Medicaid is helpful and should be protected

Put the bat away

By Barb Rea
ESPC health policy volunteer

Advocates and providers who work with low income seniors and families and individuals with disabilities should be aware of what went on at the Wyoming Legislature’s Join t Labor, Health and Social Services Committee meeting May 9-10in Evanston.
I am concerned about the ongoing attacks on Medicaid and the Affordable Care Act and the misguided belief that we can reform health care without the aid of a strong federal partner.
On the bright side, new committee members are getting intensive education from experts on health care and health reform.
Other aspects of the committee’s work were not so bright. Committee Co-Chairman Sen. Charles Scott, R-Casper, felt the need to add his personal interpretation to almost every piece of information presented. He painted Medicaid as a perennial problem in the state, and assured the committee that the new federal health care law, which he dismissively terms “Obamacare,” will be repealed or at least defunded. He also continues to portray his pet project, Healthy Frontiers, as a viable program which could be used to replace both Medicaid and the benefits offered in the new legislation.
The truth is that Medicaid is an efficient way to provide health care to many low income, elderly, blind and disabled individuals in Wyoming. Like the promise we made to the elderly with Medicare, Medicaid is the promise we made as a nation to provide healthcare to the poor, disabled, blind and elderly. Individuals who qualify for this program are guaranteed the right to comprehensive healthcare.
We learned from the experts testifying at the meeting that the federal taxes we pay in Wyoming are essentially subsidizing low-income care in other states. Wyoming’s Medicaid program has always provided bare minimum services to the fewest people possible under federal law. Other states use the program to leverage more federal dollars into their healthcare systems and provide more health care for people who would otherwise depend on emergency rooms when they are ill or injured.
Our state leadership seems intent on making sure we provide fewer services and use more state money to do it, just to send a message to Washington that we can do this ourselves.
Senator Scott used every opportunity to imply, incorrectly, that Medicaid enrollees tend to overuse the system and are always trying to game the system to get more than their fair share—making Medicaid more expensive than private coverage. At one point he digressed at some length about rules which would hypothetically allow mothers to quit their jobs so their children can qualify for Medicaid. Then, Scott said, the mothers are able to go get their jobs back and their children go right on receiving health care, “and there is nothing we can do about it.”
Scott’s attitude was bolstered by the state’s new Director of the Department of Family Services, Steve Corsi, who made a stunning assertion that 30% to 40% of people who enroll in Medicaid in Wyoming, come dressed like he was (black suit and new haircut) and driving an Escalade, “and there is nothing we can do about it.”
Senator Scott let the committee’s disgust percolate until Wyoming’s Medicaid Director, Teri Green, was able to question the validity of Mr. Corsi’s numbers. Mr. Corsi later apologized for using an inflammatory example and a “guesstimate.”
Later we learned from another presenter, that nationally less than 10% of Medicaid payments are claimed fraudulently, and in Wyoming the figure is less than 6%. Moreover, research tells us most of the fraud by far (80%) is committed by providers (primarily medical-device and pharmaceutical companies). Less than 10% of the fraud is committed by patients. Click here to read Health Insurance Fraud: An Overview
National research verifies that Medicaid is far less expensive than private coverage, but Sen. Scott continues to cite numbers to the contrary, numbers that have never been publicly vetted and do not seem logical to the people who manage Medicaid. (See below for links to this research)
Rather than persistently portraying Medicaid as a problem, the committee should be looking at Medicaid as a key component to stabilizing the entire health care system. It will help ensure that everyone has insurance coverage. Complete coverage, in turn, is part of the solution to stabilizing the market by eliminating the cost shifting that occurs when the uninsured seek and receive emergency care.
Under the Affordable Care Act, Medicaid eligibility will be simplified and expanded so that it covers all low-income people who earn up to 133% of federal poverty level ($1207/month). The state will be responsible for part of the cost of care for about 6,000 Wyoming individuals who are currently eligible for Medicaid but have not applied. These people are probably not enrolled because they are healthy, so they are not expected to add a huge burden to the state budget. The expansion of the program to finally include all low-income adults will be almost entirely paid for by the federal government (100% till 2017 and dropping to 90% in 2020).
Does it really make sense to opt out so our tax dollars can go to other states?
Don’t we want our poor citizens and blind neighbors to have access to the healthcare they need when they need it?
If Medicaid were privatized, as Senator Scott seems to be advocating, those federal matching dollars would disappear, and the costs would be shifted to state and county budgets or to those who pay premiums for private insurance. We would be paying both federal taxes that don’t come back to Wyoming and higher premiums.
If we want to accept the federal match available under the Affordable Care Act, we will have to guarantee that we will provide a program in Wyoming that will be at least as strong as the Affordable Care Act. We will have to pass a law that provides comprehensive coverage to all our citizens. Would we be able to achieve this with a private insurance industry that has been pushing poor and sick people off their roles systematically for decades? This practice is the reason we had to develop Medicaid and Medicare in the first place. We need those public programs to make our system work, and we need them now more than ever.
If we want our Medicaid program to run more efficiently, we should just ask Tom Forslund, our new, capable Director of the Health Department, to make it so, not try to reinvent the wheel. Medicaid will be a big part of our state budget because it serves an important function for our friends and neighbors who need healthcare and for those who provide healthcare services. We should prepare for the larger numbers it will cover instead of pretending poor people’s healthcare needs can be legislated away.

