My Alternative to Medicaid Expansion


I URGENTLY NEED YOUR HELP!!  My HB 39, to provide an alternative to Medicaid expansion by providing free health care to the indigent through volunteer doctors is set to be killed in Committee tomorrow.  There are big money interests that want Medicaid expanded, and my bill would get in their way!


When I received notice that HB 39 would be heard tomorrow, Delegate Landes and I asked for a short postponement as a courtesy to the doctors who need to rearrange their schedules in order to testify on behalf of my bill.  I was told by Subcommittee Chair Delegate Habeeb that I could reschedule.  Within an hour Del. Habeeb told me the bill would be heard tomorrow!

My bill is being opposed by the Trial Attorneys.  Under HB 39, if doctors donate four hours weekly of free care to the indigent in exchange for their service, the Attorney General’s office would defend them against lawsuits in their private and charity practices.  This would lessen the need for malpractice insurance.

Few doctors serve Medicaid recipients currently because of the high costs.  Adding 425,000 new Medicaid recipients to the present one million will further burden the system.

During the Governor’s race, Terry McAuliffe twice said he would not vote for a Budget unless Medicaid expansion was included.  My HB 39 is a true compromise in that the poor would get medical care, and the taxpayers would not have to suffer through more tax increases because of Medicaid expansion.

Remember, Republican leaders imposed the last three tax hikes on Virginians, including the 2013 road tax hike.  We cannot count on their “Alamo-like” resistance to Medicaid expansion unless the people make their voices heard.  My HB 39 would forestall the need to expand Medicaid, and that is why it is feared.

HB 39 will not cost a dime of tax money and will avoid Medicaid fraud because Medicaid would not be used.  No insurance billing bureaucracy would be needed to administer the program.  Doctors would keep regular patient medical records.

Thirty years ago filing insurance paperwork cost doctors 15-30% of their revenue.  Today it’s 60%+ with more to be needed for Obamacare paperwork. (Business Insider, 5/29/13). Virginia already self-insures 3,400 physicians for care they provide in free clinics with no law suits pending.

McAuliffe claims the Feds will cover 100% of Medicaid costs for three years and 90% thereafter.  Recall Obama and Mark Warner’s prior failed promises: “You can keep your own insurance,” and “you can keep your own doctor.”

The U.S. Centers for Disease Control found in their 2011 National Medical Care Survey that 31% of doctors would not take new Medicaid patients.  The 2012 Jackson Healthcare Physician Practice Trends Survey found that 36% of U.S. doctors will not take new Medicaid patients. A NEJM study (6/16/11) of Cook County, Illinois doctors found that “Overall, 66% of Medicaid-CHIP callers…were denied an appointment as compared with 11% of privately insured callers…” after women posing as mothers of pediatric patients with common health conditions made calls to identical clinic staff for appointments 30 days apart using the same script but identifying Medicaid or private insurance as payment.

So, a Medicaid card will not guarantee medical care for the poor.

Terry McAuliffe claims that “if we don’t accept money it will simply flow to other states.”  This is not true.  Virginia’s “share” of Medicaid expansion money (our federal taxes) is based on a formula.  For 2016, Congress allocated $372 Billion for Medicaid for all 50 states, with $1.5 billion for Virginia.  If every other state rejected expansion, Virginia would not get the entire $372 Billion.

McAuliffe has reappointed Governor McDonnell’s Secretary of Health, Dr. Bill Hazel, who has been working to expand Medicaid since passage of Obamacare in 2009.  McAuliffe said, “’I am confident that Secretary Hazel will be the best steward to help me carry my agenda forward and meet the challenges we face when it comes to health care in this commonwealth.”

The Obama Administration has cut from $500 million to $1 billion in reimbursements to VCU and UVA for hospital care for indigents.  The news of the VCU/UVA funding shortfall came from Health Secretary Hazel on the same day Terry McAuliffe announced he wanted Hazel to stay on as Health Secretary.  Terry McAuliffe would not be seeking to re-appoint Sec. Hazel if he were not also fighting for Medicaid expansion!

Medicaid expansion may not significantly improve health. In 2008, Oregon expanded Medicaid for low-income adults.  Two years later, The New England Journal of Medicine (NEJM) reported (5/2/13) “…Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services…”   Those words come from the authors of the article, not me.

Science magazine [1/2/14] further analyzed Medicaid usage of patients enrolled in the 2008 Oregon Medicaid expansion.  The author’s summary reported on 25,000 Medicaid lottery participants over an 18 month period.  “We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings. …  A back-of-the-envelope calculation, using $435 as the average cost of an emergency room visit suggests that Medicaid increases annual spending in the emergency department by about $120 per covered individual.”

In other words, because it is harder and harder for patients to receive primary medical care in private doctor’s offices, Medicaid eligible patients are going to hospital ER’s for primary care at a rate 40% higher than non-Medicaid patients.

