The Republican Women of Clifton

republican, conservative women and their spouses

Health Care Issues

Folks, I worked in healthcare for a decade or so and the Certificate of Public Need (COPN) is one of the big driver of healthcare costs, so this is HUGE or shall we say YUGE to have this piece of legislation before us! Please SUPPORT SB 266 by calling your Senators! See more information below. 

ACTION: Call and e-mail your Senator in Richmond and tell him/her to vote for SB 266.

Find your senator and contact info here

A vote will be called Monday or Tuesday, the last day before "Crossover."


SB 266 allows multiple exceptions to the anti-market regulations known as Certificate of Public Need (COPN).   We've been trying for years to get COPN repealed in Virginia...

SB 266 would allow independent doctors to establish certain ambulatory services in their offices instead of forcing patients to use hospital facilities for routine tests like colonoscopy, MRI, or simple surgical procedures.  Patients pay less, and significant savings to Medicare are possible.

One doctor reports*: 

If you look at Medicare colonoscopies across the entire US, every year Medicare overpays a staggering $257,527,703.72 a year by having colonoscopy done in [hospital outpatient departments] ... rather than in the office.  

The issue is about the cost of health services, which COPN keeps artificially high by stifling competition.  The same physician states:

According to the Virginia Department of Health COPN website, “The program seeks to contain health care costs while ensuring financial viability and access to health care for all Virginia at a reasonable cost.”  Is the COPN program really fulfilling its stated mission and intent, or is it in fact part of the proble

OPN is a complex issue, but you don't need to be an expert to make a call to your Senator.  This bill may be our only chance this year to begin chipping away at the monopolistic control the hospital lobby maintains on Virginians' access to affordable health care. Please share this alert widely, and call your senator right away (leave a message and ask to be called back.)

*Below  are the remarks delivered by Dr. Keith Berger to the Senate Education and Health Committee on 9 Feb.  The bill he addressed was one of several that were combined into SB 266.  

In Support SB 235 to Allow an Exception to Virginia CON for Center for Health and Cancer

Prevention in Virginia Beach

Mr. Chairman and Members of the Committee:

● I’m Dr. Keith Berger, and I’m here in support of Senator DeSteph’s SB 235

I’m a board certified Gastroenterologist. In 1985, I was the first gastroenterologist in the State

of Virginia to offer GI procedures (such as colonoscopy) in the office as opposed to the hospital,

where costs were significantly higher. Since then, office based endoscopy has become the

standard of care in Virginia

● My current medical practice is called the Center for Health & Cancer Prevention (CHCP). We

operate a single bed, single physician office endoscopy unit . We specialize almost entirely in

the early detection and prevention of colon cancer , the second leading cause of cancer

mortality in Virginia and the US.

Our Center sees about 1400 patients per year, about 350 of which are Medicare patients

Medicare patients are at the highest risk for colon cancer , and colonoscopy is a highly effective

means of preventing it.

● So why this Bill? Running an office endoscopy practice requires a lot of resources, so a single

procedure in our office costs the practice around $500, which is, however dramatically less

than the cost of the same procedure at the hospital outpatient department (HOPD), $1213, or

250% higher (see the attached actual patient bill). Since we pioneered the use of office based

endoscopy in 1985, as a result of Virginia CON Law, we have never received a single dollar of

reimbursement for the facility costs of doing Medicare patients in our office , even though

these costs are reimbursable by Medicare. Virtually every insurance company in VA uses the

office based model. For 33 years, we have absorbed the Medicare facility costs ourselves even

though we could have done these patients instead at the hospital at no cost to the practice. We

estimate that we have saved patients and Medicare over this time between $4 million and


Every year we do office based colonoscopy, the cost savings to patients and Medicare would be

$ 319,594. This figure represents only 1/10 of 1% of the (hospital’s) SVBGH’s total revenue , and

therefore would have no detrimental impact on the hospital.

