Many of the bills that move through the General Assembly are quite routine, so when a legislator from York County — Democrat Mark Downey, the only physician in the legislature — rose last week to talk about a “clean-up bill” relating to the Board of Medicine, it didn’t seem like a big deal.
Del. Wren Williams, R-Patrick County, saw it otherwise.
Downey’s bill, HB 1139, would remove the requirement that the Board of Medicine have at least one practicing physician from each of the state’s 11 congressional districts.
Williams rose to object.
“Can the patron identify which of Virginia’s current districts lacks a qualified physician willing to serve on the board and if not, what problem is this bill solving that eliminates the only structural guarantee of rural representation?” Williams asked.
Downey replied: “This is just a bill to get the Board of Medicine in line with all the other boards under the Department of Health Professions to allow flexibility.”
Downey’s bill had not attracted much attention in committee; it passed with just a single dissent. After Williams called attention to the measure on the House floor, Republicans rallied to his side. Of course, in a chamber dominated by Democrats, that wasn’t nearly enough, and on Monday, the House passed the bill 63-35 on a party-line vote (one member on each side was absent).
The subject of rural representation is part of Cardinal’s reason for existing, so Williams’ questions are, if not right up our alley, then right up our back road. Let’s explore.
Virginia has more than 300 boards and commissions, enough that the governor makes about 900 appointments each year, according to the secretary of the commonwealth’s office. A review of the secretariat’s annual report — called “the blue book” because it used to be published with a blue cover but now appears to be all-digital — finds six boards that require at least one member from each congressional district.
Those are: the Board of Agriculture and Consumer Services, the Board of Housing and Community Development, the Virginia Commission for the Arts, the Commonwealth Council on Aging, the Virginia Land Conservation Foundation and the Board of Medicine, which is at issue here.
Some boards have other geographical requirements: The Board of Elections has five members, so not enough for every congressional district. However, the law says that “no two Board members shall reside in the same congressional district.” The Southwest Virginia Cultural Heritage Foundation requires members to be from various places in Southwest. The board for the Institute for Advanced Learning and Research in Danville restricts members to Southside. The Peanut Board says members should “as nearly as possible” come from the “peanut-producing section of the Commonwealth.”
Some of those boards are of a purely regional interest, so the geographic restrictions make sense. As for the more statewide boards, it’s unclear why some have geographical requirements while most don’t. The Board of Medicine requirement predates 2001 and may go back to at least 1950 or beyond; the legislative history is murky.
The Downey-Williams exchange over what was intended as a “clean-up bill” to make the Board of Medicine’s appointment process resemble that of other health boards raises a question, although maybe not the one the sponsor intended: Why don’t all state boards have geographical requirements?
We elect legislators on a geographical basis; shouldn’t the same principle apply to state boards? That might be too extreme. I will happily concede that maybe people who aren’t from peanut-growing country shouldn’t be on the peanut board. Most boards, though, deal with statewide issues — such as medicine.
Without a geographical requirement, what would happen to the composition of these boards? Since most boards don’t have a geographical requirement, all we have to do is look at the record.
Early in Glenn Youngkin’s administration, when he started appointing board members, I looked at how well Southwest and Southside were represented on state boards. Here’s where politics enters in. As anyone who’s ever looked at an election map knows, Virginia’s voting trends have a sharp geographical divide: Republicans run strong in rural areas, Democrats run strong in the metro areas. Youngkin, a Republican, was taking office after two straight Democratic governors, so it wasn’t surprising to find boards with few and sometimes no members from Southwest and Southside — Democratic governors had few supporters there to reward with appointments. Now, after four years of a Republican governor, we’d probably be on the high side of representation from those areas, so let’s do a compare-and-contrast:
State Board for Community Colleges: In 2022, this 15-member board had just one member from outside the urban crescent, a representative from Roanoke. Youngkin diversified the board geographically. Today, it has members from Amherst County, Danville, Halifax County, Tazewell County and Washington County.
Virginia Board of Education: In 2022, one of the nine members was from Bristol, none from Southside. Today, it has members from Campbell County and Scott County.
