Direct primary care agreements; Commonwealth's insurance laws do not apply. (HB685)

Introduced By

Del. Steve Landes (R-Weyers Cave) with support from co-patron Del. Kathy Byron (R-Lynchburg)

Progress

Introduced
Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law

Description

Direct primary care agreements. Provides that the Commonwealth's insurance laws do not apply to direct primary care agreements. The measure further provides that (i) a direct primary care practice is not be subject to the jurisdiction of the State Corporation Commission (SCC) and is not required to obtain a certificate of authority or license to market, sell, or offer to sell a direct primary care agreement; (ii) entering into a direct primary care agreement shall not be considered to be engaging in the business of insurance; and (iii) a direct primary care agreement is not a contract of insurance and is not subject to regulation by the SCC. The bill defines a direct primary care agreement as an agreement entered into between a health care provider and an individual patient under which the provider charges a predetermined fee as consideration for providing primary care to the patient, subject to certain conditions. Read the Bill »

Status

03/11/2016: Passed the General Assembly

History

  • 01/11/2016 Committee
  • 01/11/2016 Prefiled and ordered printed; offered 01/13/16 16100539D
  • 01/11/2016 Referred to Committee on Commerce and Labor
  • 01/22/2016 Impact statement from SCC (HB685)
  • 01/28/2016 Reported from Commerce and Labor with substitute (22-Y 0-N) (see vote tally)
  • 01/28/2016 Committee substitute printed 16104748D-H1
  • 02/01/2016 Read first time
  • 02/02/2016 Read second time
  • 02/02/2016 Committee substitute agreed to 16104748D-H1
  • 02/02/2016 Engrossed by House - committee substitute HB685H1
  • 02/03/2016 Read third time and passed House BLOCK VOTE (97-Y 0-N)
  • 02/03/2016 VOTE: BLOCK VOTE PASSAGE (97-Y 0-N) (see vote tally)
  • 02/04/2016 Constitutional reading dispensed
  • 02/04/2016 Referred to Committee on Commerce and Labor
  • 02/05/2016 Impact statement from SCC (HB685H1)
  • 02/29/2016 Reported from Commerce and Labor with substitute (8-Y 6-N) (see vote tally)
  • 02/29/2016 Committee substitute printed 16105892D-S1
  • 03/02/2016 Constitutional reading dispensed (40-Y 0-N) (see vote tally)
  • 03/03/2016 Impact statement from SCC (HB685S1)
  • 03/03/2016 Read third time
  • 03/03/2016 Reading of substitute waived
  • 03/03/2016 Committee substitute agreed to 16105892D-S1
  • 03/03/2016 Passed by for the day
  • 03/04/2016 Read third time
  • 03/04/2016 Passed by for the day
  • 03/07/2016 Read third time
  • 03/07/2016 Passed by for the day
  • 03/08/2016 Read third time
  • 03/08/2016 Passed by for the day
  • 03/09/2016 Read third time
  • 03/09/2016 Passed by temporarily
  • 03/09/2016 Motion to recommit to committee rejected (19-Y 21-N) (see vote tally)
  • 03/09/2016 Engrossed by Senate - committee substitute HB685S1
  • 03/09/2016 Passed Senate with substitute (23-Y 17-N) (see vote tally)
  • 03/10/2016 Placed on Calendar
  • 03/10/2016 Senate substitute agreed to by House 16105892D-S1 (87-Y 8-N)
  • 03/10/2016 VOTE: ADOPTION (87-Y 8-N) (see vote tally)
  • 03/11/2016 Enrolled
  • 03/11/2016 Bill text as passed House and Senate (HB685ER)
  • 03/11/2016 Signed by Speaker
  • 03/11/2016 Signed by President
  • 03/14/2016 Impact statement from SCC (HB685ER)
  • 03/16/2016 Enrolled Bill communicated to Governor on 3/16/16
  • 03/16/2016 G Governor's Action Deadline Midnight, Sunday, April 10, 2016
  • 04/06/2016 Governor's recommendation received by House
  • 04/20/2016 Placed on Calendar
  • 04/20/2016 House rejected Governor's recommendation (34-Y 66-N)
  • 04/20/2016 VOTE: REJECTED (34-Y 66-N)
  • 04/20/2016 Communicated to Governor

Video

This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 8 clips in all, totaling 36 minutes.

Transcript

This is a transcript of the video clips in which this bill is discussed.

ALL IN FAVOR OF THE MOTION WILL RECORD THEIR VOTE AYE; THOSE OPPOSED, NO. ARE THE ARE ARE THE SENATORS REY TO VOTE? HAVE ALL THE SENATORS VOTED? PRESIDENT: THE CLERK WILL AYES 34, NOS ONE. CLOSE THE ROLL. THE BILL PASSES. Clerk: HOUSE BILL 685, A BILL RELATING TO DIRECT PRIMARY CARE AGREEMENTS REPORTED FROM THE COMMITTEE ON COMMERCE AND LABOR WITH A SUBSTITUTE. President: THE SENIOR SENATOR FROM VIRGINIA BEACH. President: SHALL THE COMMITTEE SUBSTITUTE BE AGREED TO? ALL IN FAVOR OF THE MOTION WILL RECORD THEIR VOTE AYE; THOSE OPPOSED, NO. THE AYES HAVE IT. THE SENIOR SENATOR. THE SUBSTITUTE IS AGREED TO. I ASK THAT BILLING BY FOR THE DAY.

Del. Bill Howell (R-Fredericksburg): President: WITHOUT OBJECTION, HOUSE BILL 685 WILL GO BY FOR THE DAY.


[Unknown]: REGULAR CALENDAR. HOUSE BILL 685, A BILL RELATING TO DIRECT PRIMARY CARE AGREEMENTS. COMMITTEE SUBSTITUTE ADOPTED BY THE SCIENCE. THE SENIOR SENATOR FROM VIRGINIA BEACH, SENATOR WAGNER. MR. PRESIDENT, CAN THAT BILL GO BYE FOR THE DAY. WITHOUT OBJECTION, HOUSE BILL 685 WILL GO BYE FOR THE DAY. HOUSE BILL 8, A BILL RELATING TO THE CREATION OF VIRGINIA
AYES 40, NOS 0. AYES 40, NOS 0. THE BILL PASSS. REGULAR CALENDAR. HOUSE BILLS ON THIRD READING. HOUSE BILL 685. A BILL RELATING TO DIRECT PRIMARY CARE AGREEMENT. THE COMMITTEE SUBSTITUTE ADOPTED BY THE SENATE. THE SENIOR SENATOR FROM VIRGINIA BEACH, SENATOR WAGNER.

