A mender of broken bones salves Medicaid expansion


Associated Press

Posted on February 11, 2013 at 11:05 AM

Updated Monday, Feb 11 at 11:05 AM

RICHMOND, Va. (AP) — Not too many years ago, Dr. Bill Hazel was repairing the broken bones and torn joints of clientele as diverse as the poor in Bolivia and the well-paid bruisers of the Washington Redskins.

But the healing he accomplished last week in Richmond's legislative corridors may rival anything he's done with a scalpel.

The compelling facts and figures he provided the Senate Finance Committee gave feuding Democrats and Republicans the confidence to unite behind an expedited but cautious roadmap toward a federally prescribed expansion of Medicaid in Virginia.

Achieving the expansion early next year for up to 400,000 Virginians just above the poverty level is no sure thing. It's a first-tier priority for Virginia Democrats, and reluctant Republicans say it won't happen without fundamental cost-saving reforms to the federal-state program that provides health care services to the needy, elderly, blind and disabled.

But after hearing Hazel explain the pros and cons to the committee Wednesday, a handful of senior committee Democrats and Republicans huddled extemporaneously. Notes were scrawled. Necks craned and brows furrowed. Heads nodded in agreement and smiles slowly emerged.

When the two Democrats and two Republicans rose to leave, they'd agreed on a framework for amending Medicaid expansion provisions already written into the Senate's version of the budget, which was due a floor vote the next day. The amendment was approved on a voice vote and the budget passed on a 36-4 vote, and all the nay votes were Republicans.

Without an honest broker that senators of both parties viewed Hazel to be, Medicaid would have remained a sticking point for the Senate's 20 Democrats who had threatened to block passage of the budget Thursday.

"He made a huge difference," said Finance Committee chairman Walter A. Stosch, R-Henrico. "In fact one of the concerns all of us have in the future is not being able to take advantage of his knowledge while we're going through this negotiation process."

Hazel's tenure is tied to that of Gov. Bob McDonnell. He appointed Hazel to his cabinet in January 2010 to guide the new administration through the thicket of health care policy.

McDonnell's single, non-renewable term expires in just 11 months, about the time the truly heavy lifting begins on Medicare expansion, health insurance exchanges and other federally prescribed medical reforms in the Patient Protection and Affordable Care Act . That's the landmark federal overhaul led by President Barack Obama, which Republicans derisively call "Obamacare."

In three years on Capitol Square, the good doctor's esteem as a straight shooter is bipartisan and universal.

"I don't care if you're a Republican or a conservative, (Medicaid expansion) involves some risk, and I think if Dr. Hazel weren't involved in the negotiations, we wouldn't take the risk," said Sen. Henry Marsh of Richmond, one of the Democrats' most steadfast advocates for expansion. "People on both sides had confidence in his answers."

"There has never been a better cabinet official in all the years I've been here," said the leader of the Senate's Democrats, Dick Saslaw.

"That guy is so knowledgeable and so smart that it's just unreal," Saslaw said. "And let me tell you something: the first phone call (Democrat) Terry McAuliffe should make if he's elected governor — and I think he will — should be to Hazel asking him to stay on."

Maybe, Hazel says. Maybe not.

"It's early to say. Part of me would love to finish some of the work we're doing. And part of me knows it's a personal decision. To be honest with you, this is a grueling haul," he said at the close of a demanding week Friday.

Hazel has yet to master politics. It would be a shame if he did. He's still a physician at heart, a big, guileless and gregarious man of 56 who's a bit guarded in a Capitol Square culture whose veterans know that the hand that pats you on the back today might stab you there tomorrow.

His strength lies in synthesizing his deep knowledge of the business of medicine with McDonnell's conservative health care policy objectives. "The governor and I share a lot of the same philosophy about, and we really do think you've got to get the reform done. If you can't bend the cost curve, not just in Medicaid but health care in general, none of this works," he said.

Getting just the right reforms, getting legislative enactment and funding, and getting them operational by 2014 would be like a grand slam for a team three runs down with two outs and two strikes in the bottom of the ninth in the seventh game of the World Series.

Improbable, Doc Hazel concedes, but by no means impossible.


Bob Lewis has covered Virginia government and politics for The Associated Press since 2000.