D r a f t O n l y A p p r o v a l P e n d i n g SS UUMMMMAARRYY ooff PP RROOCCEEEEDDIINNGGSS JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE COMM ITTEE M EETING I NFORM ATIO N January 9-10, 2014 Room 302, Capitol Building Cheyenne, Wyoming COMM ITTEE M EM BERS PRESENT Senator Charles Scott, Cochairman Representative Elaine Harvey, Cochairman Senator James Lee Anderson (SD 28) Senator Bernadine Craft Senator R. Ray Peterson Representative Eric Barlow Representative Lee Filer Representative Matt Greene Representative Norine Kasperik Representative Lloyd Larsen Representative Mary Throne Representative Sue Wilson COMM ITTEE M EM BERS NOT PRESENT Senator Leslie Nutting Representative Kathy Coleman LEGISL ATIVE SERVICE OFFICE ST AF F Gerald W. Laska, Staff Attorney Michael Swank, Research Analyst OTHERS PRESENT AT M EETING Please refer to Appendix 1 to review the Subcommittee Sign-in Sheet for a list of other individuals who attended the meeting. The Committee Meeting Summary of Proceedings (meeting minutes) is prepared by the Legislative Service Office (LSO) and is the official record of the proceedings of a legislative committee meeting. This document does not represent a transcript of the meeting; it is a digest of the meeting and provides a record of official actions taken by the Committee. All meeting materials and handouts provided to the Committee by the Legislative Service Office, public officials, lobbyists, and the public are on file at the Legislative Service Office and are part of the official record of the meeting. An index of these materials is provided at the end of this document and these materials are on file at the Legislative Service Office. For more information or to review meeting materials, please contact the Legislative Service Office at (307) 777-7881 or by e-mail at [email protected] . The Summary of Proceedings for each legislative committee meeting can be found on the Wyoming Legislature’s website at www.wyoleg.gov. PAGE 2 OF 12 EXECUTIVE SUMMARY The Committee met for two days at the Capitol Building in Cheyenne. The Insurance Department presented an update on health insurance exchanges and the Affordable Care Act. The Committee considered four alternative bills on Medicaid expansion and three bills on licensed hospitals' acceptance of Medicaid/Medicare patients. The Department of Workforce Services reported results of its continuing back injury study and the definition of 'worker misconduct' for purposes of unemployment compensation. The Department of Health presented an update on its study of institutional facilities and on Title 25 mental health treatment options. The Committee agreed to sponsor bills regarding "Insurance-coverage of inherited enzymatic disorders," "Medicaid expansion—limited benefits," "Public health nursing," "Unemployment insurance—worker misconduct" and "Medicaid expansion—insurance pool." CALL TO ORDER (THURSDAY, JANUARY 9) Co-Chairman Scott called the meeting to order at 8:15 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda. APPROV AL OF MINUTES Minutes from the November Committee meeting were approved without amendment. WYOMING INSURANCE COMMISSIONER Update on Federal Health Insurance Exchange in Wyoming Tom Hirsig, Jeff Rude and Jeri Melinkovich, from the Insurance Department, addressed the Committee. Mr. Hirsig advised the Committee that approximately 5,000 persons enrolled through the health insurance exchange and that approximately 80% have paid their initial premium. However, the Department does not have data on how many were previously insured or how many were Medicaid eligible. He stated that it will take two years to determine if sufficient premiums are being charged by the companies. Mr. Rude distributed a "Health Insurance Rate Comparison, 2009 to 2014, in the Wyoming Individual and Small Group Markets." [Appendix 3] The Committee discussed the causes for premium increases and the difficulty of comparing insurance products and prices before and after the Affordable Care Act because mandatory coverage is different, there is no longer a pre-existing exclusion and some companies have left the state. Insurance-coverage of inherited enzymatic disorders Senator Scott explained that last year's bill requiring insurance coverage for phenylketonuria and similar enzymatic disorders created an unintended consequence because the ADA requires states to pay for any coverage mandated after the essential benefits package for the state was approved. The alternatives are to repeal the requirement or to find a way to pay for it without violating the constitutional prohibition on appropriations in aid of private companies. Ms. Melinkovich explained the bill [Appendix 4] as providing a tax credit for companies to the