Sen. Frank Wagner (R-Virginia Beach): MR. PRESIDENT, CAN THAT BILL GO BYE FOR THE DAY.


[Unknown]: HOUSE BILL 814, REPORTED FROM HOUSE BILL 1059, REPORTED FROM COMMITTEE ON RULES. COMMITTEE ON RULES.

Del. Bill Howell (R-Fredericksburg): THANK YOU, MADAM CLERK. THE QUESTION IS SHALL THE BILLS IN THE BLOCK PASS. ALL IN FAVOR IN PASSAGE OF THE BILLS WILL RECORD THEIR VOTES AYE, THOSE OPPOSED NO. ARE THE SENATORS READY TO VOTE? HAVE ALL THE SENATORS VOTED? DO ANY SENATORS DESIRE TO CHANGE THEIR VOTE? THE CLERK WILL CLOSE THE ROLL.

[Unknown]: AYES 40, NOS 0. AYES 40, NOS 0. THE BILLS IN THE BLOCK PASS. REGULAR CALENDAR, HOUSE BILLS ON THIRD READING. HOUSE BILL 685, A BILL RELATING TO DIRECT PRIMARY CARE AGREEMENTS. COMMITTEE SUBSTITUTE ADOPTED BY SENATE MARCH 3rd. THE SENIOR SENATOR FROM
WHAT A GREAT EDUCATIONAL OPPORTUNITY YOU HAD AND WE WISH YOU THE BEST WITH YOUR ACADEMIC ENDEAVORS. JOIN ME IN OFFERING THE MEMBERS OF THE WEST END CHRISTIAN SCHOOL THE WARM WELCOME OF THE SENATE. [APPLAUSE] RETURNING TO THE CALENDAR ON PAGE 21, HOUSE BILL 685. THE SENIOR SENATOR FROM VIRGINIA BEACH, SENATOR WAGNER.

Sen. Frank Wagner (R-Virginia Beach): MR. PRESIDENT, I AM GOING TO MOVE THAT THE BILL BE REFERRED BACK TO THE COMMITTEE OF COMMERCE UNDER RULE G AND SPEAKING TO THE MOTION.

[Unknown]: THE SENATOR HAS THE FLOOR.

Sen. Frank Wagner (R-Virginia Beach): HOUSE BILL 685. >> SIMILAR TO A BILL WE THAT THE HOUSE PUT OUT TO THE HEALTHCARE. THIS IS A STEP WE ARE TAKING PROVIDING DIRECT PRIMARY CARE AGREEMENTS BETWEEN PATIENTS AND DOCTORS. THERE ARE AGREEMENTS GOING ON NOW AND SERVICES IN VIRGINIA TO THERE IS NOTHING PREVENTING ANYTHING IN THE CODE FROM GOING ON. BY PUTTING THIS IN THE CODE AND SOME OF THE LANGUAGE IN, I FEEL IT NEEDS TO BE STUDIED. I KNOW MANY DISAGREE WITH ME. BUT LOOK AT THE BILL AND ONE PROVISION PROVIDES THAT ANY PER VISIT CHARGE SHALL BE LESS THAN THE MONTHLY EQUIVALENT OF A PERIODIC FEE WHATEVER THAT MEANS. ONE OF THE THINGS THAT CONCERNS ME MOST ABOUT THE BILL AND IF WE PASS THIS BILL I BELIEVE WE WILL BE BACK HERE YEAR AFTER YEAR AFTER YEAR AFTER YEAR STARTING G TO PUT REGULATIONS ON TOP OF THIS. IT SAYS A PATIENT IS REQUIRED TO PAY FOR ALL SERVICES PROVIDED BY THE DIRECT PRIMARY CARE PRACTICE THAT ARE NOT SPECIFIED IN THE DIRECT PRIMARY CARE AGREEMENT. I'M NOT QUITE SURE WHAT THAT MEANS. I KNOW KIND OF HOW TO FIX MYSELF BUT THAT IS WHY I GO SEE A DOCTOR. YOU ARE GOING TO SIGN AN AGREEMENT SAYING HOPE THIS FIXES EVERYTHING I NEED TO WALK INTO THE DOCTOR'S OF IF ISSUE TO FIND OUT THAT IS NOT PART OF YOUR AGREEMENT I AM GO GOING TO HAVE TO CHARGE YOU FOR THAT AND CHARGE YOU FOR THAT BECAUSE THAT IS NOT IN YOUR AGREEMENT. WE SAID MANY SAID THIS IS FREE MARKET AND WE WILL FINALLY BE AGE TO CONTAIN THE COSTS OF HEALTHCARE AND I HOPE THEY ARE RIGHT. I DON'T THINK THIS IS THE WAY TO DO IT. I THINK WE NEED TO COME UP WITH PLANS THAT MERGE ONE WAY OR THE OTHER SO YOU CAN HAVE CATASTROPHIC AND HAVE A SERIES OF PRIMARY CARE PHYSICIANS WITH AN AGREEMENT THAT COVERS EVERYTHING THAT NEEDS TO BE COVERED. DOCTORS H COME UP WITH -- I BELIEVE THAT MOST THE VAST MAJORITY OF SOUND LEGITIMATE CARE GIVERS THAT WILL COME UP WITH A COMPREHENSIVE AGREEMENT THAT THEY DON'T BELIEVE HAS ANY HOLES. I BELIEVE THERE ARE THOSE THAT WOULD OFFER THE PRODUCT IEPS TENSIONALLY LEAVING HOLES IN THERE WHERE PATIENTS WOULD BE REQUIRED TO PAY MORE MONEY. IT SAYS THAT THE AGREEMENT STANDING ALONE DOES NOT SATISFY THE HEALTHCARE REQUIREMENTS. UNDER THAT LAW YOU EITHER HAVE TO BUY INSURANCE OR IF YOU DON'T BUY INSURANCE YOU WILL PAY A PENALTY. THE AFFORDABLE CARE ACT THENCE POLICIES PROVIDE AND MAKE MANTA TORRE SO THE MANY OF THE PREVENTATIVE CARE BENEFITS OUTLINED IN THE AFFORDABLE CARE ACT. WHAT IS IT THIS CONTRACT IS GOING TO PROVIDE THAT YOU ARE GOING TO SIGN IN ADDITION TO CARRYING OUR INSURANCE IS NOW GOING TO BE COVERED THAT WASN'T COVER UNDER THE AFFORDABLE CARE ACT. HOW DO YOUR CONSTITUENTS KNOW THAT THEY ARE NOT IN FACT BUYING INSURANCE AND AND THEN PAYING A PHYSICIAN TO GET THE SAMING THIS YOU ALREADY PAID FOR UNDER THE INSURANCE POLICY. ESTUDY THINGS TO COME ONE A PLAN THAT PROTECTS IT AND ULTIMATELY TO COME UP WITH A PLAN THAT PROTECTS THE CONSUMER. I WOULD RENEW MY MOTION THAT WE REREFER THIS BILL BACK TO THE COMMITTEE UNDER RULE G.