Because doctors fear lawsuits, many doctors practice “defensive” medicine which consists of ordering medical tests and treatments which shield a doctor from liability, but which may offer little or no benefit to the patient. This drives up general health care costs as well as tax-funded Medicaid and Medicare programs.

An AMA published survey, answered by 65% of 824 Pennsylvania doctors (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) found:  “… 93% reported practicing defensive medicine. … such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%).  Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. … Defensive practice correlated strongly with … perceived burden of insurance premiums.”  JAMA. 2005 Jun 1;293(21):2609-17.

As more and more Doctors consider leaving the medical profession over Obamacare requirements, HB 39 can remove the burden of insurance claims for care provided by charity doctors, a significant factor increasing health care costs across the board. Relieved of that burden, doctors will be able to exercise their best clinical judgment, and not order tests to avoid litigation.  Doctors under HB 39 will have no incentive to encourage behavior that produces repeat pathologies, where voluntary behavior and not genetic history, social condition or accidents, is the major causative factor in illness or subpar health.

Doctors serving the poor through charity care will not waste time with Medicaid. Physicians who treat the poor without charge will have their reputations enhanced, and attract more paying patients. Non-profit groups or churches will be better able to direct only the truly needy to their affiliated clinic doctors resulting in true patient-centered care by physicians delivered in the local community.

The drawback for some politicians may be the absence of political payback votes.  In other words, instead of converting citizens into government dependents, the indigent will remain free men and women not beholden to anyone or expected to vote for a particular political benefactor.

HB 39 has the potential to take us back to a medical care delivery model that preceded Lyndon Johnson’s so-called Great Society which bureaucratized Charity by creating government programs and agencies with employees who relied upon the indigent remaining so in order to keep their jobs.
Thank you for your support!

P.S. Without your urgent calls, emails and contacts to the above committee members, we will certianly not be able to cut costs and serve those who are most vulnerable among us.

On Your Side Investigators: Lawmakers tackles cell phone tracking

Your phone isn’t just a phone anymore, it’s also a tracking device. Police are dialing up the cell phone companies more and more, often asking for specific information – like a user’s whereabouts or even a call log. Under current law, they do not need a search warrant.

The top cell phone companies revealed they’d responded to 1.3 million law enforcement demands for subscribers information. The On Your Side Investigators uncovered how Richmond, Chesterfield and Henrico County all use the tactic.

Republican delegate Bob Marshall says it’s got to stop.

“Just keep stepping around this, like some people want to do too often, is to jeopardize your life and your liberty,” said Marshall during a phone interview.

Marshall has introduced a bill that would require cell phones to be considered tracking devices. Police would need a warrant from a judge before phone companies hand over location data.

Read the full article here.

Medicaid Expansion is coming in Virginia….

Dear Friends,

I have introduced three bills to address the growing disaster of Obamacare, as regards Medicaid expansion, Obamacare insurance salesmen sign-up organizers called Navigators, and keeping your previous insurance plan.  This alert discusses HB 39, to provide healthcare to the indigent without expanding Medicaid.

Medicaid Expansion Will Be Pushed in Virginia
Democrat Governor-elect Terry McAuliffe wants to add 425,000 recipients to the already 1,000,000 recipients on Medicaid arguing that 30,000 jobs will be added to Virginia’s economy.  Medicine should be about improving health.

Some businessmen and “moderate” Republican State Senators want to expand Medicaid because they want the promised 100% of federal funding (first three years) and jobs (political patronage?).  Federal funding is not free money.  It comes from “We the Taxpayers” whose tax burden continues to escalate.  They also believe Virginia can exit out of Medicaid expansion if the feds do not pay the 100%.  They fail to cite any legal authority in the Obamacare law or published regulations for support to back out after expansion.< During the Governor’s race, Terry McAuliffe twice said he would not vote for a Budget unless Medicaid expansion was included.   It is unclear if the Republican Speaker of the House would risk what will be painted in the media as “stingy Republicans” shutting down Virginia’s government over Medicaid expansion, despite such a shutdown being Democrat Governor McAuliffe’s decision. Read more

Thank You!

I have been proud to serve the citizens of the 13th district for the last 22 years and I am so thankful for your support for another term!  This was a very tight race and I appreciate so much the hard work of my family, friends and all of my volunteers and supporters.

Over the next two years I will continue to fight for my constituents to improve transportation, keep taxes low, protect our Constitutional rights and family values and stop Federal intrusions into our state government.

Thank you again for your support!



Delegate Bob Marshall

GOTV Events Saturday!

Friends, I will be having Get-Out-the-Vote events this Saturday, November 2nd at 11:00 in Manassas and at 2:30 in Haymarket. Liberals are dumping massive amounts of money into my opponent’s campaign so I need all the help I can get. If you can attend either of these events please RSVP to Claire@delegatebob.com. Thank you for your support!