If you look at Medicare colonoscopies across the entire US, every year Medicare overpays a

staggering $257,527,703.72 a year by having colonoscopy done in HOPD’s rather than in the


Because of shrinking Medicare allowances for physicians, doing Medicare patients in my office

and having to absorb the facility costs now leaves the practices losing money on every Medicare

case because under CON, I cannot be reimbursed for any of my office costs, staff, equipment,

supplies etc. This is unsustainable.

● Moreover, I now find myself focused constantly on how to keep my practice running, spending

my attention and energy on just how to ‘survive.’

● All the while, the practice of medicine is becomingly increasingly complex , particularly with the

demands of EHR, complicated insurance billing, liability, changing referral patterns and hospital

consolidations. This leaves independent physicians struggling just to stay in practice, and forces

many excellent, experienced physicians to leave medicine altogether or take employed

positions. Many of us are ‘burned out.’ We are losing invaluable and irreplaceable resources.

● So far, independent physicians have not received much help from our State or Federal

government .

● One of the common objections to CON reform or repeal is that it would negatively affect

coverage for rural or indigent populations. I believe that using the CON Law is a poor and 

actually counter-productive means of accomplishing this. Instead, I believe that the way to

solve the ‘coverage’ issue is to begin to address the incredible waste and inefficiency in our

healthcare system . And colonoscopy is just one example. What if we could take that $257

million yearly windfall by moving colonoscopy from the outpatient department to the office, and

invest those savings into indigent care, rural health initiatives and other needed services?

● According to the Virginia Department of Health COPN website, “The program seeks to contain

health care costs while ensuring financial viability and access to health care for all Virginia at a

reasonable cost .” Is the COPN program really fulfilling its stated mission and intent, or is it in

fact part of the problem?

● Based on what has been presented here, I respectfully request that the committee consider

granting my practice an exception to the CON. It would allow me to continue my services to a

very important population and health issue, i.e., colon cancer prevention in middle aged and

elderly Virginians. It would allow me to expand my contribution in healthcare, which is what I

am here to do. 


Thank you for your listening.

Keith E. Berger, MD

The Center for Health and Cancer Prevention, LLC

757-412-7737 cell




Ryan Opening Statement: Markup of Bills to Reform the IRS and Repeal the Death Tax

WASHINGTON — Today, Ways and Means Chairman Paul Ryan (R-WI) delivered the following opening statement during a markup of bills to reform the IRS and repeal the death tax.

"So, we're marking up a lot of bills today. But the point we're trying to make here is this: The IRS works for the taxpayer, not the other way around. It's their job to make doing your taxes as easy as possible. And so the burden is on them to prove any wrongdoing. The burden is on them to protect people's privacy. And the burden is on them to tell taxpayers their rights. That's the attitude they should have.

"But that's definitely not the attitude they have today. If our investigations have shown us anything, it's that bureaucracies don't do what's efficient. They do what's convenient—at least, what's convenient for them.

"Well, principles aren't always convenient. And what we have here is a matter of principle. So we're going to insist that the IRS do their job—the right way.

"Now, these reforms are simply common sense. All we're saying are things like, 'Don't target people because of their political beliefs. Don't tax donations to tax-exempt groups. Don't send taxpayer information to your private email.' Pretty simple stuff.

"And there's another thing we've learned. And that is, this kind of mischief grows in the shade. We found out about this stuff because we dug deep. The only way to hold big bureaucracies accountable is through rigorous, effective oversight.

"But the thought I want to close with is this: All the confusion, all the unfairness and frustration—all this comes from the fact that our tax code is a mess. It's way too complicated. It punishes people for working, saving, investing—all the things we need to build a healthy economy. Sometimes it even punishes people from beyond the grave.

"That's why today we're here to repeal the death tax. People work hard and pay taxes all their lives. They've earned the right to leave something for their kids—often a family business—without being penalized for it. And this tax doesn't just hit the big guy. It hits the little guy—like the small business and the family farm. It is both unwise and unfair, and it needs to go.

"In fact, we need to replace our whole tax code. We need to make it simpler, flatter, and fairer. That would create more opportunity in our country. And it would build a healthier economy for all. So I'm glad we're taking a step in that direction today. And I'm glad we're putting hardworking taxpayers and their concerns front and center."