[Unknown]: THE SENIOR SENATOR FROM LOUD, SENATOR BLACK.

Sen. Dick Black (R-Leesburg): I RISE TO SPEAK AGAINST THE MOTION. LADIES AND GENTLEMEN THIS IS A VERY BASIC AND SIMPLE MEASURE IT DOESN'T HAVE ANYTHING TO DO WITH THE AFFORD CARE ACT, NOTHING AT ALL. IT DEALS WITH THE FACT THAT WE ALL KNOW DEDUCTIBLES ARE OUT THE ROOF. MY DAUGHTER HAS FIVE YOUNG CHILDREN AND THIS HE CATCH THE FLU AND THEY CATCH ALL KINDS OF THINGS AND THEY NEED SHOTS AND DIFFERENT THINGS. AND BECAUSE OF THE DEDUCTIBLES THAT THEY HAVE WHAT THEY DO IS SAVE UP AND THEY GET HEALTHCARE IN A BLOP SO THEY CAN MEET A DEDUCTIBLE FIGURE AND I BET YOU THERE ARE THOUSANDS AND THOUSANDS OF FAMILIES WHO DO THAT TYPE OF THING. THIS IS A BASIC CONTRACT. IT IS OLD FASHIONED AND IT SAYS LOOK I AM DOCTOR, I AM GOING TO GIVE YOU BASIC SERVICES. THEY ARE NOT GOING TO BE COMPLEX, THEY WILL BE BASIC AND IF YOU NEED THEM, COME IN AND YOU GET THEM. AND YOU GOING TO PAY ME $50 A MONTH OR WHATEVER IS THE FEE. IF I DECIDE I DON'T LIKE THE SERVICE I AM GETTING FROM THE DOCTOR, I DROP IT. IT IS FINISHED. IT IS JUST A BASIC CONTRACT AND SOMETHING THAT FILLS A TREMENDOUS, TREMENDOUS PRESSING NEED. NOW, SOMEBODY SAID THE OTHER DAY, IF IT IS JUST BASIC CONTRACT LAW WHY DO YOU EVEN NEED TO HAVE THIS. BUT YOU KNOW WHAT HAPPENS IS TOMORROW POOR DOCTOR SETS UP A LITTLE NETWORK OKAY COME ONEN IN AND THE I WILL TAKE CARE OF YOUR FAMILY AND KIDS AND WHATEVER. SOME INSURANCE COMPANY IS GOING TO COME IN WITH A BUDGET OF MILLIONS AND MILLIONS OF DOLLARS IS GOING TO CRUSH THAT PERSON AND FORCE THEM OUT OF BUSINESS WHETHER THIS HE GOT A CASE OR NOT BECAUSE THEY DO NOT HAVE THE

[Unknown]: WILL THE SENIOR SENATOR FROM ABILITY. LOUDOUN YIELD FOR A YES.

Sen. Dick Black (R-Leesburg): WOULD THE SENATOR YIELD FOR A YES.

[Unknown]: I DO NOT YIELD. HE DOESN'T YIELD, SENATOR. PLEASE CONTINUE. BUT THEY HAVE THE ABILITY TO CRUSH AND EVERYBODY IN HERE WHO IS AN ATTORNEY KNOWS THIS, IF YOU ARE FACED WITH SOMEBODY WHO HAS IMMENSELY DEEP POCKETS AND YOU ARE AN ORDINARY PHYSICIAN AND ORDINARY PERSON YOU DON'T HAVE THE ABILITY, YOU HAVE GOT TO YIELD. YOU ARE GOING TO BE FORCED INTO SUBMISSION ON SOMETHING THAT PRESENTLY IS LAWFUL TO DO IT RIGHT NOW BUT IF WE PUT IT IN THE CODE, THEN THEY ARE GOING TO BE ABLE TO LOOK THAT THE CODE AND SAY HEY, LOOK, GENERAL ASSEMBLY SAID I CAN ENTER INTO THESE BASIC CONTRACTS AND I OUGHT TO DO IT. I'M GOING TO TELL YOU THERE IS PROBABLY NOTHING THAT WILL DO MORE TO PROVIDE GOOD HEALTHCARE TO ORDINARY FAMILIES, TO POOR, POOR FAMILIES THAN THIS BECAUSE IT IS GOING TO TAKE CARE OF THIG DEDUCTIBLE SITUATION THAT IS WASHING PEOPLE OUT OF THE HEALTHCARE SYSTEM. I WANT TO SEE IT, I WANT TO SEE IT FOR MY FAMILY AND I WANT TO SEE IT FOR FAMILIES ALL ACROSS VIRGINIA. I THINK THIS IS A VERY IMPORTANT MEASURE AND I HOPE THAT YOU WILL DEFEAT THE MEASURE OR THE MOTION. THANK YOU. SENATOR, THE JUNIOR SENATOR FROM HENRICO, SENATOR DUNNAVANT.

Sen. Siobhan Dunnavant (R-Henrico): THANK YOU, MR. PRESIDENT. SPEAK TO THE MOTION.

[Unknown]: THE SENATOR HAS THE FLOOR.

