A legislative commission began its work Monday on deciding whether Virginia should expand Medicaid — one of the key provisions in the new federal health care law.

As my colleague David Ress reports, Virginia is in a strong bargaining position to get the flexibility it wants if it opts to expand Medicaid, the government health insurance program for the poor and disabled, the state’s top health official told the commission.

And the state already has made much progress reforming its Medicaid services on the lines that this year’s budget compromise on expansion calls for, said the chairman of the legislative panel that will decide whether  to expand Medicaid.

But even if the Medicaid Innovation and Reform Commission decides to expand Medicaid — by no means a certainty — it is unlikely that all the people who would be eligible if the state opts to expand Medicaid  will actually get the coverage by the start of next year, state Sen. Emmett Hanger, R-Augusta County , the panel’s chairman, added.

Virginia is one of 20 states that are still weighing whether  to expand Medicaid, using federal funds through the Affordable Care Act.

Read the rest of David’s story here.

And click here to read the first installment of our series about the Affordable Care Act, “Understanding Obamacare.”

Starting today, The Roanoke Times will launch an occasional series on the Patient Protection and Affordable Care Act.

The idea is to take an issue that has so far played out on a national stage – first in Congress, then before the U.S. Supreme Court, then in last year’s presidential election – and bring it home to Southwest Virginia readers by explaining how they are affected by the law.

The first installment will be about a proposal under the ACA to expand Medicaid in Virginia. The goal of providing better medical care to the poor and the disabled is a key part of the ACA’s larger mission of making health care more affordable and accessible to all. Reporter David Ress and I have spoken to several people who would benefit from a Medicaid expansion, and you’ll hear their stories. The plan also has its critics, and you’ll hear from them, too.

Read the story here.

Later in the year, we’ll have more stories about other major provisions of the law, which are scheduled to take effect Jan. 1, 2014.

Among them: an exchange that will offer subsidized insurance plans for people who don’t qualify for Medicaid but still struggle financially; a requirement that employers with 50 or more full-time employees offer insurance to them or face financial penalties; and the so-called “individual mandate,” which directs most Americans to have health insurance.

We welcome your comments – and your suggestions for future stories.

Victor Giovanetti is resigning as president of LewisGale Regional Health System to take a leadership position with a hospital chain in Nashville, Tenn.

Giovanetti, who has led the Salem-based health system since 2008, has accepted the position of chief operating officer of LifePoint Hospitals Eastern Group.

LifePoint has nearly 60 hospital campuses in 20 states, with 28,000 employees and 3,000 physician partners.

The division that Giovanetti is joining consists of about 20 hospitals in four states: Tennessee, Virginia, North Carolina and Michigan.

Giovanetti said the close relationship he has built with the LewisGale system and the Roanoke Valley community made the decision to move on difficult.

“It is truly a bittersweet day,” he said this afternoon, shortly after his resignation was announced.

Read the rest of the story here.

Carilion Clinic is treating more of the region’s poor for free, in keeping with a new federal law that seeks to expand health care for the needy.

The Roanoke-based health care system said Thursday it is broadening the guidelines that determine who qualifies for financial assistance with their medical bills.

Under the revised “charity care” policy, people who make up to 133 percent of the federal poverty line — $15,000 annually for an individual , $31,000 for a family of four — will qualify for free care.

The previous policy had offered full write-offs for those who made up to 100 percent of the poverty guideline, assuming they were not already covered by public or private insurance.

Carilion is making the change to be consistent with the proposed expansion of Medicaid, the government insurance program for the poor and disabled, that is part of the Affordable Care Act.

Read the rest of this story here.

First came the diagnosis: Too many people of the Roanoke Valley are in poor health, lacking the insurance, awareness and assistance they need to get better.

Then the potential cure: A strategic plan, unveiled Tuesday, that strives to treat not just the patients but the health care system that serves them.

Healthy Roanoke Valley, a coalition of more than 50 public and private entities with a stake in the community’s health, outlined a broad plan that calls for increased access to medical services, better coordination of care and an enhanced culture of wellness.

The plan was drafted in response to a community health needs assessment completed last year for an area that includes the cities of Roanoke and Salem and the counties of Botetourt, Craig, Franklin and Roanoke.

While the region’s ailments have been known for years, the latest effort to address them is driven in part by the new federal health care law.

