Ohio (66 delegates)
In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.
At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.
According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.
Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.
Virginia (49 delegates)
Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.
Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.
Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.
Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.
Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.
Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.
The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.