September 13, 2012 I The Lovell Chronicle I 3
Committee debates health insurance exchanges
BY DAVID PECK
The State of Wyoming
may have painted itself into
a corner when it comes to
avoiding the mandates in
the 2010 Patient Protection
and Affordable Care Act,
testimony before the Joint
Labor, Health and Social
Service Committee of the
Wyoming Legislature re-
vealed last week.
The committee, chaired
on the House of Represen-
tatives side by Rep. Elaine
Harvey of Lovell, met for
three days at the Lovell
Community Center (see re-
lated stories).
Wyoming has taken a
strong stance against the
Affordable Care Act, com-
monly called Obamacare,
but in assuming that the
ACA would be found uncon-
stitutional, the Wyoming
Legislature delayed steps
that will now cause the
state to miss certain dead-
lines under the act, likely
resulting in Wyoming resi-
dents being offered health-
care from a federal health
insurance exchange rath-
er than a state-operated
exchange.
Members of the Health
Insurance Exchange Steer-
ing Committee testified be-
fore the Health Committee
Thursday, and in the case
of Harvey, she took off her
Health Committee hat and
put on her Exchange Com-
mittee hat.
"Ironically, sitting here
today, it's exactly what we
intended to not happen,"
said steering committee
co-chairman Bill Landen
(R-Casper) in regard to
the federal exchanges. "In
January 2014 a federally-
run exchange will come to
Wyoming."
Harvey agreed with the
irony, noting, "We strongly
felt that we wanted to steer
our own ship, seek a Wyo-
ming-based solution that
fits Wyoming people, not
the federal government. In-
stead, we have defaulted to
the federal government. We
will be subject to a federal-
ly-facilitated and operated
insurarice exchange.""
A healthcare exchange
is a virtual marketplace
where individuals and busi-
nesses can shop for insur-
ance, theoretically leading
to lower prices.
Gov. Matt Mead's
Health Care Policy Advisor
Elizabeth Hoy told the com-
mittee that dealing with
the Obama Administration
in regard to the Affordable
Care Act has been extreme-
ly frustrating, noting that
the act contains a number
of hard deadlines that can
only be changed by Con-
gress and yet the Admin-
istration has failed to an-
swer questions asked by the
Governor.
Wyoming has sent a
number of questions specif-
ic to the Wyoming situation
to the Dept. of Health and
Human Services and has
yet to receive a response.
"Without answers to
these important questions
it's hard to know how to pro-
ceed," Hoy said. "A number
of other states are on hold,
too, waiting for answers to
questions."
Meanwhile, Hoy point-
ed out, the state is facing a
deadline on Nov. 16, 2012,
to submit a 30-page form
for moving forward with its
own health care exchanges.
In a press conference
Tuesday Gov. Mead said
he sent a letter to the sec-
retary of HHS in July and
also joined Republican gov-
ernors to send another set
of questions.
"It is hard for us to
make decisions when we
cannot get answers to what
I believe are fair questions
for the Secretary," he said.
During Thursday's
Health Committee meeting,
Co-Chairman Sen. Charles
Scott of Casper said states
tend to fall into two cat-
egories: those who "feel
Obamacare is just wonder-
ful and are going all out
to be ready" and what he
called "another very large
group profoundly skeptical
and not proceeding as fast"
while awaiting the outcome
of the presidential election
in November.
"There's quite a di-
vide," Scott said, "and as I
read the act, it's more flex-
ible than HHS is claiming.
If we need to play catch-up,
we can."
"it totally blows my mind that the
secretary of HHS simply blows off a
sitting governor, and he's not the only
governor asking questions. At the end
of the day they're going to do what they
want to do if the current administration
remains in power."
Rep. Elaine Harvey
Rep. Keith Gingery
of Jackson pointed out
that the legislature this
year passed a bill - Sen-
ate File 58 - that prevents
the Health Insurance Ex-
change Steering Committee
from moving forward with
any formal agreements on
health care exchanges until
April 1, 2013, and he asked
if the Governor could "move
forward by himself."
"My opinion is that the
legislative branch ought to
make that decision," Scott
said. "If we decide to go with
an exchange, I think the
feds will bend over back-
wards to work with us."
The Health Exchange
Steering Committee, co-
chaired by Harvey and
Landen, started studying
the ACA and health care ex-
changes using funding from
a federal planning grant,
but under SF58 passed in
February "no state agency
or any person representing
the state of Wyoming" can
commit the state to oper-
ating a health exchange or
enter into any agreement
regarding the ACA before
April 1. The bill did appro-
priate $25,000 from the
general fund for legislators
on the steering committee
to travel to meetings.
