pocket might benefit from lower prices if there was real “competition” but I’m guessing that a a high percentage of payments are insurance reimbursements.

    The Heritage folks advocate putting a cap on how much of private/employer insurance premiums are tax-free and over that cap, the money spent is taxed. (Much like the govt caps how much untaxed money you can put into an IRA or 401k).

    Once that happened, when insurance premiums went up – over and above the cap – the insured would be “feeling” the impact and looking closer at the costs – and that might engender more competition although most employer healthcare is one-size-fits-all, take-it-or-leave it as opposed to being able to pick among an array of plans to perhaps pick ones with lower premiums but higher deductibles, etc.

    I KNOW that the health care industry is powerful and influences legislation – I’m not sure how we stop it – for them or other industries – like utilities or in this session – the repair shops that benefit from state inspections…

    1. sherlockj Avatar
      sherlockj

      Doctors and nurses can stop it if they organize to do so. Virginia voters have a role in holding their GA members accountable if we can get the info to them.

      1. djrippert Avatar
        djrippert

        In other words, doctors ands nurses could come together and out-bid the hospitals in buying our state government’s votes.

        1. sherlockj Avatar
          sherlockj

          Doctors and nurses already give enough money to have their opinions considered. I agree that is a sad commentary, but what I am arguing is not that they should give more money, but rather that they lack influence because they are not well organized. It is very easy to see the difference in political competence if you spend the time to watch the hospitals operate for political influence from the local chambers of commerce to the city and county councils to the GA and the statehouse. The influence of the hospitals far exceeds the relative value of their campaign contributions. The physicians could do the same, but they haven’t yet.
          As far as the Virginia General Assembly being a coin-operated institution, it is more complex than that and some of them like Del. Jason Miyares fight the system for ethical reasons, but it is certainly there in the mix of decision making. I cannot dispute your contention that we have one of the most corrupt systems because I know ours is corrupt but I simply have not studied the comparisons.
          I lay some of the dependence on lobbyists on healthcare issues to the fact that healthcare business issues are so astonishingly complex that our part-time, woefully understaffed representatives sometimes take the path of least resistance, which is going with the story they are told by the hospitals. Doesn’t make it right, but that is the truth.

          1. LarrytheG Avatar
            LarrytheG

            So there are two aspects to “influence”. One is money donated to campaigns and the other is money used to pay lobbyists whose mission is to make effective arguments on behalf of your groups interests.

            Typically, the corporate folks Dominion and others fully fund their lobbying arms, i.e. pay what it takes for enough professional staff to accomplish that mission – while other groups, for example, “green” groups may actually use activists themselves to lobby in addition to their other roles. Teacher lobbying may work similarly with folks who are full time teachers also trying to lobby.

            But lobbying itself is a professional endeavor as Mr. Haner, I’m sure will concur.

            So when you have part-time, ad hoc lobbyists going up against full-time paid lobbyists – it’s usually lop sided in results unless the paid lobbyists are riding a bad horse and the activists have a righteous issue.

            Good lobbyists know the opposing lobbyists talking points and adjust theirs accordingly so that the other side of an issue is also made known to the legislator.

            In a General Assembly where the elected are part-time and their staffs often characterized as “over-worked” – lobbyists become very important in bringing information to the discussions and, again, I bet Mr. Haner has some stories of how lobbying carried the day on some issues.

            lobbying is not a bad thing. It’s a good thing. But it needs advocates for all the aspects and lobbyists tend to only advocate for the information that helps their cause and it’s up to the other side to do good for their cause and if they are not there – decisions might be made based on a lack of adequate info.

            I’m not clear at this point exactly what points Doctors and nurses would concentrate on for their interests.

    2. sherlockj Avatar
      sherlockj

      Larry, some excellent options such as independent surgical and imagery centers are paid far lower reimbursement by both government and commercial insurers, thus patient co-pays and deductibles are lower and if they have commercial insurance, so ultimately are their premiums. That can’t happen if those independent facilities don’t exist. That costs Virginians over $500 million annually in higher outpatient surgery prices. That is the issue in Virginia. It also directly affects our physician shortages. Those are the stakes. The only government action required is to get out of the way.

      1. LarrytheG Avatar
        LarrytheG

        I do take the point but shouldn’t that also mean the insurance companies would support more lower-cost facilities that they would lobby for?