Links to Medicaid vs. private insurance research
“Trends and Indicators in the Changing Health Care Market Place: Medicaid Payment per Enrollee by Acute and Long-Term Care, 2003 http://www.kff.org/insurance/7031/ti2004-1-15.cfm

“Trends and Indicators in the Changing Health Care Marketplace: National Prescription Drug Expenditures, Percent by Type of Payer, 1994-2004” Kaiser Family Foundation http://www.kff.org/insurance/7031/ti2004-1-16.cfm

“Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance” Kaiser Family Foundation http://www.kff.org/insurance/snapshot/chcm111006oth.cfm

“MEPS Topics: Health Care Costs/Expenditures” Agency for Healthcare Research and Quality http://www.meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=5Z-1

“Comparing Public and Private Health Insurance for Children” Center on Budget and Policy Priorities http://www.cbpp.org/files/5-11-07health.pdf

“Medicaid, Private Health Insurance and the Uninsured” John Holahan, The Urban Institute http://aspe.hhs.gov/medicaid/jan/Holahan.pdf

“Expanding Medicaid a Less Costly Way to cover More Low-Income Uninsured Than Expanding Private Insurance” Center on Budget and Policy Priorities http://www.cbpp.org/cms/index.cfm?fa=view&id=429

“Administrative costs on Health Plans: A systematic review of current studies” Deloitte Center for Health Solutions http://www.deloitte.com/view/en_US/us/Industries/health-plans/1fdbe665e4e06210VgnVCM200000bb42f00aRCRD.htm


Editor's note: Barb Rea is an ESPC volunteer and represents the organization in the coalition Consumer Advocates: Project Healthcare.

Wyoming needs complete lobbyist reporting

Public deserves more information about influence

By Dan Neal

Politics and public policy-making often come down to money and who has it to spend on candidates or on lobbyists that can help a interest group get what it wants.

In Wyoming, candidates for public office must report the contributions they receive and the expenditures they make. But lobbyists don't have to report many of their expenditures nor details about their funding resources. With Wyoming's lax lobbyist disclosure law, it's as if lobbyists simply appear in the Capitol without anyone spending any money to get them there.

On May 12, the Equality State Policy Center asked the Joint Corporations, Elections and Political Subdivisions Committee to require professional lobbyists working in Wyoming as well as the companies and people who hire them to make public how much money they spend to influence state legislators and other policy-makers.

The request, by the way, implies no improper behavior. Lobbying done well with integrity fills a necessary role in a democracy.

Here’s the basic argument the ESPC made to the Joint Corporations Committee when it met earlier this month in Lander:

Why is reporting necessary?

• It demonstrates the importance of the work the Legislature does. A full accounting of lobbyist spending will show the general public how invested various interests are in the decisions made by the Legislature.

• Since individual state legislators do not have paid staff, lobbyists in Wyoming fulfill a particularly important role of providing citizen legislators with information. It is the presence of lobbyists that makes a difference. The public deserves to know what it takes to post a presence when the Legislature meets – in Cheyenne or during the interim.