We need to make a nationwide effort IMMEDIATELY to get ObamaCare defunded: House & Senate Republicans Set to Endorse and Fund Obamacare  

Or better yet, repealed: Affordable Care Act will impose new burdens on consumers, businesses

The healthcare law is turning out to be much more expensive than planned and it must be stopped NOW:  GAO Report: Obamacare Adds $6.2 Trillion to Long-Term Deficit; Health Care and the Debt Deal

Doctor shortages are a threat to ourselves and our children: Doctor Shortage Becoming Crisis Under ObamaCare. I know two doctors who are leaving their practices because they are unwilling to have Obamacare regulations interfere with what they think is best for their patients.

For those who think nothing can be done about Obamacare, that is not true:

·      CLASS, Obamacare's Long-Term-Care Entitlement, has already been overturned, and many states have refused to set up state exchanges and expand Medicaid.

·      There is bi-partisan support for getting rid of the medical device tax and the Independent Payment Advisory Board (IPAB), a fifteen-member group created in 2010 by sections 3403 and 10320 of Obamacare, which has the task of achieving specified savings in Medicare and will surely lead to rationing.

 We get the word out NATIONWIDE

 1)  Everyone needs to contact their Congressional Representatives and Senators, whether Republican or Democrat, and let them know that Obamacare must go, or they will be replaced in the next election like so many were in 2010: Poll: Democratic Support for Obamacare Falls 15 Points

 2)  In addition to contacting Congress, everyone should reach out to family and friends to do the same. The future of our country is at stake.

Taxes going up

Dear Friends,

The General Assembly is set to increase the state sales tax from 5% to 5.8%, a 16% increase as part of the Governor’s Transportation Plan unless citizens contact their representatives and urge them to vote NO.  The plan ends the gas tax for car, jet and heating fuel (not diesel).  In the second year it projects to raise an additional $85 million from the sales tax alone, and $3.1 billion over five years from increased taxes and fees.  That’s money from you and me!  It’s hardly revenue, there’s no guarantee gas prices will drop, and any future Administration could reinstate the gas tax. 

Virginia has serious transportation problems mostly in Northern Virginia and Tidewater.  Over the years, Administrations have proposed various “fixes.”  In 2010, $3 billion in road bonds were authorized.  Incredibly, Virginia has yet to lock up its transportation fund so it can’t be spent for other purposes.  I believe transportation is a core function of government, and we should cut one penny of every dollar in the budget (excluding salaries) and devote that savings to transportation.

When Democrats propose tax hikes, Republicans are not happy.  When Republicans raise taxes we are supposed to go alongI cannot.  A tax hike is a tax hike no matter which party proposes it and for this reason I voted against the Governor’s plan in Committee and will do so again on the floor of the House of Delegates. In this fragile economy, we must not go to the ATM (American Taxpayers’ Money).   We must lock up the Transportation Trust Fund, and use existing revenue, instead of raising more through tax hikes.
    The Republican Party used to oppose tax increases.  Now Republican leaders want Republicans to vote for a tax increase and in an election year no less!    

    If you do not want the sales tax increase, please contact your Delegate and Senator and urge them to vote against the Governor’s Transportation Plan.

    Just like their Washington colleagues, House of Delegates Republicans in Richmond are proposing tax increases to fund road projects instead of shifting existing funds to pay for new construction and maintenance.

And remember when we all were shocked that Former Democrat Speaker of the House of Representatives said that Congress had to pass Obamacare to find out what is in it?

Well, House of Delegates Republicans are voting for the Governor's tax increase bill with a promise of more unspecified taxes to be added at regional levels on top of other statewide taxes.

Again, I urge you to contact your Delegate and Senator to stop this tax increase. 

Thank you for your vigilence.


Delegate Bob Marshall

Virginia Schools

Here at AFP-VA, we are continuing to promote quality education and education freedom for all of Virginia’s children. We support teacher tenure reform and merit based pay; we support looking at ways to improve educational tax credit legislation and to improve access to virtual learning.