        Just FYI – many do not have co-pays or they are fixed/capped co-pays.
        If someone has Medicare and “gap” coverage or Medicare Advantage , there is no out-of-pocket anyhow.

        But you would think that most insurance companies would be lobbying for lower cost facilities, right?

        Nothing like seeing two industry titans fighting each other in the GA over a law where one wins and the other loses! 😉

        does that happen?

  10. sherlockj Avatar
    sherlockj

    The insurance industry lobbies hard for lower cost options. Like the doctors, they just don’t win.

  11. LarrytheG Avatar
    LarrytheG

    Jim – do you have a view with respect to Doc-in-the-boxes?

    We seem to have quite a few in our area – and judging by closures – too many…

    what say you?

    Are these lower cost options?

  12. sherlockj Avatar
    sherlockj

    To the degree that they keep people out of emergency rooms, they are lower cost options. Regionally dominant Sentara is getting into the business here in Virginia Beach. Doc-in-the-boxes, like stand alone emergency centers, can be used by the health systems to pre-screen patients not only for need for higher level care but also to screen their insurance. A less than ethical health system could refer those with the best insurance to its own hospitals and those uninsured or with low reimbursing insurance to those of its competitors. We all hope that is not happening.

  13. TooManyTaxes Avatar
    TooManyTaxes

    So where is the state attorney general? Why doesn’t Herring file antitrust actions against the conglomerates or at least challenge mergers before DOJ/FTC?

    1. sherlockj Avatar
      sherlockj

      Notice in the essay that Attorney General Herring has taken over $130,000 from the hospitals, including $23,000 after his last election. He wants to be Governor. Does that answer your question?

  14. LarrytheG Avatar
    LarrytheG

    Since Northam is a doctor and practices in a hospital – I wonder if he has any additional or particular insight on these kinds of issues?

    He certainly has demonstrated , he no activist on the utility front… so
    perhaps on this he is also a “no rock the boat” type?

    1. sherlockj Avatar
      sherlockj

      Notice in the essay the amount of money he has taken from the hospitals. He’s a”no rock the bank” type.

  15. TooManyTaxes Avatar
    TooManyTaxes

    Of course it does. Yet he signs briefs that argue the states have the right to regulate interstate commerce (the Internet). Only by the Washington Post’s editorial board’s standards can this be OK.

  16. TooManyTaxes Avatar
    TooManyTaxes

    Of course it does. Yet he signs briefs that argue the states have the right to regulate interstate commerce (the Internet). Only by the Washington Post’s editorial board’s standards can this be OK.

  17. LarrytheG Avatar
    LarrytheG

    I think the pragmatic cynic in me would say that no savy would-be candidate for the GOv office wants to anger entrenched interests PRIOR to the election.

    I bet that Herring is not that different than prior AGs who aspired to higher office.

    That’s our system and that’s why campaign money is so corrupting as those entrenched interests, once angered, would be quite generous in campaign donations to his opponent.

    Partisan blame by those who don’t like the opposite party guy – well.. it’s works for both parties… the same. A GOP AG would likely do the same.

    1. TooManyTaxes Avatar
      TooManyTaxes

      Larry, this is not about politics. This is about doing the right thing. If the public is being harmed by anti-competitive actions by the health care industry, the state attorney general of any party should go forward and take action. Whether they do or not is another question.

      Herring has been busy looking into gender-choice and illegal immigrant issues rather than something that affects everyone, irrespective of gender or immigration status.

  18. LarrytheG Avatar
    LarrytheG

    I think the pragmatic cynic in me would say that no savy would-be candidate for the GOv office wants to anger entrenched interests PRIOR to the election.

    I bet that Herring is not that different than prior AGs who aspired to higher office.

    That’s our system and that’s why campaign money is so corrupting as those entrenched interests, once angered, would be quite generous in campaign donations to his opponent.

    Partisan blame by those who don’t like the opposite party guy – well.. it’s works for both parties… the same. A GOP AG would likely do the same.

    1. TooManyTaxes Avatar
      TooManyTaxes

      Larry, this is not about politics. This is about doing the right thing. If the public is being harmed by anti-competitive actions by the health care industry, the state attorney general of any party should go forward and take action. Whether they do or not is another question.