• It is an important part of bringing the process of making state policy fully into the sunshine. People deserve to know what the oil industry, the coal companies, the railroads, and nonprofit organizations spend to influence their representatives and government officials.

• About 350 lobbyists registered in 2010. Existing law required only a very few to file reports, mostly to report receptions held for legislators. Many who file anyway report zero expenditures.

What is needed:

• People paid to lobby, including attorneys, should be required to report what they were paid and they should report their expenses.

• Employers of lobbyists should report how much they paid lobbyists and how much they spent on other activities intended to influence legislators, other officials, and the public to support or oppose legislation. (Current law requires reporting by the employers of lobbyists.)

• The law should cover both legislative and administrative lobbying.

• Lobbyists should file quarterly. (This provides a timely accounting.)

• Lobbyists should list clients, and how much each pays.

• They should list what bills and governmental actions were lobbied and for which client.

• Lobbyist reports should be subject to some form of enforcement mechanism.

The ESPC asked the Joint Corporations Committee that the reporting ultimately be made available in a searchable database available electronically via the Secretary of State’s website.

The committee showed considerable interest in the idea. Several, including Co-Chairman Cale Case, R-SD25, Lander and Rep. Kermit Brown, R-HD14, Laramie, asked pointed questions about lobbying by public interests, such as the University of Wyoming and other agencies.

The ESPC supports broad disclosure by all interests lobbying the Legislature. Even if they’re simply providing information at a committee meeting, state agencies and other public agencies certainly could be directed to report the cost of doing so.

When Sen. Case asked if the committee should entertain a motion to draft a bill, Sen. Charles Scott, R-SD30, Casper, objected, noting that the topic was not “noticed” on the committee agenda.

Instead, Sen. John Hastert, D-SD-13, Green River, made a request for the Legislative Service Office to research lobbyist disclosure in neighboring states and tell the committee how Wyoming’s disclosure requirements compare.

The topic is likely to appear on the agenda of the joint committee’s Sept. 28 - 29 in Casper.

A side note: Sen. Scott expressed considerable interest in determining who supports the ESPC and similar groups, saying he finds it difficult to determine who exactly they represent. He indicated he prefers disclosure legislation that would enable him to know the names of individuals who contribute to the ESPC and similar groups.

The ESPC does not provide that information, though people who do contribute funds to the ESPC certainly can make their support public. Still, the U.S. Constitution protects the right of people to associate freely. The ESPC told the committee that the right to maintain the privacy of contributor and membership lists was affirmed in a 1958 U.S. Supreme Court case, State of Alabama v. the National Association for the Advancement of Colored People.

But what the ESPC is, certainly is not a secret. The ESPC told the committee that the organizations that belong to its coalition are listed on the internet, along with brief biographies of the ESPC board officers and ESPC staff.

Sen. Scott asked the Legislative Service Office to research the law regarding protection of membership lists.

Workers' compensation reform

Senate passes Workers Comp bill

Rejects unfriendly amendments, then passes bill unanimously, 30-0

Acknowledging that Wyoming’s injured workers deserve better treatment, the Wyoming Senate Monday passed a bill improving death benefits to surviving family members and extending and increasing temporary total and permanent total disability benefits.

The Senate passed the bill unanimously, 30-0. The House similarly approved the bill on a unanimous 60-0 vote.

Injured workers, the AFL-CIO, the Wyoming Trial Lawyers Association, the ESPC worked for nearly 18 months to bring the need to improve the care extended to people hurt on the job to the public’s attention. (That's a photo of Les Vasey of the Laborers' local and AFL-CIO Executive Secretary Kim Floyd, above.)

The advocates’ mantra was short:

“No one should go broke because they went to work one day and got hurt.”

The Joint Labor, Health and Social Services Committee took the question up during last year’s interim between legislative sessions. The committee conducted several hearings, then hammered out legislation that will make things better for people aimed at changing the state’s treatment of injured worker

In Monday’s action, the senate rejected two deleterious amendments; one proposed by Sen. Charles Scott and a second proposed by Sen. Drew Perkins. Both senators represent districts that include parts of Casper.

Scott proposed an amendment that would have rejected part of the bill that requires the Workers’ Compensation division to pay its fair share of litigation costs when it claims up to 33% of the settlements won in successful third-party lawsuits filed by injured workers.