Sen. Siobhan Dunnavant (R-Henrico): I WILL -- I AM ACTUALLY SPEAKING AGAINST THE MOTION. AND I WANT TO CLARIFY A COUPLE OF THINGS. THE FIRST THING IS THAT THIS IS ABSOLUTELY NOT HEALTH INSURANCE. TO SEND IT BACK TO BE STUDIED BY AN ORGANIZATION THAT SETS REGULATIONS FOR HEALTH INSURANCE WOULD BE ABSOLUTELY THE WRONG THING TO DO. WHAT IS HAPPENING NOW AND IF YOU HAVE NOT HEARD FROM YOUR CONSTITUENTS. I HAVE HEARD FROM MY PATIENT. MOST OF OUR PATIENTS INTEREST HIGH DEDUCTIBLE MANS AND HAVE TO PAY DOLLAR FOR DOLLAR EVERYTHING ALLOWED BY THINSURANCE. THE FEES THEY ARE PAYING ARE WHAT THE INSURANCE SAYS THEY HAVE PAY FOR A SERVICE. THEY ARE PAYING THE FEES UNTIL THEY GET TO $6,000. PEOPLE PAYING 600ED PREMIUMS A MONTH ARE NOT ABLE TO AFFORD TO SEE THE DOCTOR WHEN THEY HAVE THE FLU AND PAY ANOTHER $150 FOR THAT VISIT. THIS A AN OPPORTUNITY TO PROTECT CONTRACT LAW THAT IS ALLOWABLE IN ALL OTHER ARENAS WHERE A PATIENT AND PHYSICIAN CAN DEVELOP A CONTRACT AND THAT DOCTOR CAN AMORTIZE ACROSS THE 12 MONTHS IN A PREDICTABLE WAY A MEANS OF THEM SECURING PRIMARY CARE. THE ONLY THINGS THAT YOUR INSURANCE WITH THE HIGH DEDUCTIBLE WILL PAY FOR WILL BE PREVENT AITIVE CARE SERVICES. THOSE WILL NOT WE INCLUDED IN THE AGREEMENTS. IF YOU HAVE THE FLU OR BRONCHITIS THAT REQUIRES THREE DIFFERENT VISITS HOW MANY OF US HAVE HAD THAT YOU ARE NOW COVERED IN A WAY THAT YOU CAN AFFORD TO SEEK YOUR HEALTHCARE THAT DOES NOT INVOLVE YOURENCE. IT IS IMPORTANT FOR CON AT THIS CONSTITUENTSTO HAVE ACCESS TO HE EVEN IF THEY ARE INSURED.

[Unknown]: THE SENIOR SENATOR FROM FAIRFAX, SENATOR SASLAW.

Sen. Dick Saslaw (D-Springfield): I DON'T KNOW IF YOU BROUGHT THIS UP ON YOUR MACHINES, LINES 97 THROUGH 108 SPELL IT OUT. THEY KEEP HAVING TO REPEAT THAT DIRECT PRIMARY CARE IS NOT INSURANCE AND ALSO GO ON TO SAY IT SHOULD NOT BE SUBJECT TO ANY REGULATION BY THE STATE CORPORATION COMMISSION. THAT IS THE BIGGEST PROBLEM THAT I HAVE WITH THIS. YOU CAN PEOPLE WALKING AND ENTERING INTO AGREEMENTS IN IN AN AREA THAT THEY KNOW NOTHING ABOUT AND YOU ARE GOING TO SAY THAT WE ARE NOT GOING TO HAVE A THIRD-PARTY THAT HAS OPINION SET UP TO SPECIALIZE IN LOOKING AT THESE THINGS, THESE ARRANGEMENTS WE ARE GOING TO CUT THEM OUT OF PICTURE. I GUARANTEE YOU WILL HAVE A DISASTER IF YOU DO THIS AND WE WILL BE COMING BACK HERE YEAR AFTER YEAR MAKING CHANGES IF WE PUT IT IN THE CODE. WE OUGHT TO DUPLICATE AND HAVE A STUDIED.

[Unknown]: SENATOR STANLEY.

Sen. Dick Saslaw (D-Springfield): SPEAKING AGAINST THE MOTION.