      Herring has been busy looking into gender-choice and illegal immigrant issues rather than something that affects everyone, irrespective of gender or immigration status.

  19. LarrytheG Avatar
    LarrytheG

    TMT – It’s ALWAYS about politics including the opponents blaming the AG for not doing “right” when they know doing so will hurt him politically.

    I doubt seriously that ANY GOP aspiring to Gov in Virginia would go after entrenched interests in front of a campaign and convince the entrenched interests to fund his opponents campaign.

    IN a state that allows unlimited campaign donations, it’s ALWAYs about politics.

    If we don’t like it – we ought to not like it independent of our own political leanings. right?

  20. LarrytheG Avatar
    LarrytheG

    TMT – It’s ALWAYS about politics including the opponents blaming the AG for not doing “right” when they know doing so will hurt him politically.

    I doubt seriously that ANY GOP aspiring to Gov in Virginia would go after entrenched interests in front of a campaign and convince the entrenched interests to fund his opponents campaign.

    IN a state that allows unlimited campaign donations, it’s ALWAYs about politics.

    If we don’t like it – we ought to not like it independent of our own political leanings. right?

  21. sherlockj Avatar
    sherlockj

    My personal belief is that candidates for Virginia Attorney General should refuse to accept campaign donations from any organized corporate PAC or individual donations above $1000 from any corporate official. The Attorney General must not only represent all the people in Virginia but, like Caesar’s wife, be seen to be unconflicted in doing so. Money would still filter down through the political money laundering that goes on. The PACs would still give to party organizations that would fund AG candidates, but it would be better than outright bribery. Notice I said candidates should refuse such donations, not that we should try to write a law to prevent them. Such laws have already been found to be unconstitutional. By the way, the only Virginia AG in history to use antitrust laws against hospital activities was when Bob McDonnell went to federal court to block Inova’s proposed expansion into Manassas about a dozen years ago. He effectively won, in that Inova withdrew the proposal.

  22. sherlockj Avatar
    sherlockj

    My personal belief is that candidates for Virginia Attorney General should refuse to accept campaign donations from any organized corporate PAC or individual donations above $1000 from any corporate official. The Attorney General must not only represent all the people in Virginia but, like Caesar’s wife, be seen to be unconflicted in doing so. Money would still filter down through the political money laundering that goes on. The PACs would still give to party organizations that would fund AG candidates, but it would be better than outright bribery. Notice I said candidates should refuse such donations, not that we should try to write a law to prevent them. Such laws have already been found to be unconstitutional. By the way, the only Virginia AG in history to use antitrust laws against hospital activities was when Bob McDonnell went to federal court to block Inova’s proposed expansion into Manassas about a dozen years ago. He effectively won, in that Inova withdrew the proposal.

  23. djrippert Avatar
    djrippert

    I’ve said it before and I’ll say it again … Virginia is the most corrupt state in America. The competition isn’t that broad. 45 states have limits on campaign contributions to state politicians. That puts Virginia in the “Top 5 Most Corrupt” right off the bat.

    Many states ban contributions from corporations or unions altogether.

  24. djrippert Avatar
    djrippert

    I’ve said it before and I’ll say it again … Virginia is the most corrupt state in America. The competition isn’t that broad. 45 states have limits on campaign contributions to state politicians. That puts Virginia in the “Top 5 Most Corrupt” right off the bat.

    Many states ban contributions from corporations or unions altogether.

  25. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    Here is opening of related article titled Hospital Attempt to Defend Questionable Government Accounting Scams, by Christopher Jacobs, writing in The Federalist:

    “With the federal government more than $23 trillion in debt, why should taxpayers continue to fund states’ accounting scams designed to bilk Washington out of additional Medicaid matching funds? It’s a good question, but one hospital lobbyists don’t want you to ask.

    Late last year, the Trump administration released a proposed regulation designed to bring more transparency and accountability into the Medicaid program. The hospital sector in particular has begun an all-out blitz to try and overturn the rule making process. The need for the regulations demonstrates the problems with the current American health-care system, and how hospitals stand as one of the biggest obstacles to reform.
    How the ‘Scam’ Works

    The proposed regulations call for more transparency about supplemental payments within the Medicaid program. These payments, which take a variety of different forms, are considered supplemental in nature because they are not directly connected to the treatment of any one particular patient.