The Perkins amendment would have reduced the age limit under which children of workers killed at work are eligible for survivor benefits.

Neither amendment garnered much support. Each was defeated on a voice vote. (Once again, here is the need for taking roll call votes on amendments. In the official record, there’s no telling who supported and who opposed the suggested changes.)

In its consideration of the House bill, the Senate added several amendments:

1. Allows injured workers seeking vocation rehabilitation to attend a private technical school as well as a community college or UW.
2. Allows workers’ comp coverage of single proprietorships with just one employee.
3. Changes the appropriation to set aside $100,000 for a single new position in the Office of Adminstrative Hearings* rather than $200,000 for two positions. Appropriates $50,000 for a study of OAH procedures aimed at making it technologically current. The amendment also requires the Worker’s Comp division and DOT to split those costs 55% - 45%.

The bill has been referred to the House for concurrence. It still could get hung up there, however, the ESPC and its allies believe none of the differences truly endanger ultimate passage of the bill.

House Bill 54 Workers’ compensation amendments will:

• Increase dependent children’s, death and permanent impairment benefits;
• Provide a minimum and extend the duration of temporary total disability benefit;
• Provide an annual cost of living adjustment to permanent total disability benefits;
• Extend the maximum duration of vocational rehabilitation benefits;
• Extend the period over which death benefits are paid;
• Limit the time for the Workers’ Compensation Division to recover overpayments;
• Revise the criteria for, and distribution of, employer premium credits;
• Authorize companies with as few as two employees to obtain coverage under the system;
• Require the state to pay a fair share of the costs of litigation when covered workers recover damages from third parties;
• Require the division to reconsider claims if an injured worker’s failure to meet a procedural deadline is the fault of the worker’s attorney;
• Authorize and appropriate $100,000 for one additional position in the Office of Administrative Hearings and $50,000 for the cost of investigating the acquisition of a case management system capable of accepting and receiving electronic filings and which includes a time management system.
  

Monday March 2 was a good day for Wyoming's workers and their families. Please send thanks to your legislators, especially those on the House and Senate Labor committees, for their efforts on the behalf of injured workers. The bill did not deliver all the reforms needed in the system. The ESPC still believes the division needs more case workers and needs to treat workers and employers fairly and equitably.

Also, here's a thanks to all the journalists who wrote about this issue, but a special thank-you to Dustin Bleizeffer of the Casper Star-Tribune. Reporter Bleizeffer demonstrated great devotion to workers and the state that needs them by writing many stories about the system and its flaws.

Campaign contributions reined in …

The House Monday amended Senate File 12, the proposed bill to increase the limit on campaign contributions from individuals from $1,000 per election (the primary and general count as separate elections) to $2,400 per election, the same as the federal individual contribution limit.

The amendment applied the increased limit only to statewide races (governor, secretary of state, auditor, treasurer, and state superintendent of public instruction), not to legislative or local races.

The amendment, sponsored by Rep. Mary Throne (Democrat from Cheyenne) and co-sponsored by Rep. Amy Edmonds (Republican from Cheyenne), focused the argument that campaign contribution limits should bear some relationship to the cost of races.

Contributions at the $2400 level are not necessary for legislative and local races, they argued, and it’s better for candidates to have to appeal to a larger group of people for the funds they need to campaign.

The principal argument against the amendment (and for the bill) seems to be “inflation.” It seems odd that some legislators are very concerned about inflation cutting into campaign contribution levels, but not other amounts set in statute – like minimum wage for tipped employees, for example.

Senate File 12 is on third reading and final passage Tuesday morning. Please contact your legislators and ask them to keep the amendment and, if it is removed on third reading, to oppose the bill.

Helium property tax goes to Gov. Dave

Also on Monday, the HB 287 Helium - property tax won final approval when the Senate adopted a Joint Conference Committee report that the House approved last Friday. The measure imposes property taxes on helium, putting taxation of that very valuable gas in line with property taxes levied on the extraction of other minerals in Wyoming.

The finished bill awaits signing by Gov. Dave Freudenthal.



*Briefly, OAH is the board that reviews contested Workers’ Comp cases and contested actions by the Department of Transportation on driver’s licenses.

ESPC researcher Sarah Gorin and Marcia Shanor of the Wyoming Trial Lawyers Association contributed to this report.