The Times West Virginian

West Virginia

November 19, 2012

Decision on health exchange nearing

W.Va. one of eight states likely to seek partnership with federal government

CHARLESTON — West Virginia officials expect to partner with the federal government to operate a new insurance marketplace called for by the federal health care overhaul, but say their choice appears limited by projected costs, tight timing and questions left unanswered by the Obama administration.

A state-federal partnership is one of three options for running this marketplace, known as an exchange. In each state, an exchange would aim to unite the buying power of individuals, families and small businesses as they select from coverage plans offered by private insurance companies. The federal law would also help many consumers pay premiums.

States had faced a Friday deadline for telling the U.S. Department of Health and Human Services how they planned to proceed, but federal officials gave them another month to decide. At least 16 states and the District of Columbia have already announced they want to operate the exchanges themselves. Another 15 want no role and will leave it to the federal government to handle exchanges in their states.

While its officials continue to crunch numbers and review options, West Virginia appears likely to join neighboring Ohio and six other states in building an exchange partly with federal help.

“It’s fair to say, based on everything we know, that we’re likely to head in the direction of a partnership,” Rob Alsop, chief of staff to Gov. Earl Ray Tomblin, told The Associated Press on Friday.

West Virginia’s eventual decision hinges on the relatively small size of its expected exchange. The insurance commissioner’s office has estimated that between 37,000 and 60,000 people would seek coverage through this new marketplace. The exchange would have to spread among its policyholders hefty costs from staff, call centers, a complex computer system and other operational needs.

“It’s a myriad administrative functions that when you have relatively few people participating, you have what looks like a very high-cost product,” said Revenue Secretary Charles Lorensen, whose Cabinet department oversees the insurance agency. “Those costs have to be borne by the exchange. It has to be sustainable.”

Alsop said estimates have projected an annual price tag of between $15 million and $17 million. Officials have all but concluded that West Virginia cannot afford to run the exchange by itself. The federal government, meanwhile, can likely help because it will be creating the same sort of operational network in multiple states, Alsop said.

But he and other officials noted a recurring complaint: the lack of sufficient details and guidance from Washington.

“Right now, we’re making a decision based on what we know our costs would be as a state, and it seems to be burdensome upon our consumers,” said state Insurance Commissioner Michael Riley. “Logic would tell us that the feds would be able to offer this at a lower cost because of economies of scale, but we still await that answer.”

A leading advocate of the federal law is urging the state to handle the other key exchange component: consumer engagement.

Perry Bryant, executive director of West Virginians for Affordable Health Care, believes the exchange’s success rests on the state promoting the new marketplace and then helping people and small employers pick the best coverage.

“It’s public education,” Bryant said. “This is complicated stuff, with premiums and copays and deductibles, and some of these people may have never had insurance.”

Bryant cited how well the state has enrolled those eligible for its Children’s Health Insurance Program, which covers more than 25,100 youths. He contrasted that with the special insurance pool for people otherwise denied coverage because of pre-existing provisions. Washington runs that pool for the state, and Bryant estimated it has less than 150 enrollees.

“The federal government has done a miserable job,” Bryant said. “Why would we want them to do the consumer engagement piece?”

Bryant agrees that West Virginia cannot run an exchange by itself, but also views that as a missed opportunity. The state could have pursued a federal grant to help it build and operate the marketplace, he noted. But time has run out: Exchanges must begin enrolling people for coverage next October, and the policies will take effect in January 2014.

At least some health insurers see value in a state-federal partnership, said Jane Cline, West Virginia’s longtime former insurance commissioner. Her agency studied the exchange model before the federal overhaul, which passed in 2010 while Cline was president of the National Association of Insurance Commissioners.

“Some of the health insurers we work with believe that the federal government does have some offerings,” said Cline, who is now public policy director for the Spilman, Thomas & Battle law firm. “I think it’s prudent to evaluate all of the options, and that’s what the governor appears to be doing.”