    Many of these supplemental payments represent a way for states—and hospitals—to obtain a greater share of Medicaid matching dollars from the federal government. Hospitals, local governments, or other entities “contribute” funds to the state for the express purpose of obtaining additional Medicaid funds from Washington. Those matching funds then get funneled right back to many of the same entities that “contributed” the funds in the first place. As the old saying goes, it’s nice work if you can get it.

    Over the years, even liberal groups have expressed concern about these shady funding mechanisms. In 2011, then-Vice President Joe Biden reportedly called provider taxes—in which hospitals and nursing homes pay an assessment, which gets laundered through state coffers to receive—a “scam.” Think about it: How often do you ask to pay higher taxes? Hospitals and nursing homes often propose new or higher provider taxes because they believe they will get their money back, and then some, via greater Medicaid payments.

    Likewise, in 2000 the liberal Center for Budget and Policy Priorities decried the use of “Rube Goldberg-like accounting arrangements” that “use complex accounting gimmicks to secure additional federal funds for states without actual state matching contributions.” Yet two decades later, the scams continue to proliferate, because, as a 2005 government audit noted, most states have hired contingency-fee consultants for the sole purpose of bilking additional Medicaid matching funds from the federal government.
    Hospitals’ Scare Tactics Rationalize Theft

    The Trump administration’s proposal would make these accounting arrangements more transparent, with the goal of phasing out several of the most egregious arrangements altogether. This has prompted hospital executives to consider the proposed rule something just short of Armageddon. …”

    For more see:
    https://thefederalist.com/2020/03/09/hospitals-attempt-to-defend-questionable-government-accounting-scams/

  26. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    Here is opening of related article titled Hospital Attempt to Defend Questionable Government Accounting Scams, by Christopher Jacobs, writing in The Federalist:

    “With the federal government more than $23 trillion in debt, why should taxpayers continue to fund states’ accounting scams designed to bilk Washington out of additional Medicaid matching funds? It’s a good question, but one hospital lobbyists don’t want you to ask.

    Late last year, the Trump administration released a proposed regulation designed to bring more transparency and accountability into the Medicaid program. The hospital sector in particular has begun an all-out blitz to try and overturn the rule making process. The need for the regulations demonstrates the problems with the current American health-care system, and how hospitals stand as one of the biggest obstacles to reform.
    How the ‘Scam’ Works

    The proposed regulations call for more transparency about supplemental payments within the Medicaid program. These payments, which take a variety of different forms, are considered supplemental in nature because they are not directly connected to the treatment of any one particular patient.

    Many of these supplemental payments represent a way for states—and hospitals—to obtain a greater share of Medicaid matching dollars from the federal government. Hospitals, local governments, or other entities “contribute” funds to the state for the express purpose of obtaining additional Medicaid funds from Washington. Those matching funds then get funneled right back to many of the same entities that “contributed” the funds in the first place. As the old saying goes, it’s nice work if you can get it.

    Over the years, even liberal groups have expressed concern about these shady funding mechanisms. In 2011, then-Vice President Joe Biden reportedly called provider taxes—in which hospitals and nursing homes pay an assessment, which gets laundered through state coffers to receive—a “scam.” Think about it: How often do you ask to pay higher taxes? Hospitals and nursing homes often propose new or higher provider taxes because they believe they will get their money back, and then some, via greater Medicaid payments.

    Likewise, in 2000 the liberal Center for Budget and Policy Priorities decried the use of “Rube Goldberg-like accounting arrangements” that “use complex accounting gimmicks to secure additional federal funds for states without actual state matching contributions.” Yet two decades later, the scams continue to proliferate, because, as a 2005 government audit noted, most states have hired contingency-fee consultants for the sole purpose of bilking additional Medicaid matching funds from the federal government.
    Hospitals’ Scare Tactics Rationalize Theft

    The Trump administration’s proposal would make these accounting arrangements more transparent, with the goal of phasing out several of the most egregious arrangements altogether. This has prompted hospital executives to consider the proposed rule something just short of Armageddon. …”

    For more see:
    https://thefederalist.com/2020/03/09/hospitals-attempt-to-defend-questionable-government-accounting-scams/

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