[Unknown]: THE SENATOR HAS THE FLOOR. MR. PRESIDENT, AND MEMBERS OF THE SENATE I RISE BECAUSE I SUPPORT THIS BILL BECAUSE I CARRIED IT ON THE SENATE SIDE. YOU DIDN'T GET A CHANCE UNLESS YOU WERE IN COMMERCE AND LABOR TO VOTE FOR OR ANSWER SENATE BILL 627 BECAUSE IT WAS REFERRED TO THE HERC, TO THE HEALTH INSURANCE REFORM COMMISSION BY THE BODY AT THE TIME THAT I PRESENTED THE BILL. THIS BILL AS THE JUNIOR SENATOR FROM HENRICO SAID HAS A LOT OF MERIT. HERE IS WHY. IT INCREASES ACCESS. THAT IS WHAT WE ARE LOOKING TO DO IS PUT ANOTHER TOOL IN THE TOOL BOX FOR A FAMILY ON A FIXED INCOME OR TIGHT BUDGET TO HAVE ACCESS TO THE MOST PRIMARY NEEDS AND PRIMARY HEALTHCARE. THAT IS IT. I HAVE A DOCTOR THAT IS TRYING TO START A MEDICAL SCHOOL IN OUR AREA THAT WILL TRAIN DOCTORS ONLY IN PRIMARY CARE IN RURAL AND UNDERSERVED AREAS. RIGHT NOW, LANE WE DON'T HAVE TOOK TORES COMING DOWN TO SOUTHWEST RAS TO PRACTICE. IT IS JUST NOT I GUESS FINANCIAL HI REWARDING. IF THEY WERE COMING DOWN WE WOULDN'T HAVISH SHIES IN TERMS OF THE RURAL HEALTHCARE REFORMS WE NEED. WE NEED RURAL HEALTHCARE REFORM BRICK BY BRICK STONE BY STONE TO BUILD A FOUNDATION OF QUALITY HEALTHCARE ACCESSIBLE O ALL PERSONS REGARDLESS OF THEIR INCOME OR WHERE THEY LIVE. DR. BOAZ HAS SET UP A CLINIC THAT CHARGES AN ANNUAL FEE FOR MEMBERSHIP AND A FAMILY NO MATTER HOW MANY CHILDREN PAY THE FEE ANNUALLY AND CAN BRING THEMSELVES OR CHILDREN IN AS OFTEN AS THEY FEEL THE NEED TO PROVIDE THE PRIMARY CARE FOR THE FEE. IT FITS PERFECTLY WITHIN THEIR BUDGET. THE SENIOR SENATOR FROM VIRGINIA BEACH. WOULD THE GENTLEMAN YIELD FOR A QUESTION FOR A YES? I WILL YIELD. I MADE THE STATEMENT THAT THE INSURANCE COMPANIES WILL CRUSH THESE FOLKS WITH LAWSUITS. HAS YOUR PARTICULAR CONSTITUENT BEEN CRUSHED BY A LAWSUIT FROM AN INSURANCE COUNTRY. HE HAS NOT BEEN SUBJECTED TO ANY SUCH LAWSUIT. THANK YOU. THANK YOU. PLEASE CONTINUE. THANK YOU, MR. PRESIDENT. DR. BOAZ WHEN HE STARTED THE CLINIC SAW IT GROW AND GROW AND GROW AND GROW IN ITS MEMBERSHIP AND NOW IN MAN CONTINUESVILLE AN MEDICALLY UNDERSERVED AREA WHERE THE AVERAGE AGE OF A PRIMARY PHYSICIAN IS 56 YEARS OLD. FOR EVERY TWO WE LOSE WE DON'T EVEN GET ONE BACK. FOR THOSE ON FIXED INCOMES OR 81 EMMOI WHO HAVE LARGE FAMILIES OR EVEN THE INDIVIDUAL AND REGARDLESS OF THE INCOME, GAINFULLY EMPLOYED, RETIRED OR THOSE ON FIXED ACCESS. THE GAME ACCESS TO THE SAME DOCK DOCTOR FOR THE SAME RATE. IT IS MERELY THE GATEWAY TO WHAT MAY BE FURTHER TREATMENT AND THOSE FEES THAT THEY WOULD CHARGE DO NOT COVER IT. KNOWING AND HAVING THE SECURITY WITH THE YEAR HI FEE PAID AND TAKE YOUR CHILD IN AND MAYBE A FEVER OR DOESN'T HOOK AS SERIOUS THE DOCTOR ABLE TO REFER THE CHILD OUT PAUSE IT MAY BE PORE SERIOUS OR IS MORE SERIOUS THAT ACTIVITY IS WHERE INSURANCE COMES IN OR THAT ACTIVITY, MR. PRESIDENT, BECOMES AN ADDITIONAL OUT OF POCKET EXPENSE. THIS IS KIND OF THE GATEWAY FOR PRIMARY CARE IN A WAY THAT IS EFFICIENT. IN A WAY THAT PROVIDES MORE ACCESS. IN A WAY THAT ALLOWS A DOCTOR TO HAVE A CONTRACTUAL RELATIONSHIP WITH THE PATIENT, THE PATIENT'S FAMILY, TO GIVE SECURITY TO THE PATIENT AND TO PROVIDE THEM WHAT THEY ARE OTHERWISE ARE -- IF THEY ARE NOT INSURED THEY MAY NOT BE AIBLE TO AFFORD. OR IF INSURED THE VISIT MAY HAVE A HIGH DEDUCTIBLE THAT THEY MAY NOT BE ABLE TO AFFORD. THIS IS SECURITY. I THANK YOU FOR YOUR TIME. I RISE FOR AN INTRODUCTION. THE SENATOR HAS THE FLOOR. MR. PRESIDENT, I HOPE YOU WILL JOIN THE SENIOR SENATOR FROM VIRGINIA BEACH IN RECOMMITTING THE BILL TO THE APPROPRIATE COMMITTEE. I HEARD A LOT OF COMMENTS SAID ON THE FLOOR TODAY ABOUT ACCESS TO CARE AND IT IS NOT AN INSURANCE PRODUCT BUT SOMEONE WHO DEALS WITH INSURANCE PRODUCTS EVERKY DAY IS AS PA ARE THE OF HIS HEAVE, THIS IS INSURANCE. WHILE THEY SEEK NOT TO BE REGULAR HATE THE BY THE STATE CORPORATION COMMISSION THEY OUGHT TO BE. THAT IS HOW WE MAKE SURE THAT THINGS ARE TON IN A SAFE AND EFFICIENT. THERE IS AN INSURANCE PRODUCT OUT THERE ALREADY TESTED. IT IS CALLED MEDICAID EXPANSION. THANK YOU, MR. PRESIDENT. THANK YOU, SENATOR. THE SENIOR SENATOR FROM -- [APPLAUSE] PLEASE, NO APLUS IN THE APPLE GALLERY, THANK YOU. THE SENIOR SENATOR FROM VIRGINIA BEACH. SENATOR WAGNER.

Sen. Frank Wagner (R-Virginia Beach): IF NO ONE ELSE WISHES TO SPEAK.

[Unknown]: THE SENATOR HAS THE FLOOR.

Sen. Frank Wagner (R-Virginia Beach): I WANT TO CLOSE OUT BY SAYING THAT LOOK, THIS IS PROBABLY A PRODUCT WHO WILL COME AND NEEDS TO COME TO VIRGINIA. BUT IT NEEDS TO HAVE SOME REGULATION TO IT. SO THAT THE CONSUMER KNOWS WHAT HE IS PIEING, SO THAT THE CONSUMER KNOWS THAT PROFESSIONALS HAVE LOOKED AND IT AND WHAT IN FACT IT WILL COVER WHAT WE SAY ON THE FLOOR WE ARE ABOUT IT IS TING TO COVER. THEY CAN'T DOUBLE BILL. THEY CAN'T PROVIDE THE SERVICE AND THEN TURN AND CHARGE THE INSURANCE COMPANY FOR IT. I ASK YOU WHAT PREVENTS SOMEONE FROM DOING IT? THERE IS NO CIVIL PENALTY. THERE IS NO CRIMINAL PENALTY, NO PENALTY WHATSOEVER. MR. PRESIDENT, I RENEW MY MOTION THAT THE BILL BE REREFERRED.

