Spanberger Signs Health Care Bills At Inova In Fairfax, Capping Insulin Costs, Expanding Coverage

FAIRFAX, VA — Gov. Abigail Spanberger (D) on Wednesday signed a package of health care bills at Inova Schar Cancer Institute aimed at capping insulin costs, expanding insurance benefits and limiting how insurers use prior authorization and artificial intelligence.

Speaking at the hospital in Fairfax County, Spanberger said rising costs for housing, energy and health care are a top concern across Virginia and framed the legislation as part of her “Affordable Virginia” agenda.

“Because of these bills, when your family needs care you can get it, when your doctor writes you a prescription, you should be able to afford it,” Spanberger said. “When you get sick, the cost of getting better shouldn’t break a family’s bank.”

Focus On Insulin, Drug Costs And Prior Authorization

Spanberger said the new legislation will cap out-of-pocket costs for a 30-day supply of insulin at $35, calling it a “huge deal” for the roughly 800,000 Virginians diagnosed with diabetes.

She also said marketplace plans will be required to offer options with caps on out-of-pocket prescription drug costs so residents can better budget for the care they need.

The governor described prior authorization as a barrier between patients and treatment their doctors have already recommended. She cited a Richmond-area gastroenterologist who, she said, resorted to arranging an emergency-room visit so he could perform a procedure that had been delayed by insurer approvals.

“The reality of what that means for the betrayal of trust between doctors and patients … is something that we are addressing here in the Commonwealth of Virginia,” Spanberger said.

One of the bills, HB 736, restricts insurance companies from using prior authorization to delay or deny care that doctors have approved, according to the governor.

Expanded Coverage For Doula Care, Infertility Treatment, Hearing Aids

Spanberger signed HB 328, a measure that expands Virginia’s essential health benefits to include doula care, infertility treatment and hearing aids. The measure's chief sponsor was Del. Rip Sullivan (D-Great Falls).

Del. Irene Shin (D-Herndon), who attended the event, said after the ceremony that the bill signing marked a clear shift under the new administration.

“It’s such a world of difference to serve with a Democratic governor, as opposed to a Republican one,” Shin said. “I think it’s really gratifying to serve under a governor who has made really clear affordability as part of her agenda.”

Shin, who was chief patron of HB484, said the bill responds to how insurers use artificial intelligence to review claims submitted by physicians.

“What it says is that before an insurance company can down code the claim that a physician has submitted and said, ‘Hey, I treated your patient for this, this and this, here’s what the cost of reimbursement is.’ Right now, insurance companies and carriers are using AI and algorithms to determine whether they’re going to down code or not without allowing for human intervention or an appeals process,” Shin said.

The law bars insurers from deploying AI to automatically downcode claims without a chance for human review.“Insurance companies cannot utilize AI and deploy without human intervention," Shin said.

HB 484 and its Senate companion SB 164, targets insurers that reduce what they pay on a claim “behind closed doors,” Spanberger said during the ceremony.

Work Through Health Insurance Reform Commission

Del. Rip Sullivan (D-Great Falls), who chairs the Health Insurance Reform Commission, said in an interview the bill signed as HB 328 represents years of work by lawmakers, staff and advocates. The measure came through the commission, known as HERC, which reviews health insurance proposals in detail before the General Assembly takes them up.

“This has been the culmination of a lot of people’s very hard work — advocates for the various issues that are covered in the bill,” said Sullivan, who described the legislation as spanning “many, many sessions.”

Sullivan said the commission was created because the legislature struggled to handle complex questions about what Virginia’s insurance exchange should cover through regular committees alone.

“We meet very regularly while the General Assembly is not in session, so a lot of people traveling to Richmond,” Sullivan said. “One of the issues raised in this bill was first raised in the General Assembly at least five or six years ago, and it finally worked its way” through the process.

The law sets in motion a process to add more diseases and conditions to health insurance plans offered in Virginia, according to Sullivan.

State Officials Cite Federal Uncertainty, Local Impact

Marvin Figueroa, the state’s health and human resources secretary, said the bills are intended to brace Virginians for possible federal health-care cuts and changes.

The secretary described examples of residents in Herndon, Arlington, Woodbridge, Ashburn, Dumfries and Chantilly facing high out-of-pocket costs, delays in prior authorization, and uncovered services such as doula care and fertility treatments.

“That is what we are here to prevent, and it’s exactly why we are doing today really matters,” Figueroa said. “Because responsible governing is not just about respond[ing] to crisis after it arrives. It’s about building a [system] sturdy enough that when those federal cuts come, families don’t fall.”

Spanberger said every bill she signed Wednesday passed the General Assembly with bipartisan support. She thanked Dels. Carrie Delaney, Rip Sullivan, Irene Shin, Roja Henson and Michelle Maldonado, along with several senators, for shepherding the measures.

“The number of lives who will be changed for years in the future is pretty extraordinary,” Spanberger said. “There are days that are hard … when you are in public service, but I think today is a day … we can be proud of, because we know that we are impacting people’s lives and delivering the things we promise."