State Council of Higher Education for Virginia: In 2022, only one of the 13 members was from outside the urban crescent, and that member was from Charlottesville. There was no representation from Southwest or Southside. Youngkin appointed more members from outside the urban crescent — Harrisonburg, Louisa County, Rockingham County — but there are still none from Southwest or Southside.
Virginia Economic Development Partnership: In 2022, this board had non-urban crescent members from Danville, Halifax County and Salem (two), so Southside was represented, but Southwest Virginia was not. (For those not from the western part of the state, Salem and the rest of the Roanoke Valley don’t count as part of Southwest. You’ve got to go further west.) Today, there are members from Abingdon, Bristol, Montgomery County and Rockbridge County.
Virginia Tech Board of Visitors: In 2022, only one of the 14 members was from west of the Blue Ridge, and she was from Staunton. Youngkin appointed two members from Roanoke, two from Blacksburg and others from Lexington and Shenandoah County — although there’s still no one from Southside and maybe no one from Southwest Virginia, depending on where you think Southwest starts. (Some contend you have to cross the New River.)
I could go on, but you get the idea: After two Democratic administrations, Southwest and Southside had little to no representation on major state boards. After a Republican governor, that representation has improved — but in some cases, those regions remain unrepresented.
(Yes, some boards may have members who grew up in Southwest and Southside but now live elsewhere, but I’m going strictly by current residence as the Board of Medicine rules have it.)
If Virginia had requirements that all these boards had to have geographical diversity, many of them would have more voices from Southwest and Southside than they do now.
As for those other boards under the Department of Health Professions that have no geographical requirement, many lack the geographical diversity that is mandated of the Board of Medicine.
Of the 12 boards other than the Board of Medicine, seven have no members from Southwest Virginia. Some may have members from the Roanoke Valley, but, as noted earlier, that doesn’t count as Southwest Virginia. At least seven have no members from Southside, possibly nine depending on how you classify members from Campbell County and Henry County.
Only the 10-member Board of Pharmacy has members from both Southwest and Southside.
To put the Board of Medicine “in line with all the other boards” effectively means that rural Virginia loses its voice in how health care is regulated in Virginia. That may not be Downey’s intent with the bill, but the record suggests that would be the result — and that record comes after four years of a Republican governor who was politically indebted to Southwest and Southside. (Downey’s office did not respond to a request for comment.)
“They’ve been slowly removing the geographic requirement on boards over time,” Williams told Cardinal. “It’s been a slow creep.” Maybe the question should be: Why aren’t we going the opposite direction and adding geographic requirements? Congressional districts seem a reasonably fair way to do that since they’re all the same population. (See addendum below.)
Here’s the challenge for Gov. Abigail Spanberger as she starts making her board appointments: Can she maintain, or even increase, the geographical diversity that Youngkin achieved or will we see backsliding to previous eras that essentially silences Southwest and Southside?
Here’s the challenge for the General Assembly: Is there appetite to do just the opposite of what Downey’s bill would do and pass requirements that all major state boards have diverse geographical representation? I suspect not. But are we truly a commonwealth if some parts of the state simply have no voice in the halls of power?
* * *
Now, about those congressional districts . . . .
A note about congressional districts: That’s traditionally been an easy way to require geographical diversity because it avoids messy arguments about things such as where Southwest Virginia begins or what exactly constitutes Southside. And, as noted above, they’re all the same size, population-wise.
The first challenge is that some boards don’t have that many members. That can be fixed by expanding boards, although that can be a problematic thing for functional and political reasons.
The second challenge is the impending congressional redistricting, which, if approved, would create the most gerrymandered lines we’ve seen in many an age. Under those lines, a representative from Augusta County would check off the 9th District box rather than someone from Southwest Virginia. Both of the proposed congressional districts that take parts of Southside emanate out of Richmond, so it’s possible there could be no representatives from Southside at all.
Perhaps there’s a different way to require geographical diversity other than congressional districts. I will leave all that for another day. For now, my question is more of a big-picture one: Should state law require geographical diversity on its boards or not? If not, why aren’t we worried about some regions being left out?
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