While Wyoming’s all-Republican congressional delegation decried the U.S. Supreme Court’s decision late last week to uphold the Affordable Care Act (ACA) and vowed to repeal the law, their Republican counterparts at home appeared to labor under the assumption that Wyoming may very well have to meet a series of tight deadlines under the law that they once regarded as meaningless.
Sen. Bill Landen (R-Casper), co-chairman of the Wyoming Health Insurance Exchange Steering Committee, said he and other members of the Legislature plan to meet with Gov. Matt Mead, and his advisors on Tuesday morning (July 3) to discuss Wyoming’s next steps.
On Monday, Landen told WyoFile he’s not willing to tailor any action in anticipation of national developments over the federal health care law. Rather, Landen said, Wyoming’s legislature plans to resume work, with the executive branch, toward improving health care in the state regardless of whether the ACA stands or falls after the November election.
“We’ll be meeting with the governor and legislative leadership to plot the right course, making sure whatever we do makes sense for a state like Wyoming,” said Landen.
Legislature put health on hold
This past winter, Wyoming’s legislative leadership ordered the Wyoming Health Insurance Exchange Steering Committee to “stand down” after two years of collaborative work that had attracted buy-in from a wide coalition of stakeholders.
A health insurance exchange — once a cornerstone of Republican-backed approaches to addressing health care issues — is an online, regulated marketplace where individuals and small businesses can compare costs and services among participating providers. It’s up to each state to decide whether to design and run their own exchange or let the federal government set one up and run it for them.
The Wyoming Legislature’s decision ordering the steering committee to “stand-down” in March was made after learning in the fall of 2011 that the U.S. Supreme Court would expedite its review of the ACA, which was challenged by 26 states, including Wyoming.
Certain that the court would overturn the ACA, or at least portions of it, Wyoming’s legislative leaders also decided to relinquish $220,000 in remaining federal funds that could have been used to continue developing a health insurance exchange. Wyoming leaders said they felt they were wasting time and resources on a law that many of them believed was not legitimate.
“Our fellow legislators, and many of my constituents, by the way, are saying, ‘What are you doing?’ you know. ‘This is a bad law; it’s going to be struck down.’ I, by the way, signed a letter encouraging the governor to join that lawsuit primarily because of the individual mandate,” Sen. Landen told WyoFile in March.
In fact, the Wyoming Legislature passed a bill during the 2012 winter session forbidding the use of the federal money toward planning under the ACA until the U.S. Supreme Court ruled, effectively tying the hands of the Health Insurance Exchange Steering Committee.
Now that there’s been a ruling, Wyoming leaders are in a scramble to possibly resume the health insurance exchange work in case the ACA stands — despite Republican promises to repeal the law by winning the White House and both houses of Congress in November.
“Concerning the direction Wyoming will take, it is appropriate to study the opinion, meet with health care experts, citizens and the Legislature before making further decisions. While ruled constitutional, I believe the ACA is not a good fit for Wyoming citizens and we must continue to work on solutions developed in Wyoming,” Gov. Mead, a Republican, said in a prepared statement just hours after the U.S. Supreme Court decision.
Getting back to work
First, Wyoming leadership must decide whether to ask for all, or a portion, of the $220,000 in federal funds to resume the work, or dip into the state’s own coffers, or possibly turn the work over to an interim legislative committee. Coalition leaders have had little time between the June 28 U.S. Supreme Court decision and the Fourth of July holiday to decide how to proceed.
Mead said he must notify the federal government by mid-November of Wyoming’s intention to run its own exchange, join other states in a regional exchange, or allow the federal government to set up and run a health insurance exchange for Wyoming. If the state wants to avoid a federally-run exchange in Wyoming, it must submit an implementation plan by January 1, 2013. An exchange must be up and running by January 2014.