extent that they have to pay the new mandated coverage. She also suggested two amendments to the bill [Appendix 5]. JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings WYOMING LEGISLATIVE SERVICE OFFICE • 213 State Capitol • Cheyenne, Wyoming 82002 TELEPHONE (307) 777-7881 • FAX 307-777-5466 • E-MAIL [email protected] • WEB SITE www.wyoleg.gov PAGE 3 OF 12 Representative Greene, seconded by Senator Anderson, moved the bill. The Committee amended the bill to clarify its effective date and to delete a reference to taxes due under the Wyoming Health Insurance Pool Act. The motion to sponsor was adopted on a vote of 12-0. MEDICAID EXP ANSION – EXPLANATION OF PROPOS ALS Senator Scott asked for an explanation of all of the Medicaid expansion bills before proceeding to a straw poll. He noted, however, that the Tribal Relations Committee had voted to sponsor a bill similar to 14LSO-140.C1, Medicaid waiver—tribal health programs [Appendix 6], so this Committee would not consider it further and the bill was laid back. Representative Throne explained 14LSO-0139.C1 Medicaid expansion—limited benefits, [Appendix 7]. She stated that this would be the least objectionable alternative to simple Medicaid expansion. The basic concept in the bill is the same as in the WDH August report, namely, to give the department flexibility in designing a plan to cover the expansion group within the existing Medicaid framework while saving on benefits at the same time. WDH Director Forslund explained further that the Affordable Care Act allows a state to implement different cost-sharing requirements for the Medicaid expansion population, and to provide different benefit packages for different expansion groups. One example of cost saving, he noted, would be that the federal match would pick up 100% of mental health care for the expansion population, which the state is currently paying for. He reminded the Committee that the Department studied Medicaid expansion alternatives last year and that, if the state were to expand Medicaid, this was the Department's recommended method of expansion. He thought the bill could be implemented in six to nine months.. Meredith Asay, WDH Administrator, circulated the federal poverty level guidelines for 2013 [Appendix 8]. Committee members discussed various potential cost savings, the uncertainty of all cost projections and the uncertainty that the federal matching amount will remain at 90% as provided in the Affordable Care Act. MEDICAID EXP ANSION – PUBLIC COMMENT Co-Chairman Scott suggested that the Committee hear public comment on Medicaid expansion before the lunch break. Duane Keown, UW science professor, presented written remarks in favor of Medicaid expansion [Appendix 9]. Elizabeth Hoy, Cheyenne Health and Wellness Center, distributed a PowerPoint presentation [Appendix 10] on the benefits to the Center, which is a federally qualified community health center, from addition revenue it would receive under Medicaid expansion. Edna Ramsey, Laurie Heath (Komen Foundation), Kerry Drake, Gene Halpern, Michael Selmer, Evelyn Maguire, Bonnie Saltman and Tim Locca (AARP) all spoke in favor of Medicaid expansion. Sara Robinson, tribal liaison for the Eastern Shoshone Business Council, spoke in favor of Medicaid expansion and distributed a handout entitled "Health Disparities on the Native American Population in Wyoming" [Appendix 11]. JOINT LABOR, HEALTH AND SOCIAL SERVICES COMMITTEE Summary of Proceedings WYOMING LEGISLATIVE SERVICE OFFICE • 213 State Capitol • Cheyenne, Wyoming 82002 TELEPHONE (307) 777-7881 • FAX 307-777-5466 • E-MAIL [email protected] • WEB SITE www.wyoleg.gov PAGE 4 OF 12 MEDICAID EXP ANSION – EXPLANATION OF PROPOS ALS Co-Chairman Harvey continued with an explanation of 14LSO-0110.C1 Medicaid—premium assistance options [Appendix 12]. She explained that it is based on the Arkansas model, which is a Medicaid waiver program allowing the state Medicaid program to purchase private health insurance for the expansion population instead of providing traditional Medicaid coverage. She stated that she preferred this alternative because it includes private insurance, because providers would be paid better, because it includes a self-sufficiency provision through premium contributions, and because it would group families together for coverage no matter which health program they were on before. It would also remove a barrier to upward income mobility by allowing people to keep the same policy as long as they want, even if their income increases. Senator Scott explained 14LSO-0262.C1 Medicaid expansion—insurance pool [Appendix 13] as a modification of the Arkansas model. Two of the major differences are that the bill would add a provision similar to a health