Read the rest of the story here.

Read the Community Health Needs Assessment that prompted the plan here.

His older brother is a doctor. So is his mother. So is his father. So was his father’s father.

So as Jonas Rawlins graduates today from the Edward  Via College of Osteopathic Medicine, it would be natural to assume he  felt at least a little pressure to continue in the family tradition.

Not so, Rawlins said.

As a teenager, when Rawlins first began to talk  about attending medical school, he said, “My mom would always ask me  specifically: ‘Are you sure this is what you want to do?’ ”

Not only was Rawlins sure, but he also knew he wanted to attend VCOM, where his mother, Dixie Tooke-Rawlins,  is the dean.

When he receives his diploma Saturday from the  Blacksburg medical school, Rawlins will fulfill the legacy, becoming the  fourth doctor in a family of four.

Read the rest of the story here.

The man was clearly a 10-96, police code for a  mentally disturbed person.

Calling himself the mayor of Roanoke, he was causing  a stir at a downtown business, where he had shown up for a  ribbon-cutting ceremony that existed only in his mind.

When two police officers were called to the scene,  the man explained impatiently to them that he had to wait until the  planets, stars and space station were all perfectly aligned before  snipping the ribbon.

Curious pedestrians stopped to stare. The store manager wanted the loud intruder gone. The police officers had to do something.

They could have arrested him. Instead, they listened  patiently to his ramblings – defusing delusion with calm authority -  and eventually convinced him to walk with them outside.

It was all part of their training, carried out last week  during a role-playing exercise at the Roanoke Police Academy.

Known as crisis intervention training, the week   long  program teaches Roanoke-area police officers how to de-escalate  potentially dangerous situations involving the mentally ill.

Read the rest of the story here.

A new building that will house mentally ill veterans during their treatment at the Veterans Affairs Medical Center in Salem is nearing completion.

Construction of the $9.5 million, 38-bed facility comes as more veterans return from the wars in Afghanistan and Iraq with mental health needs.

Last year, the Salem VA received $1.7 million to hire an extra 13 mental health staffers as part of a national effort by the Department of Veterans Affairs to improve its psychiatric treatment program.

A spokeswoman for the Salem hospital said plans for the new building predate that initiative.

Nonetheless, “this will be a significant improvement over our current facilities for acute psychiatry treatment,” Marian McConnell said.

Read the rest of the story here.

A health care administrator with ties to Western Virginia has been confirmed by the U.S. Senate as the new head of the federal agency that administers Medicare and Medicaid.

Marilyn Tavenner, who grew up in Henry County, will take over the Centers for Medicare & Medicaid Services (CMS) at a time of major change in the health care field.

She will be responsible for overseeing new policies under the Affordable Care Act, the new health care law that calls for more affordable insurance to be sold through exchanges and the expansion of Medicaid for the poor, among other things.

A Fieldale native, Tavenner graduated from a nursing school at Roanoke Memorial Hospital, now owned by Carilion Clinic. She worked for more than 25 years for HCA, a national hospital chain and parent company of LewisGale Regional Health System.

After starting as a nurse at Johnston-Willis Hospital in Richmond, Tavenner eventually became its chief executive officer. In 2005, incoming Gov. Tim Kaine selected her to run Virginia’s health department. After that, she served as deputy administrator and acting administrator of CMS.

“Marilyn brings with her a breadth of experience and expertise from virtually all angles of health care policy and delivery,” Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said in a statement this week.

Virginia Tech has released its latest rating of football helmets, based on scientific evaluations of how they absorb hits taken on the gridiron.

The results are the latest in a project, started in 2011, that uses sensors placed in the helmets to measure the magnitude of an impact to the head, and how well the helmet reduces the risk of a concussion.

“Our research focuses on identifying helmets that reduce concussion risk so that athletes can make informed decisions based on independent data when purchasing equipment, which in turn incentivizes helmet manufacturers to design helmets that better reduce head acceleration,” said Tech engineering professor Stefan Duma.

Duma is the director of the project, undertaken by the Tech-Wake Forest School of Biomedical Engineering and Sciences.

This year, 18 helmets were evaluated through an analysis of more than 2,000 laboratory tests. The tests were based on more than 2 million head impacts recorded in high school and college football games.

To see how the helmets rated, click here.

To read some of our previous coverage of the  project, click here and here.