Although many people were pleased with the work of the Wyoming Health Insurance Exchange Steering Committee, and pleased with the level of participation from various stakeholders, many involved share a bleak view of Wyoming’s ability to solidify behind a smart health care strategy, given the fact there have been many attempts in the past. Anne Ladd, CEO of the Wyoming Business Coalition on Health, said she sympathizes with legislators who worried they were aiming at a “moving target” in the ACA. But she also believes that Wyoming missed out on time and resources to study health insurance exchanges — an exercise Wyoming should undertake with or without the ACA.
“My group has always supported the exchanges, and we felt with or without the ACA (the exchange models) were a real value to employers. … I definitely think there’s a business case to be made (for exchanges). We were disappointed that the money was given back,” said Ladd.
Ladd compiled a list of actions that the Wyoming Health Insurance Exchange Steering Committee could have continued working on this year as Wyoming awaited a U.S. Supreme Court ruling. Among other things, Wyoming must decide who will run an exchange. It must decide how participants and various government agencies will interact in an exchange. It must decide what size employers would be encouraged to participate — 50 employees and fewer, or 100, or 200? What are the administrative costs?
Given Wyoming’s low population, many steering committee participants have discussed the possibility of joining with a group of other states to form an exchange. But other states may not want to welcome Wyoming into a multi-state plan if it doesn’t have itself organized and ready, said Ladd.
“I really worry that we are up against such a tight deadline,” Ladd said. “I wish I could see my way clear to how this is going to happen.”
Building a team already fractured over ‘Obamacare’
For Barb Rea of Casper, the U.S. Supreme Court’s decision to uphold the Affordable Care Act was a sign of hope. The 55-year-old says she’s extremely dissatisfied with her current health insurance provider, but no other provider will write her a new policy. She’s battled kidney cancer and won. Her doctor says she’s no more prone to cancer now than anybody who hasn’t had the disease, yet health insurance companies regard Rea as having a pre-existing condition.
“I’m stuck with a really bad insurance policy and I can’t change because no one will sell me insurance,” said Rea, who is also a member of Consumer Advocates: Project Healthcare, which has advocated in favor of the ACA.
One of the pillars of so-called “Obamacare” is that insurance companies will no longer be able to refuse coverage due to pre-existing conditions — just one of many life-saving improvements Rea sees in the 2010 health care law. Yet, overwhelmingly, Wyoming leaders don’t share Rea’s support of the law.
U.S. Sen. John Barrasso, (R-Wyoming), a former physician who practiced in Casper for many years, has consistently criticized President Obama’s health care reform law. “The law remains unworkable, unpopular and unaffordable. Today’s decision does not change the fact that the President’s health care law is bad for patients, providers and taxpayers,” Barrasso said in a prepared statement shortly after the U.S. Supreme Court ruled on the law last week.
Rea said she believes that, overall, the ACA will provide transparency and cost savings to benefit Wyomingites of all income brackets. She said once critics of the health care law begin to find out what’s in it, they will begin to accept it.
“People are going to like it if we can just get past this political firestorm,” said Rea. “It’s repulsive to me that they (political opponents of the bill) would put politics ahead of people’s health.”
Sen. Landen said he realizes that many participants in the Health Insurance Exchange Steering Committee stand solidly opposed in their views of the ACA, yet it will take all Wyoming stakeholders to set aside their differences to come up with a workable plan.
“That’s one thing about the state of Wyoming, whether it’s stakeholders or legislators or whatever; we have divergent views and that’s wonderful. But we’re not afraid to roll up our sleeves and go to work,” said Landen. “Really, that’s all you can do at this point.”
Landen acknowledged ongoing criticism that the steering committee has provided short and insufficient public notice prior to some meetings in the past, and that the committee has yet to post minutes of its meetings.
“I’ll be the first to admit we need to do a better job of that,” said Landen.
— Click here to read reactions in Wyoming to the U.S. Supreme Court ruling to uphold the Affordable Care Act.
— Contact WyoFile editor-in-chief Dustin Bleizeffer at (307) 577-6069 or firstname.lastname@example.org.
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