[Unknown]: THE NO ARE FROM STAFFORD, SENATOR STEWARD. THANK YOU, MR. PRESIDENT. SPEAKING TO THE MOTION. THE SENATOR HAS THE FLOOR. I HAVE LISTENED TO THIS DEWAIT -- DEBATE. I WANT TO WONDER WHY IN THE WORLD YOU WOULDN'T LET AN INDIVIDUAL HAVE A CONTRACT WITH THEIR DOCTOR TO TAKE CARE OF US. AND IT REALLY AMAZES ME BECAUSE WE SUFFER FROM THE HIGH COST OF INSURANCE. MR. PRESIDENT,. FOR WHAT PURPOSE DOES HE RISE. WOULD THE GENTLEMAN YIELD FOR A QUESTION? NOT JUST GET. WE SUFFER FROM THE HIGH COST OF INSURANCE. WE SECURE FROM THE HIGH COST OF HEALTHCARE. AND WHAT THIS BILL IS, IT IS DOCTORS, IT IS DOCTORS OUT THERE BEING PROACTIVE TO TRY TO CARE FOR THEIR PATIENTS IN AN ECONOMICAL WAY. AND I HAVE HEARD SEVERAL PEOPLE STAND UP NOW AND SAY OH, MY GOODNESS, WE HAVE GOT TO HAVE THE INSURANCE PROFESSIONALS LOOK AT THIS AND REGULATE IT AND MAKE SURE IT IS SAFE AND MAKE SURE THESE UNSCRUPULOUS DOCK ARE TOES AREN'T GOING TO TAKE ADVANTAGE OF THESE PATIENTS. THESE ARE THE DOCTORS WE ARE TRUST OF TRUSTING OUR LIVES TO AND GOING IN FOR MEDICAL CARE IN MANY ENTRANCES TO KEEP US ALIVE. I DON'T THINK WE HAVE TO HAVE THE INSURANCE PROFESSIONALS LOOK AT IT TO REGULATE. THESE DOCTORS KNOW WHAT THEY ARE DOING AND THEY ARE TRYING TO TAKE CARE OF THEIR PATIENTS AND IN SOME CASES THEY ARE DOING IT FOR $500 A MONTH. I -- THE SENATOR FROM VIRGINIA BEACH. WILL HE YIELD FOR A QUESTION. WOULD THE SENATOR YIELD. I WOULD POINT YOU THE THAT HE CAN ASK ME AFTER WE SIT DOWN. I YIELD, MR. PRESIDENT,. JUST NOT AS FUN AS IT IS IN PUBLIC, THOUGH. I WOULD ASK THE GENTLEMAN, HE MADE THE COMMENT THIS WILL ALLOW THE CONTRACTS TO GO ON. WOULD THE GO GO AGREE THEY ARE GOING ON RIGHT NOW. I AM AWARE THERE ARE CONTRACTS GOING ON RIGHT NOW. I AM ALSO AWARE THAT THE INSURANCE LOBBY IS CONCERNED ABOUT IT AND THAT THE FOLKS PARTICIPATING IN THE CONTRACTS ARE GETTING MORE CONCERNED EVERY DAY BECAUSE HERE IS THE REALITY. A SMALL RURAL DOCTOR OR A DOCTOR IN FAIRFAX THAT IS FAIRLY WELL HEELED IF THEY HAVE TO BE ON THE RECEIVING END OF A LAWSUIT FROM ONE OF THE LARGE LAW FIRMS IN THE STATE UP VIRGINIA THERE IS NOING THAT DOCTOR CAN DO BUT YIELD TO THE LAWSUIT BECAUSE THEY DON'T HAVE THE MONEY TO FIGHT THE INSURANCE INDUSTRY. IF I COULD FOLLOW UP WITH A QUESTION. I WILL YIELD. I WILL YIELD. AND IT IS SOME WHAT A LITTLE TREPIDATION A LOWLY ENGINEER GOES UP AGAINST A TRIAL ATTORNEY WHEN QUIZZING AND CROSS EXAMINING. THERE HAS BEEN NO LAWSUITS FROM THE INSURANCE COMPANIES. I RESPECT THE INTEGRITY OF MOST OF THE DOCTORS IN VIRGINIA BUT WOULD YOU AGREE HE WITH ME THAT THERE ARE INSTANCES OF MEDICAID AND MEDICARE FRAUD PARTICIPATED BY DOCTORS AROUND THE COUNTRY. THE SENATOR FROM STAFFORD. MR. PRESIDENT, I HAVE HEARD THAT THERE ARE CASES AS SUCH. MR. PRESIDENT, WOULD THE GENTLEMAN YIELD FOR A YES? I YIELD. HE YIELDS, SENATOR. WOULD THE GENTLEMAN AGREE WITH ME THAT THIS OPENS UP A DOOR AND ALLOWS THE FEW UNSCRUPULOUS DOCTORS THAT WE MAY HAVE PRACTICING IN THE COMMONWEALTH ANOTHER OPPORTUNITY TO MILK THE SYSTEM. THE GENTLEMAN FROM STAFFORD. THAT OPPORTUNITY MAY ALREADY EXIST AND THIS BILL IS NOT GOING TO DO A DARN THING ABOUT THAT. ONE MORE TIME I MOVE MY MOTION IT BE REREFERREDDED TO COMMERCE OF COMMITTEE AND LABOR AND TRY TO PUT A FRAME WORK AROUND IT AND PERHAPS A PENALTY FOR THOSE THAT MIGHT WANT TO DEFRAUD THE SYSTEM. SENATOR MARSDEN. QUICKLY I RISE IN SUPPORT OF THE MOTION. THERE IS AN OLD SAYING THAT I THINK APPLIES HERE. MEASURE TWICE. CUT ONCE. THANK YOU, MR. PRESIDENT. THE QUESTION IS SHALL HOUSE BILL 685 BE RECOMMITTED TO THE COMMITTEE ON COMMERCE AND LABOR AND CONTINUE TO THE 2017 SESSION PURSUANT TO RULE 20 G. ALL IN FAVOR SAY AYE. NOS.

Del. Bill Howell (R-Fredericksburg): THE CHAIR IS UNCERTAIN. THERE WILL BE A RECORDED VOTE. SHALL THE BILL BE CONTINUED TO THE 2017 SESSION PURSUANT TO RULE 20-G. ALL IN FAVOR OF THE MOTION WILL. ARE THE SENATORS READY TO VOTE? HAVE ALL THE SENATORS VOTED? DO ANY SENATORS DESIRE TO CH ANGE THEIR VOTE? THE CLERK WILL CLOSE THE ROLL.

