2021 Virginia Election Recap

The November 2, 2021, Virginia elections resulted in a sweeping upset, with Republicans capturing all three statewide offices and the House of Delegates majority, ending Democratic unified control of state government.

Virginia’s “off-off year” statewide and legislative elections feature the Governor, Lieutenant Governor, Attorney General, and 100 seats in the House of Delegates on the ballot. Turnout is usually relatively low, though the 2019 and 2017 elections saw turnout increase dramatically, leading to Democratic unified control of state government in 2019 for the first time in a generation.

This year, with Democratic President Biden in office after former Republican President Trump, in a political environment generally perceived as unfriendly to Democrats at both the national and state levels, the elections were highly competitive. 91 of 100 House seats were contested. Final polls showed a tossup for the gubernatorial race between former Governor Terry McAuliffe (D) and political newcomer Glenn Youngkin (R), with Youngkin having clear momentum going into Election Day. Statewide and House elections broke fundraising records and drew national attention.

Control of the governorship and House of Delegates was at stake. Record turnout was higher than in 2019 across the board, especially in Republican areas. Meanwhile, Democratic turnout was lower in traditional party bastions like Northern Virginia, as well as in key battleground suburbs like Chesterfield County and Virginia Beach. Suburban and independent voters appear to have favored Republican candidates this election.

Below is a breakdown of the statewide and House of Delegates races, followed by a preview of what to expect for next year’s legislative session.

Statewide Races

Governor. Republican Glenn Youngkin defeated former Democratic Governor Terry McAuliffe by a little over 2 points. Third party candidate Princess Blanding garnered less than a point. McAuliffe left office in 2017 after his first term. Governors are not allowed to serve successive terms in Virginia. Youngkin is a political newcomer, a former CEO of the private equity, asset management, and financial services firm, The Carlyle Group.

Lt. Governor. Republican Winsome Sears defeated Democrat Hala Ayala by less than 2 points. Ayala vacated her Northern Virginia House seat to run for Lt. Governor. Sears is a former Delegate from the Norfolk and Virginia Beach area. As Lt. Governor, she will be the first Black woman elected to statewide office in Virginia.

Attorney General. Republican Jason Miyares defeated Democratic incumbent Mark Herring, who was running for a third term as Attorney General, by 1 point. A Cuban American, Miyares leaves his current Virginia Beach-based seat in the House of Delegates to become the first Latino elected to statewide office in Virginia.

House of Delegates

After taking control of the House of Delegates in 2019, Democrats defended their 55-45 majority on Election Day. The legislative district maps are the ones drawn by the former Republican majority, with about 20 districts affected by the 2019 court-ordered redistricting that made several more Democratic. 

Republicans needed to flip 6 seats to capture the majority. As of this report, Republicans have flipped 7 seats, many narrowly. Two Democratic incumbents, Alex Askew and Martha Mugler, appear to be requesting recounts since the vote difference is less than half a point.  

Incumbents Who Lost (7):
Lashrecse Aird – District 63
Alex Askew – District 85
Josh Cole – District 28
Nancy Guy – District 83
Chris Hurst – District 11
Martha Mugler – District 91
Roz Tyler – District 75

List of all new Delegates-Elect (17):
District 7 – Outgoing Delegate: Nick Rush;* Incoming Delegate-Elect: Marie March
District 9 – Outgoing Delegate: Charles Poindexter**; Incoming Delegate-Elect: Wren Williams
District 12 – Outgoing Delegate: Chris Hurst; Incoming Delegate-Elect: Jason Ballard
District 28 – Outgoing Delegate: Josh Cole; Incoming Delegate-Elect: Tara Durant
Delegate 45 – Outgoing Delegate: Mark Levine**; Incoming Delegate-Elect: Elizabeth Bennett-Parker
Delegate 50 – Outgoing Delegate: Lee Carter**; Incoming Delegate-Elect: Michele Maldonado
Delegate 51 – Outgoing Delegate Hala Ayala;* Incoming Delegate-Elect: Briana Sewell
District 63 – Outgoing Delegate: Lashrecse Aird; Incoming Delegate-Elect: Kim Taylor
District 66 – Outgoing Delegate: Kirk Cox;* Incoming Delegate-Elect: Mike Cherry
District 75 – Outgoing Delegate: Roslyn Tyler; Incoming Delegate-Elect: Otto Wachsmann (pharmacist)
District 79 – Outgoing Delegate: Steve Heretick**; Incoming Delegate-Elect: Nadarius Clark
District 82 – Outgoing Delegate: Jason Miyares;* Incoming Delegate-Elect: Anne Ferrell Tata
District 83 – Outgoing Delegate: Nancy Guy; Incoming Delegate-Elect: Tim Anderson
District 85 – Outgoing Delegate: Alex Askew; Incoming Delegate-Elect: Karen Greenhalgh (may go to recount)
District 86 – Outgoing Delegate: Ibrahim Samirah**; Incoming Delegate-Elect: Irene Shin
District 88 – Outgoing Delegate: Mark Cole;* Incoming Delegate-Elect: Phillip Scott
District 91 – Outgoing Delegate: Martha Mugler; Incoming Delegate-Elect: A.C. Cordoza (may go to recount)

*Incumbent did not seek re-election to House of Delegates.
**Defeated in primary election.

Expected 2022 House of Delegates Partisan Composition: 52 Republicans, 48 Democrats

House Leadership. The House Republican Caucus has elected current Minority Leader Todd Gilbert as Speaker-Designee, Delegate Terry Kilgore as Majority Leader, Delegate Kathy Byron as Caucus Chair, and Delegate Jay Leftwich as Majority Whip.

The House Democratic Caucus has elected current Speaker Eileen Filler-Corn as Minority Leader and current Majority Leader Charniele Herring as Caucus Chair.

Prior Authorization Reform In Effect

In this year’s General Assembly session, PSV led passage of significant prior authorization reform for mental health treatment medications. In Virginia, effective July 1, 2021, no additional prior authorization can be required by a carrier after an initial prior authorization approval of a drug for a mental health disorder under certain circumstances. Carrier contracts must now:

  • Require that when any carrier has previously approved prior authorization for any drug prescribed for the treatment of a mental disorder listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, no additional prior authorization shall be required by the carrier, provided that
    • (i) the drug is a covered benefit;
    • (ii) the prescription does not exceed the FDA-labeled dosages;
    • (iii) the prescription has been continuously issued for no fewer than three months; and
    • (iv) the prescriber performs an annual review of the patient to evaluate the drug’s continued efficacy, changes in the patient’s health status, and potential contraindications.
  • Require a carrier to honor a prior authorization issued by the carrier for a drug regardless of whether the drug is removed from the carrier’s prescription drug formulary after the initial prescription for that drug is issued, provided that the drug and prescription are consistent with the applicable provisions listed above.

Carriers are not prohibited from requiring prior authorization for any drug that is not listed on its prescription drug formulary at the time the initial prescription for the drug is issued.

Note that this state law applies to state-regulated individual, small group, and large group insurance plans, including the Virginia state health insurance plan. It does not apply to federally-regulated plans, such as Medicaid, Medicare, and self-insurance coverage. You should consult with your patient’s insurance carrier to determine whether the provisions described above are applicable. To view this Code of Virginia section, visit

We need your help ensuring compliance with the new law. Please let PSV know if you believe patients’ insurance carriers are not in compliance with this new law. As stated above, please confirm first that the patient’s carrier is subject to this state law. We will collect feedback from PSV members and determine any necessary action to pursue enforcement.

Behavioral Health Provider Loan Repayment Program

This legislative session PSV also helped lead inclusion of $1.6 million in funding to establish the Virginia Behavioral Health Student Loan Repayment Program to help recruit and retain behavioral health (BH) professionals to practice in underserved areas or treat underserved populations in the Commonwealth. This program will repay a portion of an eligible BH professional’s student loan debt. In return, recipients commit to practicing in Virginia for a minimum of two years at an eligible site.

Applications opened October 15, 2021. For more information, please visit

2022 Outlook and PSV Legislative Agenda

With Republicans now slated to gain control of the Governor’s office and House of Delegates, we can expect a major shift in policy priorities from these arms of state government. Governor-Elect Youngkin campaigned on local education and parents’ rights issues, curbing COVID-19 masking and vaccination requirements, pro-business economic and jobs policies, lowering taxes – including eliminating the grocery tax and suspending the gas tax – crime and safety, government efficiency, and regulatory reform. 

Before the new Governor takes office, outgoing Democratic Governor Ralph Northam will submit his administration’s final full budget to the General Assembly for the next legislative session in January. The Senate of Virginia is still under narrow 21-19 seat Democratic control, with newly elected Republican Lt. Governor Sears wielding the tie-breaking vote next year.

The newly created Virginia Redistricting Commission so far has not been able to reach consensus on new legislative maps. As a result, the Supreme Court of Virginia will appoint two special masters (one from each party) to draw the maps for court approval. Depending on the approval timeline and potential litigation, Virginia may schedule another round of House elections next year based on the new maps.

We have been prepared for election outcomes, and we are ready to work with the new Administration as well as new and returning General Assembly members. PSV’s legislative agenda for 2022 is still in development as we adjust to the impacts of the elections, but our priorities include:

  • Mental health parity data collection compliance
  • Psychiatry residency slots funding
  • Telemedicine and audio-only services
  • Removing mental health questions on medical licensure applications
  • Collaborative Care Model
  • Behavioral health provider workforce
  • State hospital census
  • Supporting the Medical Society of Virginia and other specialties, as applicable

PsychMD Political Action Committee (PAC) is our profession’s voice in the political process. Contributing to the PAC is investing in your profession, patients, and high-quality care from psychiatrists. A strong and robust PAC demonstrates PSV’s leadership and investment in the political and policy process.

Your support is crucial to our advocacy success! We must be proactive and prepared. Contributions to the PAC will help raise the visibility and profile of psychiatrists, connect us to new and returning legislators, and continue to build productive relationships with key General Assembly members and the Administration.

Who does PsychMD PAC support? We support members of the legislature who care about issues affecting our profession and our patients. We support both parties and their leadership through individual legislator and caucus events, which allow our government relations team to interact directly with these policymakers. Please make your contribution now. PsychMD PAC helps raise our visibility among policymakers, connects us to new and returning legislators, and enables us to continue to build productive relationships with key General Assembly members and caucus leadership.

Given the tough issues and close elections we expect this year and next session, we ask that you contribute at least $250.

  • Please contribute ONLINE or make your check payable to PsychMD PAC and mail it today to 118 N. 8th Street, Richmond, VA 23219.

Thank you to all our contributors this year! (as of 11/17/2021)

Ahsan, Syed
Al-Mateen, Cheryl
Beatty, Kara
Bick, Michael
Chessen, Douglas H.
Choudhary, Varun
Cieraszynski, Michal
Cunningham, Steve
Dorries, Olimpia
Graham, Marlon A. (Tony)
Harp, William
Hendrickson, John
Kaul, Adam
Kryzanowski, Leslie K.
Kuchibhatia, Ajay
Lee, Meredith
Lindsay, Rebecca
Lozovsky, Janie
Markowitz, David
Mason, Joseph
Moideen, Sherin
Northwall, Karl W.
Patel, Ashvin
Peglow, Stephanie (Donor)
Perez, Enrique
Shemo, John
Trotter, Jerry
Urbach, John
Waller, Susan

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Integrative Psychiatry:
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