Both Bryant and Cline credited Jeremiah Samples, an insurance commission official, with aiding that review. Among other tasks, Samples helped develop the enrollment and cost estimates. He’s also held regular meetings with insurers, agents, medical providers and consumer advocates to keep them all in the loop.

“We’re in a tough situation, because we’re trying to convey, to tell our stakeholders information based on, really, assumptions about” the federal law, Samples said. “The burden, at this point, is on the federal government to get this information to states, and West Virginia is not unique in this.”

1
Text Only
West Virginia
  • Manchin urges mines to speak out for coal

    The Democratic senator leading the battle against the White House’s strategy to fight climate change urged the mining industry on Tuesday to speak out about coal’s role in providing affordable, reliable electricity to the country to help combat strict new emissions rules for coal-fired power plants.

    April 16, 2014

  • Many schools already meet new mandate for breakfast

    Many West Virginia public schools have changed the way they serve breakfast to students ahead of a requirement that goes into effect in September.

    April 14, 2014

  • W.Va. grower promotes unmodified feed corn

    Lyle Tabb is hoping that his non-genetically modified corn will take off with farmers who can charge top dollar for “all natural” eggs.
    Genetically modified or GMO corn has greatly simplified the process of getting rid of weeds, but has also substantially increased the amount of a chemical call glyphosate.

    April 13, 2014

  • Geologists link small quakes to fracking

    Geologists in Ohio have for the first time linked earthquakes in a geologic formation deep under the Appalachians to hydraulic fracturing, leading the state to issue new permit conditions Friday in certain areas that are among the nation’s strictest.
    A state investigation of five small tremors last month in the Youngstown area, in the Appalachian foothills, found the injection of sand and water that accompanies hydraulic fracturing, or fracking, in the Utica shale may have increased pressure on a small, unknown fault, said State Oil & Gas Chief Rick Simmers. He called the link “probable.”

    April 12, 2014

  • Phares looks forward to retirement

    James Phares looked forward to the challenge and opportunity to help make a difference in a state education system under fire when he was hired in late 2012 as West Virginia’s schools superintendent.
    After 18 months, Phares will be stepping down on June 30 — which he said was set long ago as the day at age 61 that he’d walk with his wife into retirement.

    April 11, 2014

  • Teacher planning, abortion ban among W.Va. vetoes

    Gov. Earl Ray Tomblin signed about 200 bills and nixed eight this year, leaving teachers and abortion opponents unsatisfied.

    April 7, 2014

  • Spill company president ‘bears no fault’

    The president of Freedom Industries “bears no fault” for a West Virginia chemical spill that spurred a water-use ban for up to 10 days for 300,000 people, his lawyer says in a court filing.
    On Friday, Freedom President Gary Southern withdrew his application to get paid for work he already did during the company’s bankruptcy proceedings. He also wanted Freedom and its insurance to cover his legal fees related to the Jan. 9 spill.

    April 5, 2014

  • Agencies to ask West Virginia residents about chemical spill

    Health agencies are making thousands of phone calls and going door-to-door to ask West Virginians how a January chemical spill affected them.
    The state Bureau for Public Health announced Thursday that volunteers will survey randomly selected households in nine counties about health concerns from the spill.

    April 5, 2014

  • Hearing scheduled on police shooting suit dispute

    The family of a Virginia man who was shot and killed by Martinsburg police officers after a scuffle is asking a judge to order the city to give them investigative and autopsy reports from the incident.
    The estate of 50-year-old Wayne Arnold Jones of Stephens City, Va., filed a $200 million federal lawsuit against the city after he was killed on March 13, 2013.

    April 4, 2014

  • Families remember mine disaster victims

    Four years after losing friends and relatives in a West Virginia mine disaster, 11 people preferred to watch a film together that they knew would reopen those wounds.
    The film, “Upper Big Branch - Never Again,” by former Massey Energy CEO Don Blankenship theorized that his old company wasn’t at fault for the deadly explosion, despite four investigations that concluded otherwise.

    April 3, 2014

House Ads
Featured Ads