[Unknown]: AYES 19, NOS 21. AYES 19, NOS 21. THE MOTION FAILS. THE SENIOR SENATOR FROM VIRGINIA BEACH, SENATOR WAGNER. I AM PROBABLY THE WRONG ONE TO MAKE THE MOTION BUT I WOULD RECOMMEND THE BILL BE PASSED AND RECOMMEND WE NOT DO IT.

Sen. Frank Wagner (R-Virginia Beach): THE JUNIOR SENATOR FROM HENRICO, SENATOR DUNNAVANT.

Sen. Siobhan Dunnavant (R-Henrico): I MOVE THAT WE TO PASS THIS LEGISLATION AND I WILL POINT OUT THAT IT WOULD BE NICE FOR THE DOCTORS TO ACTUALLY BE ABLE TO SET SOME FEES AS OPPOSED TO THE INSURANCE COMPANIES AND I THINK THEY WILL BE MUCH MORE REASONABLE. THANK YOU.

Sen. Frank Wagner (R-Virginia Beach): THANK YOU, SENATOR.


Del. Steve Landes (R-Weyers Cave): REQUIREMENTS OR REQUIREMENTS, REQUEST RELATED TO FURTHER DEFINING THAT FOR THIRD PARTY PAYER FEES, THAT BASICALLY DEFINING THAT, AND ALSO, LADIES AND GENTLEMEN OF THE HOUSE, MR. SPEAKER, DEALING WITH MAKING SURE THE AGREEMENT, THRSING THE AGREEMENT IS THAT IT IS NOT HEALTH CARE INSURANCE. THAT IS ALWAYS THE INTENT OF THE BILL. MR. SPEAKER, I'M GOING TO ASK WE AGREE TO THE SENATE SUBSTITUTE.

Del. Bill Howell (R-Fredericksburg): THE GENTLEMAN FROM CHARLOTTESVILLE, MR. TOSCANO.

Del. David Toscano (D-Charlottesville): THANK YOU, MR. SPEAKER, WILL THE GENTLEMAN YIELD FOR A QUESTION?

[Unknown]: GENTLEMAN YIELD?

Del. David Toscano (D-Charlottesville): MR. SPEAKER, I'D BE GLAD TO YIELD.

[Unknown]: GENTLEMAN YIELDS. THANK YOU, MR. SPEAKER, I ASK THE QUESTION THIS, CAME ROARING OUT OF THE HOUSE AND LOOKED LIKE THERE IS SOME OPPOSITION TO THE SUBSTITUTE IN THE SENATE. DOES THIS HAVE ANYTHING TO DO WITH THE AFFORDABLE CARE ACT? MR. SPEAKER, I'D SAY TO THE GENTLEMAN, NO. IN FACT WHAT OCCURRED IN THE SENATE IS THAT THERE WAS A SENATE VERSION. THE SENATE CARRIED THAT LEGISLATION OVER WE WERE ABLE TO FURTHER CLARIFY FOR THE SENATORS THE NEED TO MOVE FORWARD ON THE LEGISLATION AND IMPORTANTLY, ADDRESS SOME CONCERNS THAT WERE RAISED ON THE SENATE SIDE AND IN FACT, THE SUBSTITUTE BEFORE US IS ACTUALLY WHAT THE SENATE PATRON WAS HOPING TO BE ABLE TO OFFER, TO HAVE HIS LEGISLATION MOVE FORWARD AND THAT DID NOT OCCUR. SO IN OTHER WORDS I JUST LUCKED OUT. I THANK THE GENTLEMAN.

Del. Bill Howell (R-Fredericksburg): SHALL THE SENATE SUBSTITUTE BE AGREED TO? CLERK WILL CLOSE THE ROLL.

[Unknown]: AYE, 87, NO, EIGHT. THE SENATE SUBSTITUTE IS AGREED TO. CONTINUING WITH THE CALENDAR, NEXT CATEGORY, RESOLUTION UNCONTESTED CALENDAR, ONE BILL IN THE BLOCK.


Del. Steve Landes (R-Weyers Cave): EFFORT TO MAKE AND BRING FORWARD SOME ADDITIONAL HEALTH CARE REFORM, AND ESPECIALLY RELATED TO DOCTORS AND PATIENTS BEING ABLE TO CONTRACT DIRECTLY WITH EACH OTHER ON SERVICES THAT THEY WOULD LIKE TO RECEIVE. IT CLEARLY DEFINES THAT THIS IS NOT AN INSURANCE CONTRACT, AND THAT'S BEEN THE BONE OF CONTENTION WITH THE FOLKS IN THE INSURANCE INDUSTRY, AND I UNDERSTAND THAT. MR. SPEAKER, WHAT THE GOVERNOR'S AMENDMENT DOES, THIS PUTS A REENACTMENT CLAUSE ON THIS, WHICH WOULD DELAY THIS FOR ANOTHER YEAR. IN TALKING TO THE GOVERNOR'S STAFF, THEY DID NOT SEEM TO HAVE ANY OPPOSITION, BUT WANTED ADDITIONAL TIME TO LOOK AT THE LEGISLATION. AS THE GENTLELADY FROM CHESTERFIELD JUST SAID, I'M GOING TO ASK THAT THE HOUSE REJECT THE AMENDMENT. THIS WOULD GIVE THOSE THAT ARE INTERESTED IN THIS ADDITIONAL TIME TO MEET WITH THE GOVERNOR, THE GOVERNOR'S STAFF, TO FURTHER EXPLAIN THE LEGISLATION AND HOPEFULLY GAIN THEIR SUPPORT. IF THE GOVERNOR DOES NOT BELIEVE THAT THE TIME IS NOW TO MOVE FORWARD, THEN HE STILL HAS THE OPTION TO VETO. BUT I THINK THAT'S A FAIR WAY TO APPROACH THIS, AND MORE IMPORTANTLY, THIS IS ONE SMALL MEASURE THAT WE HAVE GOTTEN SOME BIPARTISAN SUPPORT ON TO MOVE RELATED TO HEALTH CARE REFORM. AND I HOPE THE HOUSE WILL REJECT THE GOVERNOR'S AMENDMENT.

