By JP Eichmiller
May 18, 2011
As the state’s Joint Labor, Health and Social Services committee pressed through its seventh hour of testimony and presentation regarding Wyoming’s Medicaid future, one legislator elected to cut to the chase.
“Where can we look for a state to find a model to what we are going to have [in Wyoming] if we just swallow this, ‘hook, line and sinker’?” asked Rep. Frank Peasley, R-Platte/Converse, at the subcommittee’s May 9 meeting in Evanston. “Is there a place we can look to see where this ‘affordable care’ concept has been fully applied?”
The answer was candid, if not altogether comforting to the audience and committee members.
“The state probably that comes closest is Massachusetts,” said Richard Allen, associate regional administrator for the Centers for Medicaid and Medicare [CMS] Denver office. “Their model was very much a lot of basis for the Affordable Care Act. They do have an exchange in place…. It operates very much like what the federal government is looking for in its own exchange program. Massachusetts also found a way to cover everybody.”
The Massachusetts example prompted immediate inquiries from several of the committee members. Allen was asked to explain the timeline and viability of Massachusetts’ Medicaid model and even the condition of the state’s overall budget.
The committee members’ response to the comparison provided a measure of their thirst for any viable prediction of what Wyoming may have in store should the federal Patient Protection and Affordable Care Act [PPACA] come online as scheduled at the beginning of 2014. Allen’s statement was as close as any of the invited presenters came to providing a tangible example of the effects of a PPACA insurance model on state Medicaid enrollment and costs.
The Wall Street Journal, in a staff editorial from May 12, also cited the Massachusetts model, as, “the prototype for President Obama’s version…”
The Journal article, however, warned that many of the occurring changes from the state’s self-initiated reform have resulted in rising Medicaid costs and an increase in the price for private plans. The bill was signed into state law by former Massachusetts Governor Mitt Romney in 2006. Massachusetts became the first state to establish individual mandates for residents to purchase health insurance or face penalties.
“The conceit was that a universal reform would cover everyone and all but pay for itself by reorganizing the state’s health-care finances,” stated the Journal. “Like Mr. Obama’s reform, RomneyCare was predicated on the illusion that insurance would be less expensive if everyone were covered.”
According to figures copulated by Massachusetts’ Division of Health Care Finance and Policy in November, the state has enrolled 401,000 additional residents into health insurance plans since the 2006 reforms. Of the new enrollees, 164,000 – nearly 41 percent – were accepted into Massachusetts’ Medicaid [MassHealth] program and another 154,000 — 38 percent — receive some form of government subsidized insurance plans. The remaining 83,000 new enrollees, 21 percent of the total, have reportedly signed onto purchased private plans.
Private individual and group plans in Massachusetts have declined as a share of the overall insurance market since the reforms, while the percentage of Medicaid and subsidized coverage has grown. Private plan purchase has decreased from 86 percent of the insurance plans in 2006 to 81 percent of the total last year. Conversely, Medicaid and subsidized individual enrollments have increased from 14 percent to 19 percent of the total market over the same period.
The Wyoming Labor, Health and Social Services committee is charged with the task of deciding what and when any changes should be made in the state’s social healthcare coverage. Committee co-chairs Rep. Elaine Harvey, R-Big Horn/Park and Sen. Charles Scott, R-Natrona, support prompt action by the state as an offset to federally established deadlines for PPACA Medicaid enrollment expansion in January 2014.
“We have to have our exchange set up by January 1, 2013 or the federal government will take it over,” said Harvey at the May 10 conclusion of the committee’s meeting. “We have asked for an extension of the deadlines…. So far we have been given the cold shoulder.”
Not everyone agrees with Harvey that a concrete plan needs to be in place by the beginning of 2013.
Regina Meena, policy research and legislative affairs associate with Wyoming Liberty Group, asked the committee members to consider if pushing for new legislation to align the state with the PPACA would be premature and unnecessary.
“The rules and regulations regarding how to establish [an exchange] have not even been written,” said Meena. “We don’t have to pass a law next year – [January 1, 2013] is a date for planning purposes. Our legislature is studying this and the more we know the better.”
Meena spoke to the committee members during a brief allotment made for public comment at the conclusion of the second day’s meeting. Before being cut short by Harvey, Meena provided several options for legislators to consider, including researching intrastate insurance compacts, Wyoming’s pending Health Care Freedom amendment and reorganizing medical entitlement standards.
The U.S. Supreme Court is expected to rule on appeals regarding the power of Congress to implement the PPACA on the states. A final decision by the Supreme Court, expected by June 2012, could significantly alter or eliminate the new Medicaid requirements by CMS on the states.
“All of the things you have described we are working on,” said Harvey. “We’ve been asked in a very short timeline to develop something we don’t even understand yet.”
The subcommittee is scheduled to meet next October 10 through 12 in Casper.
JP Eichmiller is an investigative journalist for Republic Free Choice. He can be reached at (307) 632-7020.