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Panel Reaches Deal on Universal Health Care, House and Senate Compromise on Manchin Effort to Help Those Without Insurance

Posted on: Saturday, 11 March 2006, 00:00 CST

By JENNIFER BUNDY

The Legislature was poised today to approve a bill to make health care coverage available to people without insurance.

A House-Senate conference committee came to a compromise late Wednesday on a bill that contains Gov. Joe Manchin's major health care proposals and goals for universal access to health care.

The bill contains Manchin's plan for pilot projects offering prepaid, clinic-based primary care.

The clinic plan was proposed late last year by a working group former Gov. Bob Wise appointed to find ways to improve insurance coverage for working adults.

The idea came from Dr. Vic Wood, a member of the working group who has been offering a clinic-based plan to his patients since 2003.

For a set monthly or annual fee, his Wheeling clinic offers primary and preventive care. That includes physicals, chronic disease management, diabetes care, acute care for things like sore throats and infections as well as treatment of strains, sprains and lacerations.

Fewer than 30 of his patients have bought the plan. He said he does not know how many patients he has, but his Wheeling clinic has about 15,000 patient visits a year.

More people would want the plan, Wood said, but he stopped advertising after the Insurance Commissioner's Office told him it considered the service an insurance plan. After much discussion, the commissioner did not order him to stop offering it, so he has continued to sign up patients who ask.

"I feel it's a moral issue," he said.

He said he is pleased Manchin and the Legislature now support the idea and he is eager for his clinic to become one of the pilot clinics so he can start advertising and offering the program to more patients.

His only complaint about the conference committee bill is that it says the pilot project would begin no later than July 1, 2007. It will last up to three years.

"We were trying to get it moved up so my patients would have access sooner rather than later," he said.

Only people who have no other health insurance can participate, with some exceptions.

The bill calls for the insurance commissioner and Health Care Authority to authorize the pilot program for no more than eight providers. Each provider can offer the pilot program at up to three sites.

The Health Care Authority will select providers to achieve diversity of practice operation and geographic location. The Insurance Commissioner's Office will oversee marketing and fees the providers charge.

The Health Care Authority will establish guidelines to evaluate the pilot project, gather data and report annually to a legislative interim committee.

The House-Senate compromise also contains Manchin's proposal for a no-frills insurance plan.

The plan would offer limited benefits that include physician, inpatient and outpatient care with emphasis on preventive and primary care.

Generally, only people who have had no health insurance for at least 12 months can get the new coverage. That's so people do not drop out of better, but more expensive plans.

The Insurance Commissioner's Office would oversee the plan and approve insurance companies' proposals to offer coverage.

The House-Senate agreement also expands the Children's Health Insurance Program to cover an additional 4,200 children.

That leaves only about 800 West Virginia children without access to health coverage of some type, according to a report from the Institute of Health Policy Research at West Virginia University.

The bill also requires the Department of Health and Human Resources to make quarterly reports to a legislative committee about the Medicaid claims processing system. The DHHR also would have to provide regular financial reports about the cost shift to private insurers created by Medicaid and other state agencies' underpayment for medical services.

And the bill sets up an Interagency Health Council to study and implement programs to move West Virginia toward universal access to health care. Representatives of the DHHR, the Health Care Authority, the insurance commissioner, the Public Employees Insurance Agency and CHIP would be on the council.

The council must have four public hearings before Jan. 1.

House leaders and health care advocates consider the council a key part of the bill because it sets up a mechanism to address structural problems in the West Virginia health care system.

An earlier House version bill envisioned a larger council with some non-governmental members that would have been "more likely to produce bold, imaginative reform," said Perry Bryant, executive director of the nonprofit West Virginians for Affordable Health Care.

"Agency heads by their very nature tend to be more conservative and more cautious," Bryant said. "If we could have solved the problems with state agencies we would have already done it."

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Source: Charleston Daily Mail

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