Del. Bill Howell (R-Fredericksburg): THE GENTLEMAN FROM ARLINGTON, MR. HOPE.

Del. Patrick Hope (D-Arlington): THANK YOU MR. SPEAKER. SPEAKING TO THE GOVERNOR'S RECOMMENDATION?

Del. Bill Howell (R-Fredericksburg): THE MAY -- THE GENTLEMAN MAY PROCEED.

Del. Patrick Hope (D-Arlington): THANK YOU MR. SPEAKER. I DID MISS THIS, AND I THINK THE GENTLEMAN'S INTENT IS A GOOD ONE. THIS MAY BE A GOOD IDEA. WE DON'T REALLY KNOW. AND LAST YEAR, THE ANNALS OF INTERNAL MEDICINE, THEY DID A STUDY ON THIS. THERE'S PROBABLY -- INTERNAL MEDICINE IS -- MOST PRIMARY CARE PHYSICIANS COME OUT OF INTERNAL MEDICINE THAN ANY OTHER STUDY AND THEY DID A QUESTION ABOUT -- A STUDY ABOUT THESE TYPES OF ARRANGEMENTS AND SAY IT POTENTIALLY CREATES A BARRIER TO LOW INCOME PERSONS, PERSONS ARE CHRONIC DISEASES AND UNDERSERVED POPULATIONS. ONE OF THE THINGS THEY POINTED OUT IN RURAL AREAS, WHEN YOU THINK ABOUT WITH THE SHORTAGE OF PHYSICIANS, IF YOU HAD A GROUP OF PHYSICIANS IN SOUTHWEST VIRGINIA, FOR EXAMPLE, THAT DECIDED TO DO THIS, THAT WOULD TAKE AWAY, IF THAT WAS ALL THEIR PRACTICE, THEY WOULDN'T SEE ANY OTHER PATIENTS AND YOU CAN SEE HOW PEOPLE THAT WERE LOW INCOME, THEY COULDN'T GET IN TO SEE THE DOCTOR'S OFFICE BECAUSE THERE IS A CHARGE TO BE PART OF THIS ARRANGEMENT. SO I SUPPORT WHAT THE GOVERNOR IS SAYING, THAT WE NEED TO TAKE A LOOK AT THIS TO SEE IF IT DOES CAUSE ANY HARM, BECAUSE IT MAY VERY WELL CAUSE HARM. SOME STATES, THERE ARE A HANDFUL THAT HAVE DONE THIS, THERE IS DATA THAT WE CAN LOOK AT THIS. I THINK WE SHOULD. I'M NOT SAYING IT'S A BAD IDEA. BUT I'M SAYING IT COULD DO MORE HARM IF WE DON'T DO THIS RIGHT AND TAKE A LOOK AT IT. I THINK WHAT THE GOVERNOR IS LOOKING AT IS ROAM, COME BACK NEXT YEAR AND SEE IF WE HAVE THE PROPER PROTECTIONS AND SAFEGUARDS SO IT DOESN'T HAVE UNINTENDED CONSEQUENCES. I ASK THAT YOU SUPPORT THE GOVERNOR'S RECOMMENDATION.

Del. Bill Howell (R-Fredericksburg): THE GENTLEMAN FROM BEDFORD, MS. BYRON.

[Unknown]: THANK YOU MR. SPEAKER, I SPOKEN YOU -- I HOPE YOU WILL REJECT THE GOVERNOR'S THIS IS THE VERY REASONABLE AMENDMENT. MEASURE. THERE ARE SO MANY PEOPLE THAT ARE COMING TO US AND TELLING US ABOUT THE INCREASE IN THEIR HEALTH CARE COSTS, AND HOW THEY CAN'T AFFORD THEIR INSURANCE ANYMORE, OR THE OUT OF POCKET COSTS THAT THEY HAVE, AND WE NEED TO BE LOOKING AT INO NATOO INNOVATIVE WAYS SUCH AS THIS TO BE ABLE TO THINK OUTSIDE THE BOX AND ALLOW PATIENTS AND DOCTORS TO WORK TOGETHER TO BE ABLE TO GET THEIR MEDICAL NEEDS TAKEN CARE OF. WE DID SOMETHING SIMILAR TO THIS SEVERAL YEARS AGO THAT ALLOWED INSURANCE CO-OPTS OR CHRISTIAN ORGANIZATIONS TO PUT TOGETHER HEALTH CARE OPPORTUNITIES FOR FOLKS THAT WAS NOT INSURANCE, AND THIS IS SOMETHING ALONG A SIMILAR PATH THAT ALLOWS FOR DOCTORS TO DIRECTLY HELP PEOPLE IN THE COMMUNITY THROUGH THESE AGREEMENTS THAT THEY MAKE UP, AND I HOPE WE WILL NOT DELAY THESE OPPORTUNITIES ANY LONGER AND ALLOW PEOPLE TO TAKE ADVANTAGE OF THIS. SO I HOPE YOU WILL REJECT THE GOVERNOR'S RECOMMENDATION.

Del. Bill Howell (R-Fredericksburg): THE GENTLEMAN FROM HENRICO, MR. O'BANNON.

Del. John O'Bannon (R-Richmond): I HOPE YOU WILL REJECT THE GOVERNOR'S REENACTMENT CLAUSE. I FIND IT INTERESTING THE GENTLEMAN FROM ARLINGTON WANTS TO SLOW THIS DOWN BUT WANTS TO SPEED UP THE DISTRICT WAIVER. THIS IS A FORM OF HEALTH CARE REFORM THAT WE HAVE AVAILABLE TO US AND I THINK WE OUGHT TO GO AHEAD AND DO IT.

[Unknown]: SHALL THE HOUSE AGREE TO THE GOVERNOR'S RECOMMENDATIONS?

Del. John O'Bannon (R-Richmond): THE CLERK WILL CLOSE THE ROLL.

[Unknown]: AYES 34, NOS 66. AYES 34, NOS 66, THE GOVERNOR'S RECOMMENDATIONS ARE REJECTED. CONTINUING ON PAGE 34 OF THE PRINTED CALENDAR, HOUSE BILL 735, GOVERNOR'S