Manassas Lit Drop
Time: 11:00 AM
Date: Saturday, November 2
Meet Location: Tony’s New York Pizza, 11674 Sudley Manor Dr., Manassas, VA 20109
We will meet back at Tony’s at 1:30 for pizza on me.

Haymarket GOTV Door-Knock
Time: 2:30 PM
Date: Saturday, November 2
Meet Location: Haymarket McDonald’s 6740 Leaberry Way, Haymarket, Virginia (corner of 15 & Washington St.
We will meet at the Penn Station Subs, 6424 Trading Square, Haymarket, VA 20169 (Walmart Shopping Center) at 4:30 for subs on me!
RSVP to Claire@delegatebob.com

“There They Go Again”

My latest ad outlining the misrepresentations my opponent and Terry McAuliffe are putting out about my legislation! The legislation is HB1, the so-called Personhood Bill that State Sen. Charles Colgan (D., Manassas) and I pre-filed in the 2012 session of the Virginia General Assembly so parents could recover ?wrongful death? damages if their pre-born child was killed in an accident. The House of Delegates approved the bill, 66-32, but it died in the State Senate. Please share with your friends!

The Truth About Birth Control

In both the statewide campaign for Governor and more recently in an ad my opponent put out there have been accusations that a bill I sponsored in 2012, HB 1, would have restricted birth control access. THIS IS NOT TRUE!

HB 1 was based on a Missouri statute which has been on the books for more than 20 years and which was reviewed by the Supreme Court. The Supreme Court declined to overturn this portion of the law specifically because it did not challenge Roe v. Wade or affect contraception in any way. Again this law has been on the books for 20+ years and it has not affected access to contraception, abortion or assisted conception in Missouri at all.

The language of the bill was designed to recognize the personhood of an unborn child to create a cause of action for a wrongful death suit for a pregnant mother in a case where someone deliberately or accidentally took the life of her unborn child in a situation other than an abortion. At the time Virginia was one of a handful of states that did not have a law on the books to do this.

My opponent and other statewide candidates have been less than truthful about my legislation. I have never made a pretense about my positions on the issues, so if you want a candidate who will be honest and straight forward vote for me, November 5th!


Del. Marshall files suit against Northern Va. Transportation Authority

State Del. Bob Marshall (R-13th) filed a complaint in Fairfax County Circuit Court Thursday charging that the Northern Virginia Transportation Authority (NVTA) failed to adhere to state law when it approved for funding a list of more than 30 transit projects last month.

At the crux of the case, Marshall said, is a Virginia statute that requires the authority to demonstrate how the projects will relieve congestion. With many of the recently-greenlit initiatives, the delegate said, that hasn’t been shown.

According to the section of Virginia Code noted in Marshall’s suit, the authority “shall give priority to selecting projects that are expected to provide the greatest congestion reduction relative to the cost of the project and shall document this information for each project selected.”

The question, it seems, is whether “shall give priority to” is a mandate.

In a prepared statement, Marshall said the NVTA “has failed to provide adequate and convincing documentation.”

“Their bond quality I am reliably advised will be low-grade, high-interest,” Marshall said. “Furthermore, projects that are seriously needed have been ignored while projects that will do little to help relieve major traffic congestion will be funded.”

Read the full article at the Loudoun Times Mirror

House of Delegates Page Program Application Period Now Open!


If you know a 13 or 14 year old who might be interested in becoming a House of Delegates page now is the time to apply!  Applications for the 2014 House of Delegates Page Program are now being taken by the Speaker’s office and must be received by no later than October 28, 2013.  If you or someone you know is interested in this program, please have them check out the website here for more information!  For the first time this year applications can be accepted online .  You must receive a letter of endorsement from your delegate to apply so if you reside in the 13th district please contact me at delbmarshall@house.virginia.gov.

Letter to the ABC

Delegate Marshall today sent the letter below to the Chairman of the Virginia Alcoholic Beverage Control Board and the Chief Operating Officer.  At issue is the case of Ms. Elizabeth Daly which has made headlines recently.

Ms. Daly was approached in a dark parking lot by plain clothes ABC officers in Charlottesville after coming out of a grocery store with food for a charity benefit including some sparkling water.  The ABC officers did not initially identify themselves and Ms. Daly was concerned for her safety so she got in her car.  Her vehicle was then surrounded by 5 other plain clothes officers who shouted at her to roll down her window or get out of the vehicle.  In order to roll down her windows she had to start her vehicle which caused one officer to jump on her hood and others to shout other directions.  Ms. Daly decided to leave the area to go to a police station and dialed 911 as she left the parking lot.  In the process of leaving she grazed two officers with her vehicle.  As a result of her actions she was charged with eluding police and assaulting two officers.

Ms. Daly should never have been stopped because the ABC officers had no probable cause and she certainly shouldn’t have been stopped in a dark parking lot by plain clothes officers.  The ABC needs to review its procedures and do further training of its officers. Read more