Wyoming officials to keep a close eye on Senate health reform

May 11--CHEYENNE -- After a health-care reform bill was pushed through the U.S. House last week, Wyoming's elected officials and health-care advocates are watching closely to see what federal lawmakers will do with it in the Senate.

Republicans attempted to eliminate what they saw as federal overreach in the Affordable Care Act, commonly known as Obamacare, while preserving aspects popular among many consumers.

Among some of the highlights:

- Individual and employer mandates to buy health insurance and subsequent penalties for failing to do so would be eliminated, though it would allow insurance companies to impose a significant penalty on those who let their coverage lapse.

- Tax increases on certain high-income people, insurers, drug companies and manufacturers of medical devices would also be eliminated.

- While there would be subsidies available to help make insurance affordable, the size changes significantly. Insurance companies would also be allowed to charge older Americans up to five times more than younger people, whereas they can be charged up to three times as much under the current law.

- In 2020, the rate at which the federal government covers states' Medicaid costs would be reduced, and the federal payment to states would shift to a per-person basis with limits on the growth in those payments going forward. States would also have the option to implement a work requirement on those receiving Medicaid, with exceptions for those who are pregnant, disabled or seniors.

- Patients with pre-existing conditions cannot be denied coverage, but states could seek a waiver to allow insurance companies to charge significantly higher rates. A total of $138 billion would be provided to states during a 10-year period to help subsidize coverage and cover people with pre-existing conditions, with an additional $8 billion over five years to set up high-risk pools.

House Republicans in Washington, D.C., including U.S. Rep. Liz Cheney, R-Wyo., voted to support the long-promised reform without any favorable votes from their Democratic colleagues. In a statement released on the day of the American Health Care Act's passage, Cheney said Wyoming suffered more than any other state under Obamacare and that the House bill would work in the favor of her Wyoming constituents.

The matter now moves to the U.S. Senate, where Wyoming Sens. Mike Enzi and John Barrasso, both Republican, are on the health-care bill's working group.

Gov. Matt Mead is following the American Health Care Act as it moves through Congress, said David Bush, Mead's communications director. While he said Obamacare has not worked well for Wyoming, he can't yet determine how the House bill would affect residents either, Bush said.

"The governor will continue to communicate with Sens. Enzi and Barrasso as they begin their difficult work," Bush said.

State Sen. Charles Scott, R-Casper, was a leader in the Wyoming Legislature in opposing expanding Medicaid under Obamacare. While doing so would have provided insurance to thousands of people in Wyoming, Scott said he and most of his colleagues in the Legislature didn't think it would be sustainable in the long run, leaving the state responsible for coverage it wouldn't be able to afford.

As Congress begins a process that could ultimately repeal Obamacare, Scott said the U.S. House bill is on track to providing Wyomingites with better coverage options.

"It's clearly needed," he said. "It looks to me like the House bill is a good step in the right direction."

Rep. James Byrd, D-Cheyenne, disagrees. Byrd said there are problems with Obamacare, but amendments made by Congress set the law up to fail. In his view, Byrd said the new law does nothing to help Wyomingites in need access coverage or care, and only serves private business interests.

"It's maintaining the profitability and protectionism of those industries to the detriment of the average Wyoming citizen," he said. "That's why I'm adamantly opposed to everything they've proposed."

Wyoming's Senate minority leader, Chris Rothfuss, D-Laramie, also said the bill offers nothing of value for Wyoming residents without access to coverage. While he agrees there's plenty to fix in Obamacare to make it work better for Wyoming, Rothfuss said the House bill isn't workable. Both Rothfuss and Byrd said they do not want to see the American Health Care Act pass the U.S. Senate.

"I'd like to see the legislation die," Rothfuss said. "It is in no way an improvement over the ACA in terms of access to affordable health care for the people of Wyoming."

Phyllis Sherard, vice president of population health and chief strategy officer at Cheyenne Regional Medical Center, said the hospital continues to be disappointed by the House's proposal for health-care reform. She said she would not support any legislation that reduces the number of people insured, does not maintain minimum benefits or causes patients to have to travel farther from home to access care.

"We're opposed to this bill as it's currently written," she said.

The Wyoming Primary Care Association also is concerned about whether Wyoming residents would be adversely affected by the American Health Care Act, said Executive Director Jan Cartwright. In 2015, 90 percent of Wyoming residents enrolled under Obamacare received subsidies, which Cartwright said is because of Wyoming's high insurance rates. Setting aside funding for high-risk pools, she said, just wouldn't be enough to cover those in Wyoming with pre-existing conditions.

"In a rural state like ours, a statewide high-risk pool would be so costly that people wouldn't be able to buy into it," she said.

Neil Hilton, vice president of the Wyoming Hospital Association, said the organization is also not in favor of the House bill as it stands.

"Cutting $880 billion out of Medicaid to help fund a non-sustainable high-risk pool is concerning," he said. "The insurance coverage is another huge concern for us."

Just returning from a trip to Washington, D.C., Hilton said he spoke with Enzi and Barrasso about reforming health care. He said he's confident Wyoming's senators listened to his concerns. With them part of the Senate working group looking at the health-care bill, he said he's optimistic the Senate could make changes better suited to Wyoming's needs.

"I really believe they're going to take what the House did, but take some time and really unravel and put a lot of effort into having the thing looked at and scored," Hilton said.

The Senate plans to have the nonpartisan Congressional Budget Office analyze the bill. In its score before the House withdrew its first attempt to pass the American Health Care Act, the CBO estimated as many as 24 million people could lose their health insurance by 2026 under the American Health Care Act.

Barrasso said in a statement Wednesday that the working group would have an "open and deliberate process to consider the House health-care legislation" and expects "the bill will be improved so it better meets the needs of people living in rural America," though he did not go into specifics on how that would be accomplished. He said, however, that he would support states having more control over health insurance coverage and would ensure people with pre-existing conditions would still have access to insurance.

"Overall, our focus must be on lowering the cost of insurance and the cost of care," Barrasso said.

With the Senate's deliberation still early in the process, Enzi also could not go into specifics, said Max D'Onofrio, Enzi's press secretary.

"Questions about what those specific changes will be to the health-care system are part of that discussion that the Senate is having right now," D'Onofrio said in an email. "At this point, no one knows what the final Senate product will look like or when it will be voted on."

Joe Jackson, a Cheney spokesman, said "inaction is not an option" for the Senate, and she expects her colleagues in the chamber to take "swift action" in making the bill law.

"She knows that we are very lucky in Wyoming to have Sens. Barrasso and Enzi representing us on this issue in the United States Senate, and looks forward to continuing to work with them to ensure we put patients and individuals back in charge of their own health-care decisions, and provide affordable, reliable access to quality care for all Wyomingites," Jackson said.

Whatever the outcome, Scott said no piece of legislation could be a perfect fit for every state or person in the nation.

"You're not going to solve the whole thing at once, that's for sure," he said.

And while President Donald Trump hosted a celebration following the House's passage of the bill in the White House Rose Garden, Hilton said the matter is far from resolved.

"We've got a long way to go," he said. "I'm not sure we'll see much before the end of summer for the Senate."

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