The work of a high-profile advisory council, led by a well-positioned secretary of health and human resources, has made Virginia “far more ready than many people think” for health care reform, according to this “Report from the States.”

Politically complex, Virginia was the first to file a lawsuit challenging the constitutionality of the federal individual mandate of the Affordable Care Act (ACA), while its Republican governor, Bob McDonnell, has continually stressed that the commonwealth must develop its own, Virginia-specific health care reform solution. According to Len M. Nichols of George Mason University, several key developments have kept Governor McDonnell’s Virginia Health Reform Initiative (VHRI) on course.

Key Developments:

• In 2010, the governor appointed a bipartisan, high-profile Advisory Council to lead the VHRI.
• Virginia’s secretary of health and human resources, Bill Hazel, was an effective VHRI leader: as a physician, he understood the perspectives of medical providers and patients, but, as a conservative Republican, he wanted to find an evidence-based solution that could be provided by the market and private sector.
• Although the VHRI was initially viewed as a Medicaid reform effort, Hazel built a consensus for both insurance and delivery reform.
• Unlike some states that chose to do nothing while awaiting the outcome of challenges to the ACA, Virginia was highly motivated by a bipartisan belief that the threat of federal takeover was too great should health care exchanges be upheld.
• Virginia also embraced the idea that a strong health care system with contained costs would make the state attractive to business, and thus, that an efficient health care system and a strong state economy are linked.

On this basis, Virginia has taken steps to create its own health care exchanges and has created the Virginia Center for Health Innovation, a public-private partnership focused on delivery reform. The commonwealth is now well positioned to await clarification from the courts on ACA.