We wanted to remind you, our activists, of the key legislation that we’re supporting and opposing dealing with education freedom. Please contact your state Delegate and Senator to let them know that they need to represent Virginia and not give in to partisan politics.

Click here to send a message to your state lawmakers and ask that they support school choice!

*Oppose SB1300 - Virtual School Programs; multidivisional online funding for providers.

This bill takes steps toward establishing a much-needed new funding model for public full-time virtual education in the Commonwealth with the “funding following the child”; however, due to several provisions in the bill it will deny school choice to students based on their zip code, a practice we oppose.  

*Support HB1555 - Virginia State Virtual School; established as statewide school division

*Support SB935 - Public schools; changes to teacher contracts and evaluation policies.

*Support HJ684 - Constitutional amendment; Board of Education authorized to establish charter schools.

Again, please contact your representatives here to let them know that we need them to stand for school choice.

Thank you for all that you do for liberty!

Audrey Jackson

State Director

Boneta Bill

Yesterday was truly a day that I will remember as a highlight of my legislative career. I didn't get a chance to update you after the long subcommittee meeting last night, but I wanted to send you a note first thing this morning to tell you the good news!

The Boneta Bill (HB 1430) passed through the Agriculture subcommittee this evening and will be heard in the full Agriculture Committee this Wednesday (January 30th) at 8:30AM!

The bill as passed last night contains key language that will protect the rights of property owners and farmers like Martha and is a leap forward in keeping government out of every aspect of our lives!

Friends, I wish you could have been there. As I came out of the elevator and headed towards the committee room, there was a massive crowd of supporters spilling out into the hallway. There were folks from all over the Commonwealth. No joke. From all over.

It was almost impossible to get into the room. Both entrances were packed.

I couldn't help but be grateful for the sacrifice that all these folks made for the sake of property rights, liberty, and free enterprise. It was humbling to see so many folks there to support Martha and my effort to move a good bill forward and we did!

And it really made a difference to the subcommittee members to see first-hand how powerful this grassroots movement really is.

The fight isn't over yet, folks, and here's where you come in. We need to show the full committee how powerful this movement is and show them that we are going to fight

So here is your call to action: WE NEED TO PACK THE ROOM ON WEDNESDAY.

Please forward this message along and make sure that we have all of our supporters at the full committee hearing.

Here are the details:

What: Meeting of the Agriculture, Chesapeake, and Natural Resources Committee

Why: To debate The Boneta Bill (HB 1430) and vote to send the bill to the floor of the House of Delegates

When: Wednesday, January 30th, 2013 at 8:30AM

Where: House Room C of the General Assembly Building (1000 Bank Street, Richmond VA)

More Information: Email

If you'd like to contact the members of the Agriculture, Chesapeake, and Natural Resources Committee, you can find there information here!

I can't thank you enough for all of your support. Like I said, I will not soon forget this day. But we've got a long ways to go before we can celebrate. The opponents of property rights are going to come out fast and hard against this bill but I know that we will out work them

I hope to see you Wednesday!


Obamacare clearly violates the 10th Amendment. The law’s first mandate—ordering Virginia to set up insurance exchanges that create thousands more patients but not one more doctor to care for them--is where Virginians will make another historic stand for freedom and individual rights.

Support HJ653,calling on the Governor, Lieutenant Governor and the Attorney General to oppose any federal mandate or usurpation of state authority that is not clearly articulated by the United States Constitution, beginning with Obamacare.

The House of Delegates Rules Committee will be considering this important resolution Tuesday, January 29th at 4:00 PM. Please contact the members of the rules committee and ask them to support this important resolution sponsored by Scott Lingamfelter.

You can read this important legislation here and if you want to be updated on this important legislation as it progresses through the General Assembly , please click here.

Stand with me as I take a stand to protect our Constitution, the supreme law of the land from those on the left who want to take our property, destroy our rights and run our lives.

House Rules

Government of the people, by the people, for the people, shall not perish from the Earth
— Abraham Lincoln