Basically, Landen
told the Health Commit-
tee Thursday, the legisla-
tion required the steering
committee to stand down,
though he and Harvey
were allowed to continue
with some study work and
research.
With deadlines passing
for Wyoming to set up its
exchange and legislation in
place to prevent it, Landen
said it is the steering com-
mittee's opinion that the
state should be prepared
with legislation that will
allow the State Insurance
Dept. to deal with any re-
quirements to be placed on
state agencies by the feder-
al government and to also
begin working with oth-
er states in a way that can
save the state money.
"Our opinion is to set
up a monitoring group to
advise the agencies and en-
act interstate compact leg-
islation so states can work
across state lines," Landen
said, adding that the state
will have to now deal with
the federal exchange pro-
gram "that is coming' and
either "partner with the
federal government on an
exchange or operate on our
own."
"We have session law
on the books preventing us
from doing anything un-
til April 1, 2013. If we pass
legislation to allow the in-
surance department to do
anything to facilitate an ex-
change, it may be a viola-
tion of state law," he said.
Hoy emphasized that
the governor's office will not
act without legislative au-
thorization, and Gingery
noted that the bill states
that the steering commit-
tee cannot "commit" the
state to an exchange or
enter into an agreement,
but he said he doesn't see
where the state is prohib-
ited from having meetings
and working on plans and
recommendations.
Harvey said the prob-
lem is that the original fed-
eral planning grant did not
commit the state to an ex-
change, but newer planning
grant requirements would
"move us into a commit-
ment stage," and with SF58
on the books, the steering
committee elected to turn
the grant money back.
The state appropriation
did allow legislators to con-
tinue work, and she said
she has attended several
meetings on the issue, but
there has been no funding
to perform detailed actuari-
al studies on the exchanges
and their ability to function
in Wyoming.
Gingery raised the
question of whether the leg-
islature could block all ef-
forts by the federal gov-
ernment to come into the
state with an exchange
and "make it clear we don't
want to assist in any man-
ner," and Scott agreed that
the federal government can-
not force the state to partic-
ipate, noting, "I don't know
how they can compel the in-
surance department to do
certain things. It's a compli-
cated situation."
Harvey said the state
still has to consider 82,000
Wyoming residents with-
out health insurance and
another 30,000 to 40,000
residents who are under-
insured, carrying cata-
strophic insurance only.
"We are penalizing our
own people by not having
an insurance plan," she
said.
Harvey said one solu-
tion might be a private mar-
ket solution in the form of
regional compacts - a way
to buy and sell insurance
across state lines, set up
risk pools and lower costs.
Some 25 states have con-
sidered compact legislation,
she said, under the guide-
lines of the Health Care
Compliance Association.
"My question is wheth-
er we can gather like-mind-
ed states and pursue like-
minded compacts," she said.
WYOMING'S
DIFFICULTIES
Harvey presented a
detailed PowerPoint pre-
sentation, the same Pow-
erPoint she delivered at a
recent Council of State Gov-
ernments meeting.
The presentation was
entitled "Health Insur-
ance Exchanges aren't Af-
fordable in Wyoming" and
detailed the issues facing
the state due to its small
population.
After initial demo-
graphic information, Har-
vey pointed out that Wy-
oming is a "low benefit
mandate state," so add-
ing all of the ACA benefits,
changing rate bands and
removing restrictions on
limits all at the same time
would increase rates in the
individual market by 30
to 40 percent. With small
group rates in Wyoming al-
ready twice the national av-
erage, more employers may
consider self-insurance as
they evaluate the financial
impact of the new regula-
tions on their business, in-
cluding the high cost of ad-
ministering the exchanges
due to the state's smal| pop-
ulation base. Others will
drop insurance.
Sen. Leslie Nutting of
Cheyenne said that as a
federal employee she par-
ticipated in an insurance
exchange for years.
"I don't think Wyoming
citizens have anything to
fear with a federal insur-
ance exchange," she said.
"The ideas (expressed to-
day) have great potential
and are not in conflict with
federal exchanges."
But Harvey countered
that she has attended prob-
ably 10 meetings with HHS
and called it "probably the
most frustrating experience
I've ever had" because the
agency won't answer specif-
ic questions.
"They could not give us
any guidance or rules," Har-
vey said. "The last one was
two weeks ago, and they
wouldn't even let us speak."
As for the Obama Ad-
ministration's lack of re-
sponse to Gov. Mead's ques-
tions, Havey said, "It totally
blows my mind that the sec-
retary of HHS simply blows
off a sitting governor, and
he's not the only governor
asking questions. At the
end of the day they're going
to do what they want to do
if the current administra-
tion remains in power."
Legislative committee takes on full agenda in Lovell
BY PATTI CARPENTER
The Wyoming Legisla-
ture's Joint Labor, Health
and Social Services Com-
mittee held a three-day
meeting in Lovell last week
to look at major issues af-
fecting the state. Rep.
Elaine Harvey (R-Lovell)
co-chaired the meeting
with Sen. Charles Scott (R-
Casper). Numerous officials
from throughout the state
attended, along with mem-
bers of the public.
The committee looked
at budget proposals for the
three departments under
its umbrella of responsibili-
ties. Each department was
asked to present a budget
with 4 and 8 percent reduc-
tions as requested by Gov.
Matt Mead earlier this year
for review by the committee.
"We had our march-
ing orders from Legislative
leadership to examine the
budget cuts proposed by
these three departments,"
explained Harvey. "We
could then accept them in
full and recommend their
acceptance, we could reject
them in full and tell them
to go back to the drawing
board or we could reject
them in part and recom-
mend other areas for them
to investigate cuts."
The committee accept-
ed the budgets "in full" pre-
sented by the Dept. of Fam-
ily Services (DFS) and the
Dept. of Workforce Services.
The Dept. of Health budget
is not due until November.
The DFS budget actu-
ally exceeded the required
cuts with a reduction of
9.5 percent recommended.
Most of the cuts were per-
sonnel related. Harvey re-
ferred to the DFS budget as
a "sweetheart deal" because
Medicaid eligibility will
no longer be determined
in their field offices, which
allows them to reduce the
personnel expenditure pre-
viously required to perform
that function.
Harvey explained that,
currently, if a family is
poor and in need of assis-
tance, they apply for Med-
icaid through the Dept. of
Family Services, but due to
changes in the state's com-
puter system due to take
effect in July of next year,
those applications will be
made directly to the Dept.
of Health. Harvey said the
procedural change made it
easy for the department to
reduce their budget due to
the anticipated reduction
in personnel needs. Layoffs
are not expected because
the department will not fill
several positions in many
areas that are currently va-
cant and will reassign du-
ties instead.
"In all of this, no one
got laid off," said Harvey.
"Through retirement and
attrition they did not re-
place staff and they just re-
assigned duties."
The Dept. of Workforce
Services presented a bud-
get that reduced expen-
ditures by 8 percent with
the biggest cuts in areas of
training.
"When the economy
picks back up, the training
programs can go back into
place," said Harvey.
Harvey noted that the
reductions included more
than $350,000 in grant pro-
grams for private employ-
ers to train employees. The
reductions also included
around $150,000 in educa-
tion programs for daycare
providers and approximate-
ly $151,000 in contractual
services to the individuals
providing the educational
services.
Harvey said that these
are all good programs and
the funding is not necessar-
ily going away, it's just been
reduced for the time being.
Other cuts for this de-
partment were for in-state
travel and equipment rent-
al expenses.
"They met their 8 per-
cent and we approved their
budget in whole," said
Harvey.
The Dept. of Health
budget proposal is not due
until November, so the
committee will review that
agency at their next meeting
in November. In the mean-
time, the committee re-
viewed numerous issues re-
lated to Medicaid and other
health related services and
issues related to the Afford-
able Care Act, sometimes re-
ferred to as Obamacare (see
• related story).
The committee also re-
viewed a number of policies
and programs, including a
review of a proposal by U.S.
Congress to cut funding to
the Temporary Assistance
to Needy Families program
(TANF), which is a feder-
ally funded program. This
proposal would impact fed-
eral block grant money re-
ceived by the state to pro-
vide "temporary" assistance
to families for rent, utilities
and other expenses not cov-
ered by food stamps. Har-
vey said the proposal did not
go through and therefore no
adjustments were made to
the program, but the com-
mittee needed to hear that
from the department's direc-
tor Steve Corsi.
The federal government
was also considering elimi-
nating the "welfare to work
program," a key element in
the state's program, which
only provides assistance for
up to five years.
"We have received na-
tional awards for our pro-
gram and we are a model
for every other state," said
Harvey. "Director Corsi re-
ported that although the
federal government was
considering eliminating the
program, they did not."
The committee also dis-
cussed Medicaid enrollment
fraud, with Corsi reporting
on current efforts to reduce
enrollment fraud since his
department is currently re-
sponsible for enrollments.
Although there is still some
fraud, according to Harvey,
it is less than 5 percent. She
said the committee contin-
ues to look for ways to re-
duce that percentage even
more.
The Dept. of Workforce
Services brought two poli-
cy changes related to unem-
ployment insurance fraud
to the committee for review.
Both were rejected by the
committee, which asked for
further study on the issues.
The first policy raised
the payback penalty for
those collecting unemploy-
ment insurance benefits il-
legally from the state's 5
percent to the federal gov-
ernment's standard of 15
percent. The committee
felt the penalty could un-
fairly penalize "innocents"
who have already collect-
ed their benefit at the be-
ginning of the month but
start a new job in the mid-
dle of the month. Harvey
said the increase could pun-
ish those looking for work
and trying to get off of un-
employment benefits. She
said the policy also had the
federal government dictat-
ing where the funds would
go instead of the state. Cur-
rently the state of Wyoming
requires penalty funds to
go into the common school
fund, but the federal gov-
ernment places them in the
unemployment insurance
revenue fund, explained
Harvey.
"The federal govern-
ment wants to do this be-
cause, in other states, there
are unemployment funds
that are going under," ex-
plained Harvey. "In our
state, the fund is healthy
because we are fiduciary-re-
sponsible. We do a good job
of keeping our fund healthy
and we want to keep it that
way. The federal govern-
ment can't tell us where the
funds from penalties should
go. Our state constitution
determines that."
The committee also de-
nied a policy that penal-
ized employers who did not
respond in a timely man-
ner because they felt it was
"subjective" and didn't take
into consideration factors
that might be outside of the
employer's control, like the
department responding to
their requests in a less than
timely manner.
"We want to differen-
tiate between those who
make a mistake and those
who intentionally defraud
the system," said Harvey.
"The law doesn't discrim-
inate in this way and the
federal government doesn't
want us to discriminate in
this way. They want a 15
percent penalty placed on
everybody."
Another hot topic cov-
ered was the costs associ-
ated with mental health
services as covered by Ti-
tle 25 rules. The commit-
tee heard extensive testi-
mony about the problems
associated with Title 25,
which requires patients to
be held under observation
in certain circumstance.s.
Problems with availability
of beds at the state hospi-
tal in Evanston has forced
patients to be either held in
jail or sent to expensive pri-
vate facilities. The commit-
tee also heard moving testi-
mony from families caught
in the middle who were lit-
erally bankrupt under the
current system and about
individuals who were re-
leased back into the com-
munity with little or no
support.
"If they're not in jail or
in the crisis beds in Wor-
land, they go to the WBI
(Wyoming Behavior Insti-
tute), which is a huge ex-
pense per day," said Har-
vey. "Although they get
some treatment there, they
don't get a treatment plan
until a bed opens up in
Evanston. There's been a
breakdown in communica-
tion at Evanston and we've
heard horror stories of peo-
ple being dropped off at
homeless shelters or with
family members who didn't
know they were coming.
We've heard about cases
where they are discharged
with only three days of
medication after spending
10 days getting their medi-
cation regulated."
"We know that there
are still problems out there
and we are working on them
and will continue to work on
them for some time," said
Harvey. "We have a new ad-
ministrator at the Wyoming
State Hospital (Bill Sexton)
and he has already recon-
figured rooms so the wait
is considerably less and he
is working on improved dis-
charge planning. As we're
starting to see things get
rearranged, we are already
seeing fewer return custom-
ers to the system."
Harvey noted that this
is about the fifth time the
committee has heard re-
porting on this issue and
the situation seems to im-
prove with every report.
The meeting discussed
many issues in depth and
resulted in several bills or-
dered into draft form, in-
cluding a bill concerning
Title 25 issues related to
minors, a bill requiring fa-
thers to pay for Medicaid
births and for the medi-
cal care of the child, a bill
dealing with Title 14 (court
ordered placements of mi-
nors) and rules regarding
eligibility for Medicaid and
Medicaid Fraud.
Harvey said she thought
that all three days of meet-
ings were very productive
and she was pleased with
the turnout and participa-
tion by residents and repre-
sentatives of organizations
from throughout the state.
The next meeting of the
committee will take place
Nov